All people have to cope with tragic strokes of fate in the course of their lives. But when the experiences are so drastic for the affected person that they can no longer be coped with by the body’s own mechanisms, then an acute stress reaction occurs.
What is an acute stress reaction?
Experienced traumas can push the human psyche to its limits, overwhelm it. A crisis situation then occurs – the acute stress reaction. An acute stress reaction is first of all a normal response of the human psyche to a stressful experience in life. For this reason, it is not an illness. Rather, it is an expression of an extraordinary emotional stress for which the affected person cannot find an adequate coping strategy. The body’s own coping mechanism fails because the stress is too extreme. As a result, a variety of symptoms occur, which manifest themselves on both a psychological and physical level.
Causes
Especially when a person has personally experienced or witnessed violence, the acute stress reaction can be observed. No matter whether war experiences, the experience of physical or psychological violence play a role. All these traumas experienced can push the human psyche to its limits, overstrain it. A crisis situation then occurs – the acute stress reaction. In addition to the death of a loved one, the experience of a terrible accident can also result in such a reaction. Of course, the reaction to a difficult event also depends on the individual’s psyche. Thus, an acute stress reaction can occur even when the experience may not be perceived as so serious from the outside.
Symptoms, complaints, and signs
Immediately during and after the stressful event, the affected person is numb. She has the feeling of not being herself, perceiving herself as if through a filter. This phenomenon is called depersonalization. This is accompanied by the affected person behaving strangely, performing seemingly senseless actions. Mental impairments at this stage include perceptual disturbances, disorientation, and narrowing of consciousness. The person is in a state of shock. In addition, there are severe mood swings. If the person is full of grief one moment, he or she may lash out in anger the next and sink into apathy a short time later. The psychological tension then also affects the body. Sweating, rapid heartbeat, and nausea may accompany an acute stress reaction. Furthermore, the person may be tormented by violent nightmares and recurring memories of the experience. Also characteristic of this crisis situation are sleep disturbances, a diminished ability to feel, and increased irritability.
Diagnosis and course
In the acute phase, i.e., the time during and shortly after the occurrence of the stressful event, the affected person is like a changed person. His personality changes, he behaves strangely and deviates from his normal behavior. Other people find it difficult to get close to him, also because of the extremely pronounced emotional mood swings. The acute reaction to a bad event can last for hours to days, or even weeks in extreme cases. In the acute phase, other symptoms occur as in the subsequent processing phase. In the processing phase, memories of the bad event return again and again. Sleep may be disturbed, nightmares are frequent. What has happened is processed during the day and at night. During this time, the affected person is more irritable and jumpy than normal. During the processing phase, the symptoms decrease in intensity and sooner or later disappear completely. However, if the typical symptoms last longer than four weeks and deeply affect the person’s everyday life, the acute stress reaction has turned into a post-traumatic stress disorder. This should definitely be treated psychotherapeutically because, unlike the stress reaction, it represents a disease.
Complications
Acute stress reaction can have psychological consequences even beyond the acute period. As it progresses, it may develop into posttraumatic stress disorder or adjustment disorder.However, other mental disorders are also conceivable as a result of the mental shock: The severe stress may serve as a trigger for disorders for which a predisposition already exists. Such critical life events may also trigger a relapse into previous mental illnesses or destructive patterns of thinking and behavior. In addition, some people who suffer from mental shock temporarily pose a danger to others or to themselves. In some cases, purposeful self-injurious behavior occurs, such as cutting, burning, hair pulling, or blunt beating. Suicidality may also occur. Aggression is another possible complication of the acute stress reaction. The person may temporarily appear completely alienated and out of character. Complications are also possible if acute stress disorder is treated incorrectly. Confronting the traumatic event too early may have a retraumatizing effect: instead of working through the trauma, it is mentally relived and solidified. Violent and insensitive reactions to aggressive or self-harming behavior can also place an additional burden on the person affected or even have a traumatizing effect themselves. For this reason, a cautious approach is necessary.
When should one go to the doctor?
If the sufferer poses an immediate danger to himself or others, professional help is needed. Persistent or severe suicidal ideation, self-harm, or physical violence toward others are examples of such situations. Initial contact may be made through the primary care physician. Those who are already being treated by a psychiatrist or psychotherapist for other reasons can also contact them directly. In Germany, no referral is necessary for an appointment with a psychiatrist or psychotherapist. Many crisis situations come to a head in the late evening or at night. Most larger cities therefore have crisis intervention services that can be contacted in the event of a mental health emergency. Particularly in the case of very strong, urgent suicidal thoughts, those affected can also turn to the emergency room of a hospital if there is no specialized clinic for acute cases locally where admission is also possible at night. It is not always necessary to see a doctor or psychotherapist for an acute stress reaction. For example, a visit to the doctor is usually not necessary if the severe stress lasts less than two weeks and there are no other urgent reasons (e.g., suicidality). A low-threshold counseling service is offered by the telephone counselling service, which is available free of charge around the clock in Germany under the nationwide telephone number 0800 111 0 111.
