Psychiatric Nursing: Diagnostic Criteria for PTSD and ASD

This report provides a comprehensive comparison of Acute Distress Disorder (ASD) and Post-Traumatic Stress Disorder (PTSD), focusing on their diagnostic criteria, features, and differential diagnosis according to the DSM-5. The report details the criteria for both disorders, including exposure to trauma, intrusive symptoms, avoidance behaviors, negative cognitions and alterations in arousal. Key differences in diagnostic features, such as the duration of symptoms and the presence of dissociative symptoms, are highlighted. The report also discusses associated features, prevalence rates, development and course of each disorder, and risk and prognostic factors. Furthermore, it outlines the steps involved in making a proper differential diagnosis between the two conditions and other related disorders, emphasizing the importance of considering the pattern of symptom progression. The information is valuable for nursing students and healthcare professionals seeking to understand and differentiate between these trauma-related disorders.

Running head:PSYCHIATRIC NURSING
Acute Distress Disorder and PTSD
Name of the Student
Name of the University
Author Note

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Comparison of Diagnostic Criteria
While the diagnostic criterion for both post-traumatic stress disorder (PTSD) and
Acute Distress/ Stress Disorder (ASD) overlap in many places, there are significant
differences in the criterion of both the conditions. According to the DSM V, they are as
follows (American Psychiatric Association., 2013).
For PTSD, Criterion A entails that the patient was directly or indirectly exposed to
death, near-death experiences, actual or threat of serious injuries or sexual violence. This
exposure may be personal, or indirect by repeated exposure to something that happened to a
closed one. Criterion A is the same for ASD as well.
Criterion B entails repeated intrusive thoughts or recollections in daily life related to
the trauma in the case of PTSD. This may also include nightmares about the trauma,
flashbacks, intense distress after the recollection and psychological reactivity after the stimuli
relating to trauma. In the case of ASD, one or none of these symptoms are apparent. Intrusive
memories may be assessed in various ways, like making the patients maintain a diary of the
memories (Kleim, Graham, Bryant & Ehlers, 2013).
Criterion C consists of the patient’s forced avoidance of any stimuli related to the
trauma that includes people, places, thoughts, conversations, objects, and others in the case of
PTSD. In the case of ASD, the patient may exhibit one or none of these symptoms.
In the case of PTSD, Criterion D entails a continuous distorted belief of oneself or the
world. This includes continuous negative emotions, unable to feel interested in pre-traumatic
activities. In the case of ASD, the patient may still exhibit this symptom, but only one or less.
Trauma-related belief distortion may present a risk of PTSD (Whiteman, 2018).

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In Criterion E, PTSD shows trauma-alterations alterations in arousal. In ASD, the
patient may or may not show this symptom.
Criterion F and G entails the persistence of all the previous criterion and distress or
functional impairment in relation to the trauma. However, for ASD, while clinically
significant distress is still apparent, the duration usually lasts less than a month.
As for Criterion H, neither PTSD nor ASD is caused by any other reason except the
trauma.
Differences in Features and Prevalence
Diagnostic Features
The patient may revisit the traumatic experience in ways such as flashbacks,
nightmares, and face intense psychological distress due to intrusive memories. The patients
tend to almost always avoid stimuli associated with the traumatic event. Negative cognition is
a large symptom of PTSD, which may result in amnesia (dissociative response), which may
last long.
For ASD, symptoms typically do not last longer than a month. Dissociative disorders
may happen but not longer than a few hours. They usually do not have intrusive memories of
the event like the PTSD patients. They may be sensitive to the things associated with the
traumatic event (American Psychiatric Association., 2013).
Associated Features Supporting Diagnosis
Auditory hallucinations may occur in PTSD, along with paranoid ideation and
dissociative symptoms. In the case of ASD, the patients may be prone to panic attacks or
even feel guilty for the traumatic event or show impulsive behaviour.

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Prevalence
In PTSD, the one year prevalence is around 3.5% in U.S. adults. It is lower in Asian
and European countries 0.5-1.0%.
The prevalence of ASD in a trauma-experienced population within one month of the
event is less than 20%, where it was not interpersonal trauma. It is higher otherwise (20% to
50%). This is in accordance to the DSM-V (American Psychiatric Association., 2013).
Development and Course
PTSD symptoms usually begin within the first three months of the event, but ASD
cannot be diagnosed before three days of the traumatic event.
Risk and Prognostic Factor
For PTSD, there is a vast array of risk factors that may be before the event (old
psychological trauma), during the event (severity of the event) or after the event (negative
responses from others). For ASD, pre-existing mental issues may pose risks. It has been seen
that if the patient has suffered from PTSD in the past, the chances of developing ASD is
higher (Ptsd.va.gov., 2020). Biologically, those who have a higher cortisol awakening
response closely after the event, it acts as a protective factor against PTSD (Marin et al.,
2019).
Differential Diagnosis
There are six steps in making a proper differential diagnosis, which can be used to
make a definite diagnosis. At first Malingering and Factitious Disorders must be ruled out
and it must be ensured that the symptoms are not due to substance abuse or due to any genetic
condition. Then, the primary disorder must be specified, which in this case would be ‘trauma-
related stress disorder’ as both PTSD and ASD have overlapping symptoms. Then the
clinician must different between PTSD/ ASD and adjustment disorder. In the latter, the

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severity can be of any magnitude than that required by the Criterion A which is definitely
followed by ASD or PTSD. Finally, it must be made sure that the symptoms are clinically
significant to diagnose ASD or PTSD. It is important to remember that both PTSD and ASD
has similar symptoms. The differential diagnosis is based on the pattern of progression. The
symptoms of ASD is restricted to one month only. For PTSD, diagnosis cannot be given
before a month from the trauma. So, if the patient has persisting symptoms over a month, the
diagnosis is PTSD. If the symptoms occur within a month of the event, it may be considered
as ASD (American Psychiatric Association., 2013).

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Reference
American Psychiatric Association. (2013). Diagnostic and
statistical manual of mental disorders (5th ed.). Washington, DC:
Author.
Kleim, B., Graham, B., Bryant, R. A., & Ehlers, A. (2013). Capturing intrusive re-
experiencing in trauma survivors’ daily lives using ecological momentary
assessment. Journal of Abnormal Psychology, 122(4), 998. DOI:
http://dx.doi.org/10.1037/a0034957
Marin, M. F., Geoffrion, S., Juster, R. P., Giguère, C. E., Marchand, A., Lupien, S. J., &
Guay, S. (2019). High cortisol awakening response in the aftermath of workplace
violence exposure moderates the association between acute stress disorder symptoms
and PTSD symptoms. Psychoneuroendocrinology, 104, 238-242. DOI:
https://doi.org/10.1016/j.psyneuen.2019.03.006
Ptsd.va.gov. (2020). VA.gov | Veterans Affairs. Retrieved 30 March 2020, from
https://www.ptsd.va.gov/understand/related/acute_stress.asp
Whiteman, S. (2018). Post-traumatic Stress Disorder and Suicidal Ideation: The Moderating
Effect of Cognitive Distortions DOI: https://dx.doi.org/10.1037%2Fccp0000220.