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Trauma and Post-Traumatic Stress Disorder in Patients With HIV/AIDS

December 2007

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III. Acute Stress Disorder (ASD)

Recommendation:

For patients who meet the criteria for ASD, clinicians should follow the same guidelines as those recommended for management of PTSD (see Section II. C: Management of Survivors of Trauma).

Many of the symptoms of ASD (see Table 2) overlap with those of PTSD. ASD defines a severe stress response that follows shortly after a traumatic event, whereas PTSD cannot be diagnosed until symptoms have persisted for 30 days or longer. The presence of full or partial ASD is associated with an increased risk of developing PTSD. In various studies, the presence of numbing, depersonalization, a sense of reliving the trauma, motor restlessness, and peri-traumatic dissociation were found to predict progression to PTSD.4 These associations raise the possibility that effective early treatment of trauma symptoms can be a useful strategy in the prevention of PTSD. However, it should be noted that many trauma survivors who develop PTSD do not have initial ASD symptoms, and many individuals with ASD will not develop PTSD.


Table 2: Diagnostic Criteria for Acute Stress Disorder

A. The person has been exposed to a traumatic event in which both of the following were present:

  1. The person experienced, witnessed, or was confronted with an event or events that involved actual or threatened death, serious injury, or a threat to the physical integrity of self or others
  2. The person's response involved intense fear, helplessness, or horror

B. Either while experiencing or after experiencing the distressing event, the individual has three (or more) of the following dissociative symptoms:

  1. A subjective sense of numbing, detachment, or absence of emotional responsiveness
  2. A reduction in awareness of his/her surroundings (e.g., "being in a daze")
  3. Derealization
  4. Depersonalization
  5. Dissociative amnesia (i.e., inability to recall an important aspect of the trauma)

C. 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

D. Marked avoidance of stimuli that arouse recollections of the trauma (e.g., thoughts, feelings, conversations, activities, places, people)

E. Marked symptoms of anxiety or increased arousal (e.g., difficulty sleeping, irritability, poor concentration, hypervigilance, exaggerated startle response, motor restlessness)

F. The disturbance causes clinically significant distress or impairment in social, occupational, or other important areas of functioning or impairs the individual's ability to pursue some necessary task, such as obtaining necessary assistance or mobilizing personal resources by telling family members about the traumatic experience

G. The disturbance lasts for a minimum of 2 days and a maximum of 4 weeks and occurs within 4 weeks of the traumatic event

H. The disturbance is not due to the direct physiological effects of a substance (e.g., a drug of abuse, a medication) or a general medical condition, is not better accounted for by brief psychotic disorder, and is not merely an exacerbation of a preexisting Axis I or Axis II disorder.

Reprinted with permission from the Diagnostic and Statistical Manual of Mental Disorders, Text Revision, Copyright 2000. American Psychiatric Association.


References

  1. Cohen M, Hoffman RG, Cromwell C, et al. The prevalence os distress in persons with human immunodeficiency virus infection. Psychosomatics 2002;43:10-15.
  2. Essock SM, Dowden S, Constatine NT, et al. Risk factors for HIV, hepatitis B, hepatitis C among persons with severe mental illness. Psychiatr Serv 2003;54:836-841.
  3. Cooper J, Carty J, Creamer M. Pharmacotherapy for posttraumatic stress disorder: Empirical review and clinical recommendations. Aust N Z J Psychiatry 2005;39:674-682.
  4. Harvey AG, Bryant RA. The relationship between acute stress disorder and post-traumatic stress disorder: A prospective evaluation of motor vehicle accident survivors. J Consult Clin Psychol 1998;66:507-512.


Further Reading

American Academy of Psychosomatic Medicine. Bethesda, MD. Available at: www.apm.org.

Bisson JI. Post Traumatic stress disorder. BMJ 2007;334:789-793.

Cohen MA, Gorman JM, eds. Comprehensive Textbook of AIDS Psychiatry. New York: Oxford University Press; 2008.

Fernandez F, Ruiz P, eds. Psychiatric Aspects of HIV/AIDS. 1st ed. Philadelphia, PA: Lippincott Williams & Wilkins; 2006.

Foa EB, Stein DJ, McFarlane AC. Symptomatology and psychopathology of mental health problems after disaster. J Clin Psychiatry 2006;67:15-25.

Organization of AIDS Psychiatry. Bethesda, MD: Academy of Psychosomatic Medicine. Available at: www.apm.org/sigs/oap.

Yehuda R.  Biology of posttraumatic stress disorder. J Clin Psychiatry 2001;62:41-46.

Yehuda R. (ed.) Treating Trauma Survivors With PTSD. American Psychiatric Publishing Inc, Washington DC, 2002.

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This article was provided by New York State Department of Health AIDS Institute.
 
See Also
Guide to Conquering the Fear, Shame and Anxiety of HIV
Trauma: Frozen Moments, Frozen Lives
More on Coping With Stress and Anxiety
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