Classification of Acute Stress Disorder

The diagnosis of acute stress disorder (ASD) was originally introduced in the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV) to identify survivors soon after a trauma who were likely to develop posttraumatic stress disorder (PTSD). However, despite demonstrating acceptable predictive power, subsequent research often failed to display high rates of sensitivity or specificity for ASD predicting PTSD. This led researchers to question the utility of the diagnosis and ultimately led to a revision of the diagnosis in the fifth edition of DSM. The updated ASD diagnosis was intended to primarily promote access to healthcare services following a traumatic event, and symptoms were not selected with the aim of predicting likelihood of one developing PTSD. Ultimately, the DSM-5 ASD criteria align more closely with PTSD symptoms without an emphasis on dissociative symptoms (as was true of the DSM-IV). This chapter summarizes the development of the ASD criteria/diagnosis and evaluates the utility of the reconceptualized diagnosis for both clinicians and researchers.