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September 20, 2017
by Hilda Huj

Surviving a Crime: ASD and PTSD

September 20, 2017 21:21 by Hilda Huj

Stressors are events or circumstances that threaten our physical and/or mental well-being. While everyday stressors pose a minimal threat and, therefore, provoke only slight stress reactions that are generally easy to cope with, certain types of stressors pose a significant threat and thus provoke debilitating stress reactions that are significantly more difficult to cope with. Traumatic stressors are an example of the latter.

According to the American Psychiatric Association (APA), traumatic stressors are events characterized by exposure to actual or threatened death, serious injury, or sexual violence. We can experience these events in one (or more) of the following ways: (1) Directly experiencing the event; (2) Witnessing, in person, the event as it occurred to others; (3) Learning that the event occurred to a close other; and (4) Experiencing repeated or extreme exposure to aversive details of a traumatic event.

As I discussed in my previous article, when we are faced with traumatic stressors we may react in a number of ways. Most of the reactions we experience right after surviving a crime are adaptive and normal. However, if our reactions are extremely intense and prolonged, we may our experience may become maladaptive and abnormal. And, if we fail to recognize that our reactions are becoming maladaptive and abnormal, we may become prone to developing a long-term reaction in a form of disorder, such as Acute Stress Disorder (ASD), Posttraumatic Stress Disorder (PTSD), or a Mood Disorder.

Acute Traumatic Stress Reactions

Acute traumatic stress reactions represent a normal reaction to traumatic events. They are automatic and instinctive attempt to protect our mind and body and, essentially, to survive exposure to trauma, both physically and mentally.

Therefore, we may experience hyperarousal and hypervigilance, and as a consequence remain physiologically aroused for several hours, and even days, after exposure. This may disrupt our sleep patterns and we can experience fatigue, tension, and edginess. In addition, we may try to avoid the trauma by concentrating on bodily symptoms instead and, therefore, experience somatization.

Another means of protecting ourselves, especially from repeated exposure to traumatic events, is peritraumatic dissociation. The peritraumatic dissociation includes feelings of numbness towards, or a lack of reactivity to, the traumatic stressor. At times, it is experienced in a form of derealization, depersonalization, and/or amnesia.

Even though they seem might seem counterintuitive, unwanted memories and flashbacks are also one way of coping with traumatic stressors. While unwanted memories and flashbacks force us to relive the traumatic event and thus may seem torturous, they can serve to redirect our attention from the stress reactions to the traumatic stressor itself, and thus allow us to attribute more of our resources to immediately surviving the stressor.

Furthermore, we may experience a disruption in our core beliefs. We may become suspicious and doubtful of one’s self-efficacy, of others’ inherent goodness, and of a hopeful future. These disruptions are most likely accounted for by the generalization of threat. If the traumatic stressor we experience is severe, unpredictable, and uncontrollable, it is likely that it will be generalized and that we will start perceiving ongoing danger.

Because traumatic stressors are rare, we usually experience disbelief and shock once we are faced with them. Therefore, we may feel emotionally disconnected from, or numbed to, the experience. And, again, this emotional disconnect is adaptive at the beginning, given that it spares us from the emotional reality, or meaning, of the event, which we may not be ready to process. On the other hand, we may experience intense emotional experiences after the exposure. We may become extremely resentful, angry, and sad. Once again, these intense emotional experiences are adaptive at the beginning, but with time they may become more intense and cause a significant disruption in our life.

Acute Stress Disorder and Posttraumatic Stress Disorder


Above I mentioned acute stress reactions that we may experience after exposure to a traumatic stressor, such as crime. While all above-mentioned reactions present an adaptive and normal first response to a traumatic stressor, if we continue to experience them two days after the exposure, we might be experiencing ASD. And, if we are experiencing the ASD for more than 30 days, then the ASD diagnosis is switched to PTSD. Moreover, even if we have no prior history of, we can experience delayed-onset PTSD. While symptoms of PTSD typically emerge within three months, they can suddenly appear months, even years after the traumatic event.

The main differences between ASD and PTSD are the following:
Acute Stress Disorder
- Any nine symptoms from the intrusion, avoidance, negative mood, arousal, and dissociative clusters.
- The presence of dissociation is included as one of the nine symptoms.
- Can be diagnosed any time between three days and one month after exposure.
Posttraumatic Stress Disorder
- At least: one intrusion symptom, one avoidance symptom, two negative mood symptoms, and two arousal symptoms.
- The presence of dissociation is marked as a specifier and represents a more severe presentation.
-Can be diagnosed any time after one month following exposure.

In general, it can be concluded that ASD and PTSD mostly differ in intensity and duration of clinical symptoms, with PTSD causing more intense and longer disruption.
Getting the Needed Help

As it was discussed in my previous article, the first step on our healing journey is to become aware of the symptoms and recognize that we need help. Once we recognize that we need help, we can choose to engage in one of many therapeutic approaches that treat or address symptoms present in trauma-related disorders.

In general, we will be able to find two kinds of approaches: trauma-focused and non-trauma-focused approaches. Trauma-focused psychological approaches address PTSD symptoms by directly confronting thoughts, feelings, or memories of the traumatic event (e.g., cognitive behavior therapy). Non-trauma-focused psychological approaches target an individual's experience of PTSD symptoms without a direct confrontation to thoughts and emotions related to the traumatic experience (e.g., interpersonal therapy).

In the end, it will depend on our personal characteristics which therapeutic approach will be best for us.



Literature
Leclerc, M-E., Delisle, C., Wemmers, J-A., and Brunet, A. (2017). Assessing and Treating Traumatic Stress in Crime Victims. Retrieved from http://www.cicc.umontreal.ca/public/media/files/prod/onglet_files/8/F2017Traumatic-Stress-in-Crime-Victim1.pdf.

About the Author

Hilda Huj Hilda Huj, B.A., M.A.

Are you looking to talk with somebody who can help? Together we can gain insight into your situation, find a deeper understanding, evoke meaningful changes, improve your relationships, and heal you by using a potential that you already have.

Hilda Huj has a clinical practice in St Albert, AB