Acute Stress Disorder (ASD), as defined in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), emerges in response to a person being exposed to a traumatic event, typically involving an actual or threatened death, serious injury, or sexual violation. The onset of ASD occurs within three days to four weeks following exposure to the traumatic event. Core features of this disorder include intrusive symptoms where individuals may have recurring, involuntary, and distressing memories, dreams, or flashbacks of the event. A persistent negative mood is also daily, with individuals experiencing emotions such as fear, horror, anger, guilt, or shame. Dissociation, a notable characteristic of ASD, manifests as a sense of unreality concerning one's surroundings or oneself or an inability to remember crucial aspects of the traumatic event, known as dissociative amnesia.

Moreover, individuals may exhibit avoidance behaviors, steering clear of reminders of the traumatic event, such as places, people, conversations, or any triggers that might evoke trauma memories. Symptoms of arousal are also prevalent, encompassing sleep disturbances, irritable behavior, hypervigilance, or concentration problems, with individuals being easily startled. Alterations in arousal and reactivity might lead to irritable behavior, aggressive outbursts, or self-destructive or reckless behavior. Functional impairment is often observed as there could be significant distress or impairment in social, occupational, or other crucial areas of functioning. Individuals with Acute Stress Disorder may appear visibly distressed, anxious, or detached in a clinical or social setting. They may have trouble focusing or concentrating, exhibit a reduced awareness of their surroundings, or appear dazed — a reflection of the dissociative symptoms associated with ASD. This disorder significantly impacts a person’s social interactions, work capacity, and other vital areas of functioning, highlighting the importance of providing appropriate support and treatment to individuals grappling with the aftermath of traumatic incidents.

Diagnostic Criteria

The diagnostic criteria for Acute Stress Disorder (ASD), as outlined in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), highlight the necessity of exposure to traumatic events as a precipitating factor (American Psychiatric Association, 2013). Traumatic events usually involve actual or threatened death, serious injury, or sexual violation. The individual's response to the traumatic incident involves intense fear, helplessness, or horror. After exposure, individuals manifest symptoms in various clusters, such as intrusive symptoms, mood alterations, dissociative symptoms, avoidance behaviors, and arousal symptoms. For a diagnosis of ASD, these symptoms should manifest within three days to four weeks following the traumatic event.

Intrusive symptoms include recurrent, involuntary, and intrusive distressing memories of the traumatic event, often leading to significant distress or impairment in major areas of functioning. The literature often highlights the detrimental impact of intrusive symptoms on individuals' daily functioning (Bryant et al., 2011). Moreover, persistent negative mood like fear, horror, anger, guilt, or shame is commonly observed. Dissociative symptoms are also a significant aspect of ASD, with individuals often experiencing a sense of unreality regarding their surroundings or themselves or might not remember critical elements of the traumatic event (dissociative amnesia).

Avoidance of reminders of the traumatic event and heightened arousal, such as sleep disturbances, irritable behavior, hypervigilance, or problems with concentration, are also part of the diagnostic criteria for ASD. Individuals often exhibit a marked avoidance of stimuli that remind them of the traumatic event. This behavior is believed to be a coping mechanism to manage overwhelming emotions associated with the traumatic memory (Lancaster et al., 2014).

Functional impairment is another critical factor for the diagnosis, as individuals often experience significant distress or impairment in social, occupational, or other important areas of functioning. This aspect of ASD is vital as it underscores the need for prompt intervention to alleviate symptoms and improve functioning (Bryant et al., 2011).

The Impacts

Acute Stress Disorder (ASD) impacts a person in many ways, often pervading various domains of an individual’s life. One of the pronounced effects is on an individual’s mental health. Those with ASD often exhibit intrusive and disruptive symptoms in their daily lives, such as recurring distressing memories, flashbacks, or even dissociation, which can be severely disturbing (Bryant, 2011). The emotional toll is considerable, with individuals commonly experiencing persistent negative mood states, including fear, horror, anger, guilt, or shame (American Psychiatric Association, 2013). The recurrent intrusive memories and heightened arousal symptoms can also lead to sleep disturbances, which, in turn, may exacerbate other symptoms of ASD (Bryant et al., 1998).