Treatment and therapy
In the case of acute stress reaction, there is initially no need to seek help. It is first completely normal that the affected person develops strong symptoms. However, these should disappear on their own after a few weeks during the processing phase. If this does not happen, however, or if the person is in such a desolate state, then professional help should be sought. Psychotherapeutic treatment by an experienced therapist is indicated here. Three phases can be distinguished in the course of therapy: the stabilization phase, confrontation with the event and the integration phase. In the first part, an attempt is made to calm the affected person emotionally and to help him gain a new perspective. The goal is to bring him out of the desperate state. Trauma confrontation is about the affected person becoming aware of what happened in detail. By recounting the event, he can process the trauma in all its details. In the third part, the integration phase, the affected person is helped to resume normal life. Relatives can also be included in the therapy. If the affected person has major problems coping with everyday life, the use of antidepressants and tranquilizers has proven effective. In the case of a traumatic experience, the person can be helped with two measures. Firstly, with psychological first aid, with which the person is supported by a competent contact person while still at the scene of the event. The other is delayed psychological early intervention, which aims to alleviate symptoms and prevent post-traumatic stress disorder.
Outlook and prognosis
It is not always possible to respond properly to an acute stressful situation. Traumatic experiences often make themselves felt later through an acute stress disorder or post-traumatic stress syndrome. In this case, the prognosis is only good if the affected person confidently turns to a specialist. If he increasingly withdraws because of his problems, the acute stress situation can turn into a dangerous situation. It can lead to depression and suicide. An acute stress situation can also feel dramatic. Unnoticed, it can lead to burn-out or a nervous breakdown. Therefore, it is even more important to react immediately to acute stress. By talking about it and seeking help, the situation can often be defused. If stressful situations last for a few days, the outlook is worse. The acute situation has turned into a disorder. The extent to which this requires treatment varies. The symptoms of a stress disorder can often be alleviated by talking. Provided that those affected do not want to burden their family with this, a psychological day clinic is the right place. The long waiting times for psychological treatment often worsen the situation. The primary care physician is best able to decide when medical intervention is necessary and when medication help might be sufficient.
Prevention
Because acute stress reaction is not a disease but a response of the psyche to a traumatic experience, there are no preventive measures that can be taken in advance.
Aftercare
In most cases, aftercare only takes place insofar as a serious experience has occurred and the affected person is foreseeably unable to process all the circumstances. In this case, post-traumatic stress disorder threatens to develop. Complaints then occur again and again. The actual therapy is the responsibility of a psychologist or psychotherapist. They sometimes prescribe supplementary medication to support the self-healing powers. The goal of treatment is to prevent complications. In a pronounced form, acute stress disorder can lead to suicide. In such a case, hospitalization is necessary. Often, the close environment plays a role in how quickly recovery succeeds. Aftercare is not only aimed at making everyday life easier and ruling out complications. Rather, it is also about preventing a recurrence. Depending on the severity of the disease, the attending general practitioner makes an appointment for a re-evaluation. However, this is the exception after a final recovery. Instead, the patient is discharged as cured. If an acute stress disorder occurs due to a different event, he or she must begin therapy anew. Affected persons cannot prevent a recurrence. The body’s coping mechanism can fail at any time.
Here’s what you can do yourself
Acute stress reaction represents a temporary mental illness that can lead to limitations in social, work, and family life. Depending on how severe the acute stress reaction is, the person may be unable to work. In this case, for example, sick leave is possible through the family doctor. Affected persons who do not live alone can inform roommates or family members about the acute stress reaction. In this way, they can ask for support or consideration, for example. If possible, affected persons should clearly communicate whether and how family and friends can help them. Daily life with an acute stress reaction is often characterized by high levels of stress. Resources can help reduce this stress. These include social resources (such as family, friends, etc.) as well as practical distractions, exercise, and things that are good for the person in general. Although an acute stress reaction is a temporary condition, it can persist as post-traumatic stress disorder or promote other mental illnesses. For this reason, it is wise to monitor the acute stress reaction closely and seek professional help in a timely manner. Only a few affected persons find a place with a psychotherapist in private practice promptly.Therefore, in cases of severe symptoms or suicidality, it is reasonable to also consider inpatient treatment or to first consult the primary care physician.
