Psychology

Acute Stress Disorder (ASD) is a result of a traumatic experience.  Many persons acquire this disorder during childhood, having faced a fear that was too emotional to bear.  This fear unmet, will linger into adulthood.  The disorder can occur in people of any age, represented by a traumatic experience that has overwhelmed the cognitive process and has filled the mind with unsettling thoughts.  Those affected by life and death situations are often plagued with unsettling thoughts, intermittent flashbacks, and continuing dreams, which their minds replay in an endless cacophony of sight and sound (Meiser, 2007).

Predictions made for those suffering from ASD carry the weight of acute or chronic pressures in coping with this disorder.  Coping skills vary by individual and are dependent on length of endurance withstood and pharmacologic interventions in association with psychotherapeutic practices.  Much is still unknown in the area of ASD however, known responses to traumatic events are based on the responses of those suffering from posttraumatic stress disorder (PTSD).   Thereby, the basis of much research conducted on the subject is on the premise of commonality while facing new insights (Elklit  Brink, 2004).

Traumatic Episodes and Research
The basis of a traumatic episode does not necessarily need to be that of a life or death scenario.  Research in the reactions to stress levels are indicative that whatever one perceives as overtly affecting on a physical and emotional level, is a traumatic event.  Trauma stems from any event in which pain and suffering is monumental thereby affecting emotional status.

Studies on children involved in car accidents or hit by cars, and based on the severity of their injuries show the degree in which parents are affected.  At least 12  of parents diagnosed with ASD, and 25 had partial ASD.  Further evaluation also showed that after six months 8 of those with ASD now had PTSD, and 7 of those previously diagnosed with partial ASD, now had partial PTSD (Kassam et al, 2009).  The symptoms of the parents were relevant to the pain symptoms of the children, the more severe the injuries the deeper the parents response.

There have not been very many studies on the association of parents developing ASD, or PTSD, relevant to the injury or illness of their child.  Findings have indicated from 16 to 51 of parents develop ASD, after their children were involved in a car crash.  Percentages increased for those with children admitted to an intensive care unit, and for those whose children received a diagnosis of cancer (Kassam et al, 2009).

Basis for severity of diagnosis for parents were factors involving pre-existing conditions such as parent trait anxiety, and peritrauma factors such as witnessing a childs injury (Kassam et al, 2009).  More research has been on the development of PTSD, in evaluating associations with ASD.  Presently 4 to 40 of the 16 to 51 of those diagnosed with ASD have subsequently been diagnosed with PTSD in relation to severity of injuries, physiological, and psychological response (Kassam et al, 2009).

Studies on parents and stress related symptoms developing when children are injured looked at other injuries and illness such as surgery.  Scrimin et al (2009) tells us within the 24 hour, time span after surgery is when parents stress levels are at peak function.  The study found that there are three levels of anxiety related to stress levels in association with severity.

Targets were aimed at factors concerning parents Social network, socio-economic status and parental locus of control were evaluated as contributors (Scrimin et al, 2009).  Other factors considered was the type of surgery the child had, in addition to parents gender, trait anxiety, and health external locus of control (Scrimin et al, 2009).  The findings show that it is normal for increased anxiety and stress levels, which are predictive in relation to parents trait anxiety, education, and social contacts.

Anything outside the norm could result in the development of ASD, and PTSD depending on several characteristics including the severity of child surgery these aspects should be taken into consideration when interacting with parents in the aftermath of their childs surgery (Scrimin, 2009).

A recent research question looks at how participating in research to address ASD, and PTSD, is affecting trauma survivors, in if it adds to the harm they have already experienced.  It has been thought that in participating in research to establish criteria in seeking treatment modalities, may lead to emotional distress for participants.  It has been thought that participants might be too fragile emotionally to deal with instances that may retrigger strong emotional responses leading to increased emotional harm (Griffin et al, 2009).

The research also brought to light that 14 out of 15 women did not recall having signed consent to participate in research, with another 14 out of 15 women advising that they did not mind being contacted to participate in the research.  This information raised a new question regarding having patients sign consent forms to participate in future research programs so soon after the trauma had occurred (Griffin, 2009).

Research results indicate that it is normal for participants to experience an emotional response in reliving the experience through participation in studies.  However, research has shown that this response falls into normal levels and does not lead to increased emotional harm for participants (Griffin, 2009).