ASD also significantly impacts an individual’s social and occupational functioning. The avoidance symptoms, such as removing reminders of the traumatic event, can lead to social withdrawal and impairments in occupational functioning. Individuals may find it challenging to carry out their work responsibilities or maintain social relationships, leading to isolation and potentially contributing to longer-term mental health issues like depression and anxiety disorders (Shalev et al., 1998).

Moreover, the symptoms of ASD may also adversely affect individuals’ physical health. The chronic arousal and hypervigilance associated with ASD can lead to physical symptoms like fatigue and cardiovascular issues over time (Buckley et al., 2000). Individuals with ASD may also be at an increased risk for developing Post Traumatic Stress Disorder (PTSD) if left untreated (Bryant, 2011).

Furthermore, the economic burden of ASD should not be overlooked. Individuals may face challenges in maintaining employment or require extensive medical and psychological interventions, which can be financially draining (Kilpatrick et al., 2013). The overarching implications of ASD underscore the necessity for early identification and intervention to mitigate these adverse outcomes and promote recovery and resilience in affected individuals.

The Etiology (Origins and Causes)

The etiology of Acute Stress Disorder (ASD) is an intricate interplay of environmental, biological, and psychological factors. One primary factor in the onset of ASD is exposure to a traumatic event, which is the core of ASD’s etiology. The nature, duration, and severity of the trauma significantly contribute to the development of ASD, with events perceived as life-threatening or posing severe physical harm being primary triggers (American Psychiatric Association, 2013).

On a biological level, neurobiological processes play a pivotal role. The dysregulation in the hypothalamic-pituitary-adrenal (HPA) axis, crucial in stress response, has been closely associated with the onset of ASD. Elevated cortisol levels, typically indicative of heightened stress, have also been found to play a significant part in the development of ASD (Yehuda, 2002). Additionally, there is a genetic aspect to consider. Studies have hinted at a genetic predisposition to ASD, suggesting a hereditary component in the susceptibility to and manifestation of stress-related disorders (Cornelis et al., 2010).

Psychologically, individuals with pre-existing mental health conditions or those who have had previous traumatic experiences may be at an elevated risk for developing ASD (Bryant & Guthrie, 2005). Cognitive processes also significantly contribute to the onset of ASD. The individual's appraisal of the traumatic event and coping capacity in extreme stress are vital factors influencing ASD's development (Ehlers & Clark, 2000).

Environmental factors, including the availability and adequacy of social support post-trauma, are significant determinants of ASD. Lack of social support has been identified as a risk factor for ASD, and conversely, supportive environments may mitigate the trauma’s impact, reducing the likelihood of developing ASD (Ozer et al., 2003).

Furthermore, sociodemographic factors such as age, gender, and socioeconomic status can also influence an individual’s susceptibility to ASD (Brewin et al., 2000). These factors may alter the perception of the traumatic event or the availability of resources to cope with the event, thus impacting the likelihood of ASD development.

In sum, the origins and causes of ASD are multifactorial, with each factor potentially playing a contributory role. Understanding this complex etiology is vital for developing effective prevention and treatment strategies for ASD.

Comorbidities

Comorbidities refer to the simultaneous presence of two or more disorders in an individual. In the context of Acute Stress Disorder (ASD), comorbid conditions are not uncommon, and their presence can complicate the clinical picture, prognosis, and treatment. Here is a detailed look at the comorbidities commonly associated with ASD:

• Post-Traumatic Stress Disorder (PTSD): One of the most significant concerns for individuals diagnosed with ASD is the risk of developing PTSD. While ASD and PTSD share many symptomatological overlaps, ASD is short-term, emerging immediately after the traumatic event and lasting up to four weeks. If the symptoms persist beyond this period, there is an increased risk of the individual developing PTSD (American Psychiatric Association, 2013).
• Depressive Disorders: Individuals with ASD frequently exhibit symptoms of depression. The emotional turmoil resulting from trauma can lead to feelings of hopelessness, persistent sadness, and even suicidal ideation. Major Depressive Disorder (MDD) is commonly observed in tandem with ASD (Bryant et al., 2011).
• Anxiety Disorders: Apart from PTSD, other anxiety disorders can coexist with ASD. This includes Generalized Anxiety Disorder (GAD), Panic Disorder, and specific phobias, especially if they are related to the trauma (Harvey & Bryant, 1998).
• Substance Use Disorders: To cope with the distressing symptoms of ASD, some individuals may resort to alcohol or drugs, leading to substance use disorders. The use of substances can be an attempt to self-medicate or escape from the traumatic memories and associated distress (Stewart, 1996).
• Dissociative Disorders: While dissociation is a crucial symptom of ASD, prolonged and severe dissociative symptoms might lead to the development of dissociative disorders. This could manifest as Depersonalization/Derealization Disorder or other related conditions (Briere et al., 2005).
• Somatic Symptom Disorders: Without a clear medical cause, physical complaints might emerge or intensify following trauma. This could be due to the heightened arousal and hypervigilance associated with ASD, leading the individual to be more attuned to physical sensations and misinterpret them as indicative of a medical condition (Roelofs & Spinhoven, 2007).

