Acute Stress Disorder (ASD) is a pathological condition that affects brains of individuals who have been involved in distressing events such as accidents. ASD is regarded as a traumatically induced fear condition that reveals through behaviors such as negative emotions, incompetence, and loss of self-wellbeing. Many patients of ASD acquire the condition through involvement in threatening events such as assault, rape, accident, kidnapping, natural calamities, and/or terror activities. This essay is based on Cynthia’s case that explains how she narrowly escaped death while driving on a freeway. She crashed into an 18-wheel truck that jack-knifed in front of her. According to the case, she did not experienced any injuries at the accident scene. However, she began experiencing some unique behaviors that required psychological therapy a few weeks after the incident. This essay elaborates on Cynthia’s ASD condition with a view of examining the appropriate treatment to correct the disorder using differential analysis.
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Symptoms for the Diagnosis of Cynthia’s case
To diagnose the patient correctly, the patient must experience or re-experience at least one or several distressing activities. Patients of ASD should also exhibit two symptoms such as hyperactive arousal, involuntary intrusive thoughts, avoidance, and/or numbing.
Involuntary Intrusive Thoughts
Involuntary intrusive thoughts are symptoms that are seen through reactions and prolonged emotions that remind the patient about the traumatic occurrence. For example, whenever Cynthia drives her car against oncoming trucks, she becomes sweaty and hyperventilated. Furthermore, every time she hears break sounds screeching in the nearby road, she remembers the accident.
Cynthia finds it difficult to concentrate on her activities. Furthermore, she has developed hyper-vigilance. In the case text, it is noted that from time to time Cynthia goes blank and feels unreal. She feels detached from the environment due to lack of concentration (Hobfoll, 1991).
Individuals with ASD disorder have a tendency of circumventing distressing situations. Avoidance can lead to further development of anxiety (March 1990). For instance, Cynthia has avoided driving on the freeway as she used to do before her fateful day. When she tried driving on the freeway after the incident, she tensed when she spotted a truck that was on the oncoming lane. The fact that she tensed reveals that she has developed avoidance behavior.
This symptom involves emotional actions that detach individuals from events that surround them. Numbing symptoms are characterized by behaviors such as depression, loss of interest in favorite activities, hopelessness, and reduced emotions (Hobfoll, 1991). For example, when Cynthia is playing with her child in a room, the screeching sound of a braking track on the nearby road steals her attention from the play and she unknowingly stops playing with her child (March, 1990).
Differential Diagnosis Approach
There are many similarities between ASD and Post Trauma Exposure Disorder (PTSD). However, the difference between ASD and PTSD is that ASD symptoms are diagnosed within a period of less than four weeks while PTSD symptoms can be diagnosed after a month (Kaplan & Sadock, 1995).
Many differential diagnostic tools can be applied to diagnose ASD. For instance, the DSM IV is an essential tool that is used to categorize individuals into various pathological groups. Although many researchers who diagnose ASD conditions have recommended the use of DSM IV, the method has some shortcomings that make it unreliable for diagnosis of the disorder. Some disorders have symptoms that are overlap with the symptoms of other disorders. For instance, differences that exist between ASD and PTSD are based on time but symptoms are the same (Cassano et al., 1999).
DSM IV Model Chosen
Vignette criteria should be used to assess a patient who is suspected to have ASD. This criterion involves examination of the patient’s premorbid global assessment function (GAF) score, determination of impairment, and determination of a causal link between the accident, psychological impairment, and stability of impairment. It also seeks to determine the impact of the distressing event on the person’s ability to complete daily activities and calculation of the patient’s loss because of the impairment (Lemma, 1996).
In the context of Cynthia’s case, a DSM IV model of diagnosis is suitable for assessing her condition due to its ability to detect consistent patterns of symptoms that include avoidance of thought about the accident, hopelessness or feelings of emptiness, on hearing the screeching sounds of braking vehicles, depression, traumatic stress, and numbing among others (Lemma, 1996). Therefore, a diagnosis of Cynthia’s ASD condition was realized.
Criteria for the Acute Stress Disorder as observed in Cynthia’s case
The criterion that was used to assess Cynthia’s condition entailed the use of a multipart survey questionnaire. A detailed self-assessment questionnaire that has been used to evaluate the level and nature of traumatic effects on Cynthia revealed that her condition is deteriorating. This situation is portrayed by her negative behavior towards sounds. In addition, when she tries to drive again, she panics upon seeing oncoming trucks (Lemma, 1996).
Shortfalls of DSM IV
The DSM IV diagnosis method has various shortfalls. Different conditions have similar symptoms. As a result, to make a decision on a particular therapy for a particular disorder is cumbersome. Consequently, the decisions theoretically made; hence, much experience and training is required. The DSM IV does not adequately separate the symptoms of different disorders. This situation leads to confusion since it therapy procedures cover many disorders. As a result, it does not show related symptoms. This state of affairs makes it difficult for psychiatrics to differentiate between the symptoms of different mental impairments (Cassano et al., 1999).
DSM IV also portrays cultural biasness. The manual has specific orientation to certain groups of people such as the Anglo-American culture. As a result, other people who are not of their cultural norms can easily be diagnosed for the wrong disorders; hence, they can be categorized as non-pathological. Furthermore, this model in only used for classification of disorders; thus, it cannot replace clinical practice for better treatment. Therefore, the DSM IV is more of a categorical system that is not as efficient the dimensional model (Cassano et al., 1999). Consequently, the DSM IV model is unreliable due to its inability to differentiate symptoms dimensionally, which can lead to clinical misjudgment.
Missing Information that was to be Included
According to Cynthia’s case, there is no provisional background information that includes her family or friends. Previous medical and psychological reports are also missing. Furthermore, no history of accidents that match with the actual one that Cynthia experienced (Lemma, 1996).
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Justification of the relationship between accidents and mental impairment based on the DSM IV model can be made since Cynthia was able to realize strange behaviors immediately after the accident. This situation has affected her emotionally. It has also made her experience hyper-arousal characteristics. Although a conclusive recommendation can be difficult to specify her exact condition due to inaccuracy of the model, its application can be of great importance in treatment of such cases.
American Psychiatric Association. (1994). Diagnostic and Statistical Manual of Mental Disorders. Washington, DC: American Psychiatric Association.
Cassano, G., Dell’Osso, L., Frank E., Minati, M., Fagiolini, A., & Shear, K. (1999). The bipolar spectrum: a clinical reality in search of diagnostic criteria and an assessment methodology. J Affect Disord, 54(1), 319-28.
Hobfoll SE. (1991).Traumatic stress: A theory based on rapid loss of resources. Anxiety Res, 4(1),187-97.
Kaplan H., & Sadock, B. (1995). Comprehensive textbook of psychiatry. Baltimore: Willians & Wilkins.
Lemma, A. (1996). Introduction to psychopathology. Thousand Oaks, CA: Sage Publication Ltd.
March, J. (1990). The nosology of posttraumatic stress disorder. J Anxiety Disord, 4(1), 61-823.