PTSD & Acute Stress Disorder
What is Acute Stress Disorder?
Acute Stress Disorder (ASD) is the mind and body’s immediate response to a traumatic event. ASD is diagnosed when symptoms develop between three days and four weeks after a traumatic experience. During this period, you may experience flashbacks, intrusive thoughts, nightmares, dissociation, emotional numbness, hypervigilance, difficulty sleeping, or a sense of unreality, as though what happened is not quite real or you are watching your own life from a distance. These are normal reactions to a traumatic experience. For many people, these responses settle naturally as the nervous system processes the event. But when they do not settle, and instead persist or worsen beyond four weeks, the condition may have developed into PTSD.
What is the difference between Acute Stress Disorder and PTSD?
The core difference is time. ASD describes the acute response that develops within the first four weeks following a traumatic event. PTSD is diagnosed when those symptoms continue beyond four weeks, or when they worsen over time rather than resolving. In ASD, the brain is still actively attempting to process what happened, and the window for recovery is often more accessible. In PTSD, the traumatic memory has become consolidated in a fragmented, rigid form, and the nervous system has settled into a chronic state of alert that it can no longer switch off on its own.
It is also important to know that not everyone who develops PTSD experiences ASD first. Some people appear to cope well in the immediate aftermath, only for symptoms to emerge weeks, months, or sometimes years later.
What is PTSD?
Post-traumatic stress disorder develops when the mind and body remain stuck in a state of threat long after a traumatic event has passed. The nervous system, which mobilised to protect during the original experience, is not been able to return to its baseline. The symptoms that follow can feel bewildering and exhausting, but they are, at their core, the nervous system continuing keep a person safe from danger it believes is still present.
PTSD can develop after a wide range of experiences, including physical or sexual assault, serious accidents, witnessing violence, military combat, natural disasters, complicated childbirth, and sudden bereavement.
What are the signs of PTSD?
• Reliving the event through flashbacks, intrusive memories, or nightmares that feel as vivid and distressing as the original experience
• Physical reactions when reminded of the trauma, including a pounding heart, sweating, nausea, or a sudden sense of panic
• Avoiding people, places, or situations that bring the experience to mind
• Feeling constantly on edge, hypervigilant, or easily startled
• Emotional numbness, a sense of disconnection from yourself or the people around you
• Difficulty sleeping, concentrating, or being present in daily life
• Shame, guilt, self-blame, or a persistent feeling that the world is no longer safe
• Irritability, anger, or mood changes that feel out of proportion to the situation
• Loss of interest in relationships, social contact, or activities that previously mattered to you
• Substance use as a way of managing unbearable feelings
What is Complex PTSD?
Complex PTSD develops from prolonged or repeated trauma, particularly when it occurs in childhood or within relationships where you were dependent on the person causing the harm. This includes sustained physical, sexual, or emotional abuse, chronic neglect, and growing up in an environment of fear or unpredictability.
Where PTSD from a single event primarily produces fear-based symptoms, Complex PTSD affects something broader: your sense of who you are, your capacity to regulate your emotions, your ability to trust, and how you relate to others. Many people with Complex PTSD do not recognise themselves as trauma survivors because their symptoms do not match the flashback-and-nightmare picture most commonly associated with PTSD. Instead, they may experience chronic emptiness, persistent shame, difficulty maintaining relationships, a fragmented sense of identity, or patterns of self-destructive behaviour that have been present for so long they feel like personality rather than symptoms.
What are the recommended Approaches for PTSD?
Trauma-focused CBT begins by normalising your symptoms, understanding them as predictable responses rather than signs of failure. The work then focuses on reclaiming the parts of your life that PTSD has caused you to withdraw from, processing the traumatic memory through reliving and narrative techniques so it can be stored as a past event rather than an ongoing threat, and restructuring the distorted meanings that became attached to the experience, such as self-blame or a belief that the world is permanently unsafe. Alongside this, we identify the triggers that activate your symptoms in daily life, work to stop the avoidance and safety behaviours that maintain the condition, and where appropriate, revisit the context of the trauma as part of reclaiming your sense of agency.
Narrative Exposure Therapy (NET) is an evidence-based approach for people who have experienced multiple or prolonged traumatic events. Rather than focusing on a single incident, NET works with your entire life story, constructing a chronological narrative that places traumatic experiences alongside the positive moments that also shaped who you are. Traumatic memories are often stored as fragments with no anchor in time, which is why they can feel as though they are happening now. NET reconnects these fragments to their context, transforming them into a coherent part of your life story rather than intrusive, overwhelming experiences
Can therapy help me?
Yes. Whether you are in the early days following a traumatic event or living with symptoms that have been present for years, recovery is possible. The brain’s capacity to reorganise and repair is substantial, and the evidence for recovery from both ASD and PTSD is well-documented. You do not need a formal diagnosis to seek help. If something happened to you that continues to affect how you feel, how you relate to others, or how you live your life, that is reason enough. I offer a free initial consultation where we can discuss what you are experiencing and whether my approach feels right for you. You can book a consultation via my Contact page.