The presence of comorbidities with ASD underscores the necessity of comprehensive assessment and multidimensional treatment approaches. Recognizing and addressing these associated conditions can significantly improve the prognosis and overall well-being of the affected individuals.

Risk Factors

The development of Acute Stress Disorder (ASD) after exposure to a traumatic event is contingent on many risk factors broadly categorized into pre-trauma, peri-trauma, and post-trauma domains. Understanding these risk factors is pivotal for identifying individuals at heightened risk, thus enabling timely intervention and support.

In pre-trauma risk factors, prior psychiatric history is a significant predictor. Individuals with a history of psychiatric disorders, notably anxiety or mood disorders, are at a heightened risk for developing ASD following a traumatic encounter (Brewin et al., 2000). Additionally, previous exposure to traumatic events escalates the likelihood of ASD manifestation upon facing subsequent trauma (Ozer et al., 2003). The resilience factor, or rather the lack thereof, also plays a crucial role; individuals with lower levels of psychological resilience are more susceptible to ASD, demonstrating a notable vulnerability in the face of adversity (Luthar et al., 2000).

Transitioning to peri-trauma risk factors, the traumatic event’s severity and nature significantly dictate the likelihood of ASD development. Events perceived as more severe or life-threatening are associated with higher incidences of ASD (American Psychiatric Association, 2013). Moreover, an individual’s perception of life threat and the level of fear experienced during the event are strongly linked to ASD onset (Brewin et al., 2000). A potent predictor of ASD is dissociation during trauma, which often mediates the relationship between acute panic and chronic post-traumatic stress disorder (Bryant et al., 2011).

In the post-trauma phase, the availability and adequacy of social support emerge as significant risk factors. A lack of social support post-trauma considerably exacerbates the risk of ASD (Ozer et al., 2003). Additionally, encountering supplementary stressors after the traumatic event can aggravate the stress response, thereby contributing to the onset of ASD (Norris & Slone, 2013).

These risk factors engage in a complex interplay, often having a cumulative impact that renders some individuals particularly vulnerable to ASD post-trauma. The meticulous identification and mitigation of these risk factors can significantly thwart the onset of ASD, mitigating its adverse ramifications on an individual’s psychological well-being. By comprehensively understanding these risk factors, mental health professionals can devise more effective preventive and intervention strategies, paving the way for better mental health outcomes post-trauma.

Case Study

Introduction: Acute Stress Disorder (ASD) is a psychological condition that may arise following exposure to a traumatic event, often characterized by intrusive memories, negative mood, dissociation, avoidance, and arousal. The following case study elaborates on the experience of a 28-year-old female, Jane Doe, who developed ASD after a severe car accident.

Case Presentation: Jane, a 28-year-old marketing executive with no prior psychiatric history, was involved in a severe car accident that resulted in multiple fatalities. Although she survived with minor physical injuries, she witnessed the death of other passengers at the scene. In the immediate aftermath, she started experiencing intense, distressing, and intrusive memories of the event. She also began avoiding routes that reminded her of the accident, exhibited exaggerated startle responses to loud noises, and had trouble sleeping.

Two weeks post-accident, Jane sought help from a mental health professional as her symptoms interfered with her daily functioning. She reported experiencing dissociative episodes where she felt detached from her surroundings and persistent feelings of sadness and hopelessness.

Assessment: On assessment, using the Acute Stress Disorder Scale (ASDS), Jane scored significantly high, indicating a precise diagnosis of ASD. A structured clinical interview confirmed the absence of prior psychiatric conditions and substance abuse. The severity of her symptoms, along with the dissociation and the distress, were notably impacting her work and interpersonal relationships.

