As I write this the wildfires in Los Angeles have displaced more than 100,000 people, and destroyed homes and communities. I’ve heard heartbreaking stories of older adults and people with disabilities unable to leave their homes and evacuate safely. While, at the same time, others have. Imagine you’re working with older survivors of this traumatic event.  They’re shaken, struggling to sleep, and can’t seem to stop replaying the event in their mind. You reassure them it’s natural to feel this way after such an ordeal, after all these reactions are a “normal reaction to an abnormal event.”

 

But what if these feelings don’t fade? What if weeks pass, and their fear starts to take over their daily life?

 

As mental health professionals, understanding the difference between acute distress that is normal after a trauma versus Acute Stress Disorder (ASD) and a longer-lasting condition like Post-Traumatic Stress Disorder (PTSD) is critical.

 

This is especially true when working with older adults, who may process trauma differently due to unique life experiences and challenges. Let’s explore what sets these conditions apart and how to support older clients in navigating the aftermath of trauma.

 

What Are Typical Distress Reactions to Traumatic Events?

Acute distress reactions are the body’s immediate, short-term response to a traumatic event. Think of it as your mind going into overdrive to process what just happened. Symptoms for older adults might include:

Emotional Reactions

• Anxious or fearful
• Overwhelmed by sadness
• Angry
• Guilty, even though he or she had no control over the disaster
• Heroic, able to do anything
• Disconnected, as though he or she doesn’t care about anything or anyone
• Numb, or unable to feel joy or sadness

Physical Reactions

• Having stomachaches or diarrhea
• Having headaches or other physical pain for no clear reason
• Feeling very hungry or not hungry at all
• Sweating or having chills for no physical reason
• Having tremors or muscle twitches
• Feeling jumpy or easily startled

 

Behavioral Reactions

• Having trouble falling asleep or staying asleep or sleeping too much
• Having increased or decreased energy and activity levels
• Feeling sad or crying a lot
• Using alcohol, tobacco, illegal drugs, or prescription medication in an attempt to reduce distressing feelings or to forget
• Having outbursts of anger
• Having difficulty accepting help or helping others
• Wanting to be alone most of the time and isolating him- or herself

 

Cognitive Reactions

• Having trouble remembering things
• Having trouble thinking clearly and concentrating
• Worrying a lot
• Having trouble making decisions
• Having trouble talking about what happened or listening to others talk about it

The Key Details of Distress We Expect to See After a Traumatic Event.

• Timing: ASR happens quickly—often within minutes or hours of the event—and typically resolves within a few days to a month.
• Purpose: It’s the body’s way of trying to cope with something unexpected and overwhelming. These are “normal responses to an abnormal event” and often do not require mental health intervention.

 

Acute Stress Disorder

Acute Stress Disorder is a mental health condition that can occur within the first month following exposure to a traumatic event. It is characterized by a range of symptoms that develop immediately after the trauma and last between 3 days and 4 weeks.

The diagnostic criteria for Acute Stress Disorder (ASD) according to the DSM-5-TR (Diagnostic and Statistical Manual of Mental Disorders, 5th edition, Text Revision) are as follows:

1. Exposure to a traumatic event (directly or indirectly)
2. The symptoms cause significant distress or impairment in social, occupational, or other important areas of functioning.
3. The symptoms are not attributable to the physiological effects of a substance or another medical condition.
4. Presence of 9 or more symptoms from the following 5 categories, lasting for 3 days to 1 month after the traumatic event:

Intrusion Symptoms

• Recurrent, involuntary, and intrusive distressing memories of the event
• Recurrent distressing dreams related to the event
• Dissociative reactions (e.g., flashbacks)
• Intense psychological or physiological distress when reminded of the event

Negative Mood

• Persistent inability to experience positive emotions

Dissociative Symptoms

• Altered sense of reality
• Inability to remember important aspects of the traumatic event

Avoidance Symptoms

• Efforts to avoid distressing memories, thoughts, or feelings associated with the event
• Efforts to avoid external reminders of the event

Arousal Symptoms

• Sleep disturbance
• Irritability or angry outbursts
• Hypervigilance
• Difficulty concentrating
• Exaggerated startle response

It’s important to note that ASD is diagnosed when symptoms last between 3 days and 1 month after the traumatic event. If symptoms persist beyond one month, a diagnosis of Post-Traumatic Stress Disorder (PTSD) should be considered instead

 

Post-Traumatic Stress Disorder

Post-Traumatic Stress Disorder, on the other hand, is a longer-term condition that can develop after experiencing or witnessing a traumatic event. PTSD is diagnosed when symptoms persist for more than one month and can sometimes emerge months or even years after the initial trauma.

According to the DSM-5-TR, the diagnostic criteria for Post-Traumatic Stress Disorder (PTSD) are as follows:

Criterion A: Stressor

Exposure to actual or threatened death, serious injury, or sexual violence in one or more of the following ways:

• Direct exposure to the traumatic event
• Witnessing the trauma as it occurred to someone else
• Learning about a close family member or friend being exposed to trauma
• Indirect exposure to aversive details of the trauma (e.g., first responders)

Criterion B: Intrusion Symptoms

Presence of one or more of the following intrusion symptoms associated with the traumatic event:

• Recurrent, involuntary, and intrusive distressing memories
• Recurrent distressing dreams related to the event
• Dissociative reactions (e.g., flashbacks)
• Intense or prolonged psychological distress at exposure to cues
• Marked physiological reactions to reminders of the event

Criterion C: Avoidance

Persistent avoidance of stimuli associated with the traumatic event, evidenced by one or both of:

• Avoidance of distressing memories, thoughts, or feelings about the trauma
• Avoidance of external reminders that arouse distressing memories, thoughts, or feelings

Criterion D: Negative Alterations in Cognitions and Mood

Negative alterations in cognitions and mood associated with the traumatic event, evidenced by two or more of:

• Inability to remember important aspects of the trauma
• Persistent and exaggerated negative beliefs about oneself, others, or the world
• Persistent, distorted cognitions about the cause or consequences of the trauma
• Persistent negative emotional state
• Markedly diminished interest in significant activities
• Feelings of detachment or estrangement from others
• Persistent inability to experience positive emotions

Criterion E: Alterations in Arousal and Reactivity

Marked alterations in arousal and reactivity associated with the traumatic event, evidenced by two or more of:

• Irritable behavior and angry outbursts
• Reckless or self-destructive behavior
• Hypervigilance
• Exaggerated startle response
• Problems with concentration
• Sleep disturbance

Criterion F: Duration

Persistence of symptoms in Criteria B, C, D, and E for more than one month

Criterion G: Functional Significance

The disturbance causes clinically significant distress or impairment in social, occupational, or other important areas of functioning

Criterion H: Exclusion

The disturbance is not attributable to the physiological effects of a substance or another medical conditionAdditionally, the DSM-5-TR includes two specifiers for PTSD:

1. With dissociative symptoms (depersonalization or derealization)
2. With delayed expression (full diagnostic criteria are not met until at least 6 months after the trauma)

 

 

Wrapping It All Up