In relation to studies performed in assessing, the ability to suppress thought of the traumatic events show that those diagnosed with ASD and PTSD had difficulty in suppression of the experience (Nixon et al, 2008).  The use of avoidance coping strategies does not work as symptoms persist in relation to the trauma.  It is necessary to deal with the memories for appropriate emotional processing for proper mental adjustment (Nixon et al, 2008).

The need to find a proper balance is necessary in the overall treatment, as patients failed attempts at suppression are likely to rebound when suppression is not maintained (Nixon et al, 2008).  Findings suggest that the inability to suppress for those diagnosed with ASD and PTSD is limited to those memories of traumatic experience and does not affect the ability for thought suppression itself.  Further research is needed to discover a way to manifest greater effort within these individuals for successful suppression of traumatic episodes (Nixon et al, 2008).

In an effort to treat patients in finding a way to balance suppressive thought regarding trauma, research in the area of using triggers, as patients are predisposed to triggers in affiliation of their symptoms, is being used.  These triggers are specific to a remember or forget instruction (Moulds, 2008).

The basis of the research targets the process of direct forgetting.  The process uses words as indicators of desired response in treating patients to deal with traumatic experiences.  Neutral wordage in association to remembering and forgetting allows a balance in facing the trauma to an extent that does not affect emotional levels to a degree of disorder, thereby alleviating stress levels.  The findings show that individuals who develop ASD possess an encoding style for positive material that reflects trait-like manner of information processing which is an ideal foundation for this type of treatment to be effective (Moulds, 2008).

Diagnosis Criteria
The first step in establishing treatment for acute stress disorder is to receive a professional diagnosis.  From within the guidelines of the DSM- IV-TR, a psychiatrist will look at the following criteria in determination of the disorder.  Relevant data such as background, series of events, and proposed emotional status play a role in the process.  Medications and the addressing of other mental and physical issues are factors considered (Axelrod, 2007).

In discerning the criteria for diagnosis of ASD, or PTSD, is to take into account the difference between acute trauma reactions as opposed to acute stress disorder.  Psychiatrists turn to the DSM-IV in making that determination, as they look for psychological distress suffered by persons who have been traumatized, and any indications of the development of PTSD.  Effective screening in relation to the criteria representative of the DSM-IV will accurately confirm or differentiate from acute trauma reactions in making a diagnosis of ASD (Harvey et al, 1999).

Symptomology
Mulhauser (2010) advises to reach a diagnosis of acute distress disorder the factors evaluated consist of a dual primary indicative relation consisting of having witnessed a traumatic event in which death or severe injury occurred and of having an overwhelming response of horrification leading to a state of helplessness. There is a subsequent reactionary initiative in a cumulative of three or more relative instances resulting in detachment of emotion in becoming numb and unresponsive Loss of time and space in being in a dazed and disoriented state loss of reality loss of sense of self disassociation from the events resulting in amnesia.

The events continue in a pattern of thoughts, with an inability to control. Focus is on increased avoidance of triggers in having to deal with the reoccurrence of the event. In addition to these criteria, there is mounting anxiety with a heightened awareness, affecting active daily living and sleeping. Acute onset of symptoms relative to the trauma occurs anywhere from two to four days, or within 4 weeks of event. Furthermore, physiological and, or psychological conditions should be ruled out as a causative factor.

An evaluation to identify and determine specific symptoms is relevant in initiating a clear and concise diagnosis for treatment.  Symptoms that professionals look for include stress related responses.  Stoppler (2010) expresses the physical impact of stress on the nervous system and its contribution to other bodily dysfunctions.  Physical attributions are raised blood pressure, suppression of the immune system, increased risk of heart attack and stroke, contribution to infertility, and age progression.

ICBS (2007) provides the emotional signs and symptoms of stress.  These symptoms
allude to an emotional disorder that could, depending on severity and time, constitute a diagnosis of ASD apparent within a month of the event and short lived, or that of a posttraumatic disorder, which is chronic. These symptoms include irritation, anger and hostility, depression and withdrawal, jealousy, restlessness and anxiousness, decreased initiative, inability to be reality based or overtly alert, decreased personal involvement, crying bouts, critical depiction of others, self-deprecating,  nightmares, and weak reflexes of emotional responses.

