Why Employers Should Care About Acute Stress Disorder
Acute stress disorder (ASD) is a development of symptoms such as intrusion symptoms, negative moods, dissociative symptoms, avoidance symptoms, and arousal symptoms that occur following a traumatic event. [1] ASD occurs in approximately 6-50% of people that experience a traumatic event, depending on the severity of the event. [2] Untreated, ASD can lead to post-traumatic stress disorder which has a negative impact on a person’s daily living, personal and professional relationships, and overall productivity.
A person is diagnosed with acute stress disorder when they exhibit any nine out of a list of fourteen symptoms lasting anywhere from three days to one month. Some of the common symptoms prevalent in patients with ASD are as follows:
Intrusion symptoms: involuntary thoughts, memories, or dreams relating to the traumatic event
Negative mood: inability to experience positive emotions
Dissociative symptoms: the inability to remember an important part of the traumatic event
Avoidance symptoms: efforts are made to avoid external reminders of the traumatic event
Arousal symptoms: sleep disturbances or an exaggerated startle response
Treatment for ASD includes psychosocial intervention and/or pharmacologic treatment with medications. [3] The recommended psychosocial interventions are cognitive behavior therapy (CBT), exposure therapy or cognitive therapy. These psychosocial interventions are meant to help people with ASD recognize their triggers and find ways to manage and confront the stress experienced from their trauma.
Some of the medications for ASD include selective serotonin reuptake inhibitor (e.g. escitalopram, citalopram), antidepressants (e.g. imipramine, fluoxetine), and benzodiazepines (e.g. clonazepam, alprazolam). These medications are used to treat the symptoms associated with ASD such as anxiety (e.g. selective serotonin reuptake inhibitor, benzodiazepines) and pain (e.g. antidepressant). The goal of drug therapy is not only to treat the symptoms of ASD but are also targeted prevent the likely progression and possible development of post-traumatic stress disorder (PTSD), which occurs when symptoms last for longer than one month.
The cost of treatment for the lesser-known ASD is generally not covered under workers’ compensation, while coverage for the treatment of the potentially ensuing PTSD under workers’ compensation varies by state. [4] For example, Texas only covers PTSD under workers’ compensation for certain occupations such as first responders including firefighters, police officers, emergency medical technicians. In California, on the other hand, psychiatric injuries that have been determined to be caused by work is eligible for coverage under workers’ compensation. However, this coverage only applies to PTSD cases lasting longer than 6 months.The level of ambiguity causes confusion for payers on what to cover, frustration for clinicians, while patients are ultimately disenfranchised.
ASD impacts employees performance through reduced work productivity, lack of motivation, absentism, conflicts and accidents in the workplace. A person with ASD can also show signs of fear, sadness, anxiety, and dissociation, all of which can affect their work.
All of these factors do not only impact the employer financially, but they also present some downstream health and psychosocial impact on the entire workforce as well. Therefore, it is crucial for employers to provide adequate support and resources to employees, especially after a traumatic event at work. Resources such as support groups or counselors have been shown to reduce the incidence of ASD after a traumatic event. [5]
Contributors
Brielle Magno, PharmD Candidate
Sarah Cirildo, PharmD Candidate
Citations
DeFraia G. S. (2015). Psychological Trauma in the Workplace: Variation of Incident Severity among Industry Settings and between Recurring vs Isolated Incidents. The international journal of occupational and environmental medicine, 6(3), 155–168. https://doi.org/10.15171/ijoem.2015.545
Substance Abuse and Mental Health Services Administration. Impact of the DSM-IV to DSM-5 Changes on the National Survey on Drug Use and Health [Internet]. Rockville (MD): Substance Abuse and Mental Health Services Administration (US); 2016 Jun. 3, Mental Illness. Available from: https://www.ncbi.nlm.nih.gov/books/NBK519704/
Treatment of acute stress disorder in adults. UpToDate. (n.d.). Retrieved February 9, 2023, from https://www.uptodate.com/contents/treatment-of-acute-stress-disorder-in-adults#references
Patterson, J. (2022, November 9). Workers' compensation for PTSD: Which states offer benefits? Atlanta, GA Workers Compensation Lawyer Gerber & Holder Workers' Compensation Attorneys. Retrieved February 9, 2023, from https://www.gerberholderlaw.com/workers-comp-ptsd-by-state/
Kissen, D. (2022, July 14). How to prevent trauma from becoming PTSD. Anxiety. Retrieved February 23, 2023, from https://adaa.org/learn-from-us/from-the-experts/blog-posts/consumer/how-prevent-trauma-becoming-ptsd-0