Intervention: A cognitive-behavioral therapy (CBT) based intervention focusing on trauma-focused cognitive restructuring, exposure therapy, and relaxation training was initiated over six weeks. Jane was also enrolled in a support group for individuals who had survived traumatic events.

Outcome: Throughout treatment, Jane significantly reduced her ASD symptoms. Her intrusive memories decreased, and her avoidance behavior markedly improved. While she continued to experience some mild anxiety, especially while driving, her sleep normalized, and her interpersonal relationships improved. She reported feeling more hopeful and was able to return to her regular work routine.

Discussion: This case underscores the debilitating impact of ASD post-trauma and the importance of early intervention. CBT and peer support showed a significant positive impact, aiding Jane's recovery. Early identification and treatment are crucial for preventing the transition of ASD to Post-traumatic Stress Disorder (PTSD) and fostering resilience and adaptive coping in individuals post-trauma.

Conclusion: Timely mental health intervention is crucial for individuals exhibiting signs of ASD following traumatic events. A multidisciplinary approach encompassing CBT and peer support can significantly improve the prognosis and enhance the quality of life for individuals with ASD.

Recent Psychology Research Findings

The Acute Stress Disorder Scale (ASDS) remains a crucial tool in trauma psychology, allowing for the swift assessment and identification of Acute Stress Disorder (ASD) following individuals' exposure to traumatic events. The meticulous structure of the ASDS, which encompasses various symptom clusters of ASD, is a testament to the rigorous conceptual framework underpinning this assessment tool. Recent research endeavors have extensively probed the psychometric properties of the ASDS, shedding light on its diagnostic precision and utility across diverse clinical settings. A seminal study by Bryant, Moulds, and Guthrie (2000) laid the groundwork by establishing the solid internal consistency and convergent validity of the ASDS. Their findings reverberated through the scholarly community, underscoring the ASDS's robustness as a diagnostic tool.

Furthermore, researchers have turned their lens toward the cross-cultural applicability of the ASDS. Freedman et al. (2015) embarked on an exploratory journey to unravel the cultural nuances that might influence the ASDS’s diagnostic accuracy. Their insights have been instrumental in propelling discussions around potential modifications to the ASDS, thereby amplifying its cultural competence and relevance across a broader spectrum of populations. This stream of research has substantially enriched our understanding of the multifaceted nature of ASD and the imperative for culturally sensitive diagnostic tools.

Moreover, the prognostic utility of the ASDS has been a focal point of scholarly inquiry. Bryant et al. (2015) delved into the ASDS’s ability to foretell the onset of Post-Traumatic Stress Disorder (PTSD), unveiling its remarkable predictive validity. Their findings echo the pivotal role of early intervention and underscore the ASDS’s value in forewarning clinicians of potential PTSD development, thus allowing for timely therapeutic interventions.

Venturing into the practical domain, Shalev et al. (2019) explored the application of ASDS in primary care and emergency departments. Their work illuminates the critical nexus between early ASD identification and prompt intervention, potentially thwarting the transition to chronic PTSD. This research has significantly broadened the scope of ASDS application, offering a glimpse into its profound impact in real-world clinical settings.

Furthermore, the burgeoning field of technology has intersected with ASDS research. Scholars are investigating digital platforms for administering the ASDS, which heralds a paradigm shift toward leveraging technology for streamlined, accessible, trauma-informed care. This burgeoning area holds promise for enhancing the ASDS’s reach and efficacy, providing a robust framework for assessing and addressing ASD in the digital age.

The corpus of research surrounding the ASDS has markedly expanded our understanding of ASD's diagnostic landscape, providing invaluable insights into early intervention strategies, cross-cultural applicability, and technology integration in trauma care. The ASDS continues to be a linchpin in ASD research and practice, and its evolution reflects the dynamic, multidimensional nature of trauma psychology.

Treatment and Interventions

Treating Acute Stress Disorder (ASD) necessitates a nuanced understanding of trauma and its impact on the individual. Empirical evidence has illuminated several practical treatment approaches that aim to ameliorate symptoms and prevent the progression to Post-Traumatic Stress Disorder (PTSD). One of the most researched and validated treatments is Cognitive Behavioral Therapy (CBT). Research demonstrates that trauma-focused CBT, encompassing interventions such as cognitive restructuring and exposure therapy, can significantly reduce symptoms of ASD and lower the risk of developing PTSD (Bryant et al., 1998). Cognitive restructuring aims at identifying and challenging maladaptive thought patterns, while exposure therapy encourages individuals to confront and process traumatic memories.