The most common behaviors associated with ASD are easily recognizable according to Aetna (2007).  Such behaviors exhibit frequently and increase in frequency if intervention does not occur.  Recurring behaviors include nail biting, increased smoking, or use of alcohol and drugs, neglect of responsibility, poor job performance, and poor hygiene.

Primary indicators of ASD associated with life and death or serious injury occurs within four weeks of the traumatic event.  If the symptoms persist, the individuals assessment for PTSD (posttraumatic stress disorder) indicates that the disorder may be deep rooted in a history of events, which likely stems from childhood.  A study of PTSD tested 243 children injured in various car crashes. The research provided results of eight percent of children met the symptom criteria for ASD and another 14 had subsyndromal ASD 6 met the symptom criteria for PTSD and another 11 had subsyndromal PTSD. ASD and PTSD symptom severity were associated (Kassam et al, 2004).

The unknown factor of ASD is in accordance with its construct.  The Symptomology is known as stress reactions inclusive of dissociation, reexperiencing, avoidance, and arousal. Research findings confirm the four associative reactions pursuant to ASD and development of PTSD however, studies are needed to find what causes the reactions to manifest (Brooks, 2008).

Significant Factors in Differential Diagnoses
In light of the results of this study, it is indicative that the possibility of the 6 meeting the criteria for PTSD, could have suffered from it as a child lacking diagnosis.  The conduction of further studies into the 6 of children is in need to confirm this hypothesis.   The answer to the question of a diagnosis of ASD as a predictor of PTSD was inconclusive.  Other relevant studies conducted on children examined diagnosis of ASD, with predictability of PTSD resulting from assault, or motor vehicle severity of injury.  The results confirmed that ASD was a good predictor of later PTSD but that dissociation did not play a significant role (Meiser, 2005).  In addition, another study of children diagnosed with ASD using the intervention of pharmacological treatment performed to evaluate for prevention of PTSD.  Study involved three symptom clusters to analyze history of events.  ASD Symptomology provided beneficial data in depicting lack of onset of PTSD versus ASD parameters with pharmacological treatment (Adler, 2005).

An interesting study involving rescue workers brought to light the connection of ASD with PTSD.  The results indicated that prolonged Symptomology to ASD was evident in the development of PTSD.  The study tested participants at 2 months, 7 months, and at 13 month, intervals.  The participants were comprised of directly exposed to disaster, and of those indirectly exposed to disaster.  Those with direct exposure ranked 7.96 higher on developing PTSD, and being depressed at 18 months (Fullerton, 2004).

Etiological Factors and Assessment Issues Involved in Acute Distress Disorder
When we look at etiological factors such as in the case of combat related trauma, views are that PTSD is a normal reaction. The evaluation on a case study on the development of PTSD in relation with the concept of war neurosis comparative to combat fatigue and shell shock parameters indicated wide spread affect.  It was decidedly adapted to be representative of all combat personnel.

Configurative measures are unclear as to the use of one source in the determination however, the expectation of the disorder affecting all combat soldiers preempt both a combination of psychotherapy and pharmacological treatment (Bracha, 2006).

In looking at combat related trauma, which involves direct and indirect association with extreme violence, there is increased knowledge of the connection between mental health issues, and massive violence of various natures and degrees.  Of evaluations conducted regarding psychiatric disorders, top of the list were acute stress disorder and posttraumatic stress disorder.  The cross mix of symptoms were relative to various disorders but representative of key elements of ASD and PTSD (Murthy, 2007).   Murphy also advises of associative and comparative symptoms including bereavement, depression, fear, poor physical health, anxiety, physiological arousal, somatization, anger control and function disability, and the arrest or regression of childhood development progression.

The impact stemmed from the amount of pain severity and loss of body parts in correlation with the increased numbers of those afflicted and diagnosed.  For this reason, measures taken to expand on the variety of symptoms will be applicable for future studies (Murthy, 2007).

Identify Dominant Treatment Modalities
Modalities in place in attribution of treatment of ASD are psychotherapy and pharmacology, prescribed separately, or a combination of both may apply.  It all depends on the individual diagnosis and response.  There have not been many studies on the effects of pharmacological treatment on patients, but from those conducted it is known that the administration of serotonin reuptake inhibitors prove invaluable in providing quality of life to those who need treatment (Seedat, 2006).

