Understanding Acute, Chronic, Immediate, and Delayed Traumatic Stress
In case you haven’t read my other posts on Post-Traumatic Stress (PTS), let me clarify that going through trauma doesn’t mean that someone has a “disorder” such as Post-Traumatic Stress Disorder (PTSD). Rather, PTS is simply a set of symptoms describing a specific form of stress. This article will cover the differences between Acute, Chronic, Immediate, and Delayed Traumatic Stress and single- and multiple-traumatic events.
Acute Traumatic Stress
Acute Traumatic Stress, sometimes called Acute Stress Disorder, occurs when symptoms last from a few days up to one to three months. To receive a diagnosis of Acute Stress Disorder, symptoms should not last longer than one month.
Symptoms of Acute Traumatic Stress
There are five basic categories of psychological symptoms:
- Intrusion – Intrusive memories of the traumatic event invade day-to-day consciousness and/or dreams (often referred to as “Flashbacks”)
- Negative Mood – Irritability, depression, anxiety, and/or confusion
- Dissociation – Your experience of life feels a bit detached, like time slowing down, walking around in a haze or fog, and even feeling like you are experiencing life from “outside of yourself”
- Avoidance – A pattern of avoiding thoughts, emotions, and people associated with the trauma. Drug and alcohol use may be one method of avoidance. Engaging in high-risk behaviors may be another avoidance behavior. Avoiding the location of the trauma is also extremely common.
- Arousal – Difficulty sleeping, feeling “amped up,” irritable, and having difficulty concentrating
Physical Symptoms of Acute Traumatic Stress
Physical symptoms are based on the activation of the sympathetic nervous system (the “fight-or-flight” response) and include:
- Increased heart rate
- Quick breathing
- Increased blood pressure
- Muscle tension
- Increased metabolism
These physical symptoms are part of the fight-or-flight survival mechanism (the sympathetic nervous system) and are designed to give your body the sudden boost of energy needed to either fight or flee. Immediately preceding either fight or flight, some people experience the freeze reflex.
Psychological and physical symptoms begin and may worsen after a traumatic event like violence, natural disaster, or even witnessing a traumatic event. It is the perception of severity that causes traumatic stress. Remember, traumatic stress can be triggered even if the event is not actually life-threatening because perception defines reality.
Chronic Traumatic Stress
Chronic Traumatic Stress occurs when PTS symptoms last more than three months. Generally speaking, when people refer to “PTSD,” or Post-Traumatic Stress Disorder, they are usually referring to chronic traumatic stress.
Symptoms of chronic traumatic stress
These are the same symptoms as the acute symptoms above, but persist longer and may increase to include panic attacks, more vivid flashbacks, and more avoidant behaviors like total or partial isolation.
Multiple and single traumatic events
Another important factor in understanding the different forms of traumatic stress is to differentiate between single and multiple traumatic events. Single traumatic events include natural disasters, accidents, and physical or sexual assaults. Multiple traumatic events are usually chronic, long-term, or recurring such as abuse or living in a war zone, and are more likely to lead to chronic or complex PTS(d).
Single traumatic events
When an individual experiences a single traumatic event, their acute stress symptoms will typically begin immediately or within a few hours of the event. If the symptoms persist beyond three months, the person may be experiencing chronic stress symptoms, or they may have developed PTSD.
Multiple traumatic events
When individuals experience multiple traumatic events, their symptoms may be more severe and longer lasting than those experiencing only one traumatic event. Multiple traumatic events can create a more complex form of post-traumatic stress known as complex post-traumatic stress disorder (C-PTSD). This condition may result from prolonged and repeated exposure to interpersonal trauma. People with traumatic childhood homes frequently report multiple traumatic events that lead to C-PTSD.
Please remember that we are all different and what triggers PTS, PTSD, or C-PTSD will be different. Some people are just wired to handle intense situations more easily. Having a pre-existing anxiety disorder may intensify the experience; however, some people who report early trauma say that they are calmer than most in intense situations…that it is almost like they were vaccinated against trauma. Very often, however, they also report being more easily upset by day-to-day stressors that don’t impact others.
Delayed traumatic stress
Most often, PTS symptoms will begin within a few hours of the traumatic event. However, sometimes the symptoms are delayed for weeks, months, or even years. This is Delayed Traumatic Stress.
Delayed post-traumatic stress, also known as delayed-onset post-traumatic stress disorder (PTSD), is a form of PTSD that occurs when symptoms do not manifest until months or even years after the traumatic event. This delay in symptoms can make it difficult for individuals to associate their current struggles with the original traumatic experience. Delayed PTSD can be caused by a variety of traumatic events such as sexual assault, combat, or natural disasters. Treatment for delayed PTSD typically involves therapy, medication, or a combination of both, and it is important for individuals to seek help from a mental health professional if they suspect they may be experiencing symptoms of delayed PTSD.
Treating Traumatic Stress
The effective treatment of traumatic stress can be achieved through the use of various evidence-based modalities. Mindfulness-based Cognitive-Behavioral therapy (CBT or m-CBT) has been shown to be effective for all types of traumatic stress. One specific type of CBT, Dialectical Behavior Therapy (DBT), teaches helpful strategies in four major areas: mindfulness training, emotional regulation, distress tolerance, and interpersonal effectiveness.
DBT & DBT: Dialectical Behavior Therapy and Cognitive Behavioral Therapy
Trauma recovery groups based on DBT and/or CBT have been found to be effective for many individuals. Critical Incident Stress Debriefing and Management, which is based on these concepts, is particularly effective when initiated within 48-72 hours of the traumatic event. However, seeking treatment after this time frame can still be beneficial.
EMDR: Eye Movement Desensitization and Reprocessing
Other highly effective modalities for treating traumatic stress include EMDR (Eye Movement Desensitization and Reprocessing), which involves syncing the two hemispheres of the brain to balance the processing of trauma, and Trauma-Focused Cognitive-Behavioral Therapy, a specific application of CBT that addresses the unique needs of trauma survivors.
Intensive therapy and Group therapy
The treatment of chronic post-traumatic stress disorder (PTSD) and complex post-traumatic stress disorder (C-PTSD) is similar to that of acute and individual-incident traumatic stress but may require longer or more intensive therapy. Survivors of intense child abuse, for example, may require different dynamics than those who survived a natural disaster such as a flood. Moving from individual therapy to group therapy is a common way to transition out of therapy.
Trauma affects individuals in different ways and can be classified into different forms of traumatic stress such as acute, chronic, immediate, and delayed traumatic stress. Additionally, single and multiple traumatic events create unique forms of trauma and may result in the development of different forms of post-traumatic stress. It’s important to seek professional help if you or someone you know is experiencing any form of traumatic stress.
*Updated July 13, 2023
Learn more about Counseling for Trauma and PTSD in Austin.
Jonathan F. Anderson, LPC-s has worked in the helping profession since he started college in 1990. After completing his Bachelor’s degree at the University of Texas, Austin in 1994, he attended the highly-regarded University of Minnesota to earn his Master’s degree in 1997. He is a Licensed Professional Counselor and is recognized as a Board Approved Supervisor by the State of Texas Board of Examiners of Professional Counselors. Jonathan has completed Level-2 of the Gottman Method of Couples Counseling, and in 1998 received training from the International Critical Incident Stress Foundation in Advanced Critical Incident Stress Management & Debriefing. To learn more about Jonathan’s practice, click here: Jonathan F. Anderson, LPC-s.