Eye Movement Desensitization and Reprocessing (EMDR) is another evidence-based intervention with growing empirical support for treating ASD. This therapeutic modality involves processing distressing memories from the trauma while engaging in guided eye movements (Shapiro, 2001). It has shown promise in alleviating distress and promoting adaptive coping.

Pharmacotherapy may also support managing severe symptoms, although it is not typically a first-line treatment. Medications such as SSRIs or benzodiazepines may be used temporarily under strict medical supervision to manage severe anxiety or insomnia (Robert et al., 2012).

Mindfulness-based interventions, including Mindfulness-Based Stress Reduction (MBSR) and Mindfulness-Based Cognitive Therapy (MBCT), have also demonstrated potential in reducing symptoms of ASD by promoting present-moment awareness and reducing negative rumination (Vøllestad et al., 2012).

Lastly, psychoeducation about trauma and its effects can immensely benefit individuals with ASD. This approach helps normalize their reactions and provides tools for managing symptoms. Additionally, peer support groups can offer a sense of community and understanding that may be healing in the aftermath of trauma.

Furthermore, early intervention is crucial as it can prevent the transition from ASD to PTSD. Prompt identification and treatment of ASD through structured clinical assessments can significantly enhance prognosis and quality of life for individuals with ASD.

Implications if Untreated

When Acute Stress Disorder (ASD) goes untreated, it holds significant implications for an individual's mental, emotional, and physical well-being. One of the most concerning outcomes is the potential progression of ASD to Post-Traumatic Stress Disorder (PTSD), a more chronic condition that can profoundly disrupt a person's life. The transition from ASD to PTSD can lead to more entrenched symptoms and a need for more extensive, longer-term treatment (Bryant, 2011). Besides, untreated ASD can also exacerbate existing mental health conditions, making the therapeutic process more complex.

The negative ramifications extend beyond psychological distress; individuals with untreated ASD may experience many physical health issues. Research has elucidated a connection between chronic stress conditions and cardiovascular diseases, sleep disorders, and a weakened immune system (Sareen, 2014). The constant state of heightened arousal and stress can strain the body, potentially leading to many long-term health concerns.

Furthermore, untreated ASD can strain interpersonal relationships and disrupt social functioning. Individuals may find it difficult to communicate or relate to others, resulting in social withdrawal and isolation (Pietrzak et al., 2011). Moreover, the impact on occupational functioning cannot be overlooked. The debilitating symptoms of ASD may impair concentration, decision-making abilities, and overall work performance, possibly leading to job loss and financial instability.

Lastly, untreated ASD carries a substantial economic burden for the affected individuals, the healthcare system, and society. The costs associated with managing the chronic repercussions of untreated ASD, including medical care, psychiatric treatment, and lost productivity, are considerable (Amaya-Jackson et al., 1999). In sum, the lack of timely intervention for ASD can create a ripple effect, touching every facet of an individual's life and having broader societal implications.

Summary

In the face of adversity and the profound effects of Acute Stress Disorder, there emerges a beacon of hope. It is heartening to recognize that the world of mental health has made significant strides in understanding, addressing, and treating ASD. Armed with evidence-based approaches and treatments, many individuals who grapple with the disorder have found a path to recovery, reclaiming their lives and embracing a future filled with potential.

The very essence of ASD, being an immediate response to trauma, underscores the inherent resilience in many affected individuals. This resilience can be harnessed, cultivated, and strengthened with the right interventions. The advancements in trauma-focused Cognitive Behavioral Therapy, EMDR, and mindfulness practices offer healing and empowerment, allowing individuals to process their trauma, reclaim their narratives, and move forward with strength and determination.

Furthermore, the societal perception of ASD and trauma-related disorders has witnessed a transformative shift. No longer shrouded in stigma, there is a growing acceptance and understanding of ASD as a genuine mental health concern. This compassionate embrace by society means that individuals are more likely to seek help, share their stories, and find communal strength in collective healing.

The journey through ASD, while undoubtedly challenging, need not be undertaken alone. A robust support system of mental health professionals, loved ones, and communities stands ready to assist, uplift, and champion the cause of every individual. The ever-evolving realm of research and therapeutic practice continually seeks innovative ways to enhance recovery processes, ensuring that hope is not just a distant dream but a tangible reality.