Ponniah and Hollon (2009) speaks on Cognitive Behavior Therapy (CBT) and eye movement desensitization and reprocessing (EMDR) as efficacious and specific for PTSD it has made monumental progress in going forward, in addition to stress inoculation training, hypnotherapy, interpersonal psychotherapy, and psychodynamic therapy introduced as having great possibilities in treatment of PTSD (Ponniah  Hollon).

As research has pointed to the affliction of development of ASD, and PTSD, in association with childhood trauma and the cognitive and physical response relays into adulthood.  It is interesting to note that psychotherapy treatment for children is not common.  Psychotherapy treatment is provided to adults in relation to current ASD, or PTSD factors.  Yet, it is provided to children in relation to single-incident trauma such as sexual abuse, with such treatment modalities as cognitive behavior therapy (CBT), eye movement desensitization and reprocessing (EMDR), and play therapy (Adler et al, 2005).

This may be due to the difficulty in diagnosing young children with regard to ASD, and PTSD, as in a 4 year old, they tend to be quite subjective communicatively.  Changes in DSM-IV criteria with regard to the three clusters in alternative criteria that are focused on consistent behavior patterns and sensitivity in connection with development will assist in determining diagnosis of PTSD (Adler et al, 2005).

Another problem with effective treatment for children is that treatment measures and information is targeted to adults.  There are extreme differences between children and adults that suffer from PTSD, therefore treatment measures for adults is not adequate for treatment of children.  Taking into account the variables of association with Type I and Type II trauma, and the distinction between sexual abuse and other forms of trauma may also be relevant to treatment (Adler et al, 2005).

There is a need to study the relationship in treating children for cognitive response on a scale that will have greater efficacy regarding CBT.  This is in accordance with determining a protocol foundation predisposed to pediatric intent as a basis for increased efficacy for children.  The expansion from single-incident trauma will assist in this dilemma involving effective treatment for children to cease being a neglected field of study (Adler, 2005).

Preferred Therapeutic Interventions of Treatment for Acute Stress Disorder
The possibilities of intervention practices in alleviation of stress have proved to be effective on a broad scale.  Historically continued exposure to stress can lead to psychological disturbances.  Cases reportedly advise of physical reactions to stress such as manifestations of blindness.  The American Civil War was the first to notice the effects of combat on soldiers.  The traumatic neuroses, war neurosis, shell shock, battle fatigue, or physioneurosis (Hughes  Thompson, 2004).  These historical events personified further study into the early views of the existence of stress, and its impact on mind and body.  The mixing of intervention practices in using Anxiety Management Techniques, and Direct Therapeutic Exposure (DTE) catapulted treatment measurements to even greater heights.

Basis for studies relied on the fact of reactions to horrific events outside the range of usual human experience (Hughes  Thompson, 2004).  This was a breakthrough of scientific significance, regarding the preponderance of evidence that events of traumatic nature could affect persons in such a way as to emotionally cause harm.  Even further, this discovery revealed that based on the exposure time, and the individual, the impact could be acute or chronic based.  

Other intervention practices developed over time in the treatment for acute stress disorder have clarified the connection of ASD to PTSD in recognition of acute to chronic realism on a functional scale that escalates from minor to major in debilitation.  With the early studies indicative of the existence of stress overall in relation traumatic events, it is still not decidedly accepted as a precise science.  There is still much more to know in its acquisition, and about the triggers that result in manifestation of physical and emotional turmoil, and effective treatment from a short and long-term stance (Johnson  Greenberg, 2010).

What has been so readily accepted by the military in relation to American soldiers diagnosed with ASD, and PTSD, has not been so easily accepted as fact by all, as the Canadian military is concerned with mental health practices and their effects on Canadian soldiers.  One thing that is agreed is that stress comes with the territory per se.  Even though Americans have since changed their outlook decidedly that if it does go with the territory, it does not necessarily make it standard to the point of acceptance.  Thus, clinical interventions developed multiple times over and research will continue until proper perspective and adequate treatment are availed to those who suffer from these disorders (Conference Papers, 2008).

