The person's response involved intense fear, helplessness, or horror

Either while experiencing or after experiencing the distressing event, the individual has 3 or more of the following dissociative symptoms:

• A subjective sense of numbing, detachment, or absence of emotional responsiveness
• A reduction in awareness of his or her surroundings (e.g., "being in a daze")
• Derealization
• Depersonalization
• Dissociative amnesia (i.e., inability to recall an important aspect of the trauma)
• The traumatic event is persistently re-experienced in at least one of the following ways: recurrent images, thoughts, dreams, illusions, flashback episodes, or a sense of reliving the experience; or distress on exposure to reminders of the traumatic event.

Criteria summarized from:

Acute stress disorder is characterized by panic reactions, mental confusion, dissociation, severe insomnia, suspiciousness, and being unable to manage even basic self care, work, and relationship activities. Relatively few survivors of single traumas have this more severe reaction, except when the trauma is a lasting catastrophe that exposes them to death, destruction, or loss of home and community. Treatment includes immediate support, removal from the scene of the trauma, use of medication for immediate relief of grief, anxiety, and insomnia, and brief supportive psychotherapy provided in the context of crisis intervention.

DISTINGUISHING ACUTE TRAUMA FROM PTSD

Discussion with professionals who work with both the acute and the long-term aftermath of trauma has led me to conclude that aside from physical injury due to trauma, acute traumatic reactions may be indistinguishable from PTSD in the body and behavior of the victim. The same disorientation, fear, and indications of ANS activations - elevations in heart rate, blood pressure, respiration, shaking, etc. - may be present.

In the aftermath of a disaster, for example, most of those suffering from acute trauma will be easy to spot. Those who have been injured will be obvious. Among the uninjured there will also be many who look stunned, appear pale and faint, or be shaking. Some of those who appear to be suffering from trauma may not even be the actual victims of the disaster, but witnesses or rescuers who may be deeply affected by what they have or are seeing. Some may not be immediately identifiable, they may be highly active - looking for others or after others, organizing help and rescue. A percentage of these may, in the next days or weeks, develop symptoms of trauma.

Months or years later, the vast majority of the survivors, witnesses and rescuers will no longer be suffering psychologically from the after effects of the event. However, a minority will be suffering to an extreme degree, their lives decreased in quality, and a diagnosis of PTSD will be appropriate.

While symptoms of acute trauma and PTSD may not differ very much, response to these must differ significantly. Response to acute trauma may include emergency medical intervention for treatment of injuries and/or medical shock. On the psychological side reassurance and comfort will be the key. Often talking about what happened will be important for the survivor in the immediate aftermath of the event. Telling and re-telling the story to caring individuals may help prevent dissociation, and aid in integrating the experience. Providing physical support - holding, an arm around the shoulders, a comforting hand - may be appropriate, especially if the survivor is hysterical or shaking violently. The victim may be cold and in need of blankets and warm beverages. The victim may need to be reminded that the event is passed and they have survived it, "You're safe now." The more complete and appropriate the response to acute trauma, the greater the chance of preventing subsequent PTSD.

Later, working with those who do develop PTSD may resemble some of the aspects of response to acute trauma. Certainly a reassuring and comforting attitude on the part of the psychotherapist is important. But when the trauma is long past, simple comfort and reassurance will not be enough. The victim of PTSD will feel unable to contain his traumatic experience(s), will have become afraid of his body, and will have lost the sense of what was then and what is now. It is these three areas - containment, positive body awareness, dual time awareness - that must first be strengthened, before addressing the memory of a traumatic event can be done productively.

Containment of out-of-control emotions and thinking processes will help restore a feeling of control over the psychological self. Positive body-awareness will help restore a sense of the body and its sensations as friend, not foe. Dual time awareness will help to separate that the trauma occurred in the past even though it feels as if it is occurring now (Rothschild 1996, Rothschild 1997).

    CONCLUSION