The prevalence of acute stress disorder in recently trauma-exposed populations (i.e., within 1 month of trauma exposure) varies according to the nature of the event and the context in which it is assessed. In both US. and non-U.S. populations, acute stress disorder tends to be identified in less than 20% of cases following traumatic events that do not in- volve interpersonal assault; 13%—21% of motor vehicle accidents, 14% of mild traumatic brain injury, 19% of assault, 10% of severe burns, and 6%—12% of industrial accidents.
Higher rates (i.e., 20%—50%) are reported following interpersonal traumatic events, in- cluding assault, rape, and witnessing a mass shooting.
Acute stress disorder cannot be diagnosed unti13 days after a traumatic event. Although acute stress disorder may progress to posttraumatic stress disorder (PTSD) after 1 month, it may also be a transient stress response that remits within 1 month of trauma exposure and does not result in PTSD. Approximately half of individuals who eventually develop
PTSD initially present with acute stress disorder. Symptom worsening during the initial month can occur, often as a result of ongoing life stressors or further traumatic events.
The forms of reexperiencing can vary across development. Unlike adults or adoles- cents, young children may report frightening dreams without content that clearly reﬂects aspects of the trauma (e.g., waking in fright in the aftermath of the trauma but being unable to relate the content of the dream to the traumatic event). Children age 6 years and younger are more likely than older children to express reexperiencing symptoms through play that refers directly or symbolically to the trauma. For example, a very young child who sur- vived a fire may draw pictures of ﬂames. Young children also do not necessarily manifest fearful reactions at the time of the exposure or even during reexperiencing. Parents typi- cally report a range of emotional expressions, such as anger, shame, or withdrawal, and even excessively bright positive affect, in young children who are traumatized. Although children may avoid reminders of the trauma, they sometimes become preoccupied with reminders (e.g., a young child bitten by a dog may talk about dogs constantly yet avoid g0- ing outside because of fear of coming into contact with a dog).
Temperamental. Risk factors include prior mental disorder, high levels of negative af- fectivity (neuroticism), greater perceived severity of the traumatic event, and an avoidant coping style. Catastrophic appraisals of the traumatic experience, often characterized by exaggerated appraisals of future harm, guilt, or hopelessness, are strongly predictive of acute stress disorder.
Environmental. First and foremost, an individual must be exposed to a traumatic event to be at risk for acute stress disorder. Risk factors for the disorder include a history of prior trauma.
Genetic and physiological. Females are at greater risk for developing acute stress dis- order. \
Elevated reactivity, as reﬂected by acoustic startle response, prior to trauma exposure increases the risk for developing acute stress disorder.
The profile of symptoms of acute stress disorder may vary cross-culturally, particularly with respect to dissociative symptoms, nightmares, avoidance, and somatic symptoms (e.g., dizziness, shortness of breath, heat sensations). Cultural syndromes and idioms of distress shape the local symptom profiles of acute stress disorder. Some cultural groups may display variants of dissociative responses, such as possession or trancelike behaviors in the initial month after trauma exposure. Panic symptoms may be salient in acute stress disorder among Cambodians because of the association of traumatic exposure with panic- like khyfil attacks, and ataque de nervios among Latin Americans may also follow a traumatic exposure.