Prognosis for Recovery
Recovery is at the core of treatment.  There is not enough data gathered or research performed to provide a reliable scale on proposed patterns of treatment with confirmed response.  Studies thus far confirm the available treatment that has shown rewarding maintenance of the disorders, in prevention on a small scale, but the outlook is to find alternative treatments to provide effective rehabilitation to sufferers on a larger scale.  Predisposition factors call for the need for genetic ruling, based on ASD, or progression to PTSD.

Studies geared towards early prognostic screening for posttraumatic stress disorder, which demonstrated that the potential of patients to develop PTSD, after developing ASD, is 89 respectively.  In light of these findings, further studies will need to be conducted in cross-referencing depression and anxiety to validate the results (Sijbrandij et al, 2008).

In response to the findings it was preferred to use the four item span of startle, physiological arousal, anger, and numbness over the seven item DTS, as it proved more reliable.  Either the overall findings indicated that with the 4-item span, or 17 item DTS, the results were positive in reflecting that early screening effectively identified PTSD, as early as 9 days after the traumatic event (Sijbrandji et al, 2008).

Latest Research on Acute Stress Disorder
Progress continues to make breakthroughs in scientific rationale in regard of physiological response in answering the query if ASD is a predictor of PTSD.  Research is now confirming the possibility.  The argument exists in the results of studies performed.  There are discrepancies as some are inconclusive while others support predictability confirmation (OKearney  Perrott, 2006).

There is more research needed on specific measures in addressing the inherent discrepancies that exist.  New findings on physical impacts are arising in attribution to ADS, and PTSD.

Hospitalizations are bringing to light that accidents or severe injuries may have causative factors of the diagnosis of these disorders, which vary regarding direct or indirect exposure to the environmental factors imposed such as military or home front, although advances in acute trauma care have increased survival among service members with burn and explosion injuries (Gaylord et al, 2008).

The Navy made a breakthrough on treatment for PTSD.  Testing using a brain scan and blood tests confirmed the existence of a chemical reaction and release of enzymes that restructure cognitive receptors in accordance with traumatic events.  There is a connection of neurosteroid levels of the brain that interplay with neurosteroid blood levels.  The studies have shown that by testing the neurosteroid levels in the blood the correlated to symptom severity in PTSD, depression, and pain issues (Kennedy, 2009).

Conclusion
For all various intent and purpose, research is the key to mans knowledge of scientific measure upon which we face new and disturbing occurrences.  The variables involved with any disorder are monumental and diverse.  Even more so for the connection of cognitive stimuli structuring connected to physiological factors, resulting in overlapping of one symptom to another occurring frequently.  The ability to determine factors prevalent to a specific analogy is difficult, but with determination and multiple research options, headway continues to make progress in providing new technology to assist with the enhancement of quality of life (QOL) for those who suffer from ASD, and PTSD.  The continuance of breakthroughs and effective ways to cope in keeping with expansion on treatment and prognosis factors are directives in store.  To meet these directives, research will take the lead on evaluating the crossover connection between ASD, and PTSD in hopes of one day having a better handle on this sporadic and fearful disorder with its debilitating impact.

Research will take a harder look at applicable demographics constituting a percentile of factors involving the likelihood of experiencing a traumatic event, with results indicative of one person out of 60.7 percent of men, and 51.2 percent of women.  In ensuring that the criteria for diagnosis in relation to overall patient satisfaction is provided for effective coping skills, in addition the advancements with pharmacological and psychotherapeutic treatment have not gone unnoticed (Frey, 2010).

TFCBT (trauma focused cognitive behavior therapy) is an early preventive intervention that has produced good results in treating patients with ASD, in preventing the development of PTSD.  The intervention is focused on administering the treatment within 3 months of the onset of ASD in preventing the stress disorder from becoming chronic or developing PTSD (Korner et al, 2008).

Treatment consists of At least one of the following techniques should be included in the intervention exposure, systematic desensitization, stress inoculation training, cognitive processing therapy, cognitive therapy, assertiveness training, biofeedback, relaxation training (Korner et al, 2008).

There should be at least 4 sessions of therapy administered in recommended outcomes for success.  The number of sessions set in accordance to comparison of PD (patient debriefing) results, as well as SC (stress counseling) to indicate if the treatment was as effective, or more effective for treatment purposes.  Studies also maintained an effort to combine these techniques in evaluation of effectiveness (Korner, 2008).