1.

ACUTE STRESS REACTION

a. DSM IV Diagnostic criteria
i. Person has been exposed to a traumatic event, which both of
the following were present
1. Person experienced, witnessed or confronted with life
threatening or injury causing events of self or others
2. Persons response involved intense fear, helplessness,
horror
ii. Individual has three (or more) of symptoms while or after
experiencing event
1. Subjective sense of numbing, detachment or absent
emotional responsiveness
2. Reduce awareness to surroundings
3. Derealisation
4. Depersonalization
5. Dissociative amnesia (unable to recall important
aspect of trauma)
iii. Event is persistently re-experienced
1. Recurrent images
2. Thoughts
3. Dreams
4. Illusions
5. Flashback episodes
6. Sense of reliving experience
7. Distress on exposure to reminders of the event
iv. Avoidance of stimuli that arouse recollection of trauma
(thoughts, feelings, activities, places, people)
v. Marked symptoms of anxiety or increased arousal (sleeping
difficulties, irritability, poor concentration)
vi. Disturbance causes impairment in social, occupational or
other abilities to pursue some necessary task
vii. Disturbance lasts minimum 2 days, maximum 4 weeks,
occurs within 4 weeks of traumatic event
b. Symptoms
i. Emotional
1. Intense anxiety
2. Restlessness
3. Insomnia
4. Panic attacks
5. Depersonalisation
6. Derealisation
ii. Somatic
1. Palpitation
2. Sweating
3. Tremor
iii. Dissociative
1. Numbing
2. Difficulty in recall stressful events
3. Being in daze
4. Flashbacks
c. Coping strategies
i. Avoid reminders of stressful events
ii. Avoid social contacts

iii. Maladaptive cooping

iv. Release emotion through histrionic or aggressive behaviour
(deliberate self- harm, excessive alcohol drinking)
d. Management
i. Reduce emotion
1. Sympathetic listening
2. Short term anxiolytics
ii. Encourage recall of events
iii. Help with more effective coping
iv. Help with residual problem
2. ADJUSTMENT DISORDERS
a. DSM IV Criteria
i. Development of emotional or behavioural symptoms in
response to identifiable stressor(s) occurring within 3 months
of stressor(s) onset
ii. Symptoms or behaviour clinically significant, evidenced by
one or both of the following;
1. Marked distress that is out of proportion to severity or
intensity of stressor
2. Significant impairment in social, occupational, or other
important areas of functioning
iii. Stress relate disturbances does not meet criteria for another
mental disorder and not merely an exacerbation of a preexisting mental disorder
iv. Symptoms do not represent normal bereavement
v. Once stressor or its consequences have terminated,
symptoms do not persist for more than additional 6 months
b.