Hope is the most potent antidote in trauma and its aftermath. With every story of recovery, every breakthrough in treatment, and every hand extended in support, we are reminded that the human spirit is indomitable. For those confronting ASD, there is a promise of brighter days ahead and a world that stands with them, ready to journey together toward a horizon of hope, healing, and renewed possibilities.

References

Amaya-Jackson, L., Davidson, J. R. T., Hughes, D. C., Swartz, M., Reynolds, V., George, L. K., & Blazer, D. G. (1999). Functional impairment and utilization of services associated with posttraumatic stress in the community. Journal of Traumatic Stress, 12(4), 709-724.

Brewin, C. R., Andrews, B., & Valentine, J. D. (2000). Meta-analysis of risk factors for posttraumatic stress disorder in trauma-exposed adults. Journal of Consulting and Clinical Psychology, 68(5), 748-766.

Briere, J., Scott, C., & Weathers, F. (2005). Peritraumatic and persistent dissociation in the presumed etiology of PTSD. American Journal of Psychiatry, 162(12), 2295-2301.

Bryant, R. A. (2011). Acute stress disorder as a predictor of posttraumatic stress disorder: A systematic review. The Journal of Clinical Psychiatry, 72(2), 233-239.

Bryant, R. A., & Guthrie, R. M. (2005). Maladaptive appraisals as a risk factor for posttraumatic stress: A study of trainee firefighters. Psychological Science, 16(10), 749-752.

Bryant, R. A., Brooks, R., Silove, D., Creamer, M., O'Donnell, M., & McFarlane, A. C. (2011). Peritraumatic dissociation mediates the relationship between acute panic and chronic posttraumatic stress disorder. Behaviour Research and Therapy, 49(5), 346-351.

Bryant, R. A., Creamer, M., O'Donnell, M., Silove, D., & McFarlane, A. C. (2015). The capacity of acute stress disorder to predict posttraumatic psychiatric disorders. Journal of Psychiatric Research, 63, 22-26.

Bryant, R. A., Friedman, M. J., Spiegel, D., Ursano, R., & Strain, J. (2011). A review of acute stress disorder in DSM-5. Depression and Anxiety, 28(9), 802-817.

Bryant, R. A., Harvey, A. G., Dang, S. T., Sackville, T., & Basten, C. (1998). Treatment of acute stress disorder: A comparison of cognitive-behavioral therapy and supportive counseling. Journal of Consulting and Clinical Psychology, 66(5), 862-866.

Bryant, R. A., Harvey, A. G., Dang, S. T., Sackville, T., & Basten, C. (1998). Treatment of acute stress disorder: A comparison of cognitive-behavioral therapy and supportive counseling. Journal of Consulting and Clinical Psychology, 66(5), 862-866.

Bryant, R. A., Moulds, M. L., & Guthrie, R. M. (2000). Acute Stress Disorder Scale: A self-report measure of acute stress disorder. Psychological Assessment, 12(1), 61-68.

Bryant, R. A., O'Donnell, M. L., Creamer, M., McFarlane, A. C., & Silove, D. (2011). The psychiatric sequelae of traumatic injury. American Journal of Psychiatry, 168(3), 312-320.

Buckley, T. C., Blanchard, E. B., & Neill, W. T. (2000). Information processing and PTSD: A review of the empirical literature. Clinical Psychology Review, 20(8), 1041-1065.

Cornelis, M. C., Nugent, N. R., Amstadter, A. B., & Koenen, K. C. (2010). Genetics of post-traumatic stress disorder: Review and recommendations for genome-wide association studies. Current Psychiatry Reports, 12(4), 313-326.

Ehlers, A., & Clark, D. M. (2000). A cognitive model of posttraumatic stress disorder. Behaviour Research and Therapy, 38(4), 319-345.

Freedman, S. A., Gilad, M., Ankri, Y., Roziner, I., & Shalev, A. Y. (2015). Social relationship satisfaction and PTSD: Which is the chicken and which is the egg? European Journal of Psychotraumatology, 6(1), 28864.

Harvey, A. G., & Bryant, R. A. (1998). The relationship between acute stress disorder and posttraumatic stress disorder: A prospective evaluation of motor vehicle accident survivors. Journal of Consulting and Clinical Psychology, 66(3), 507-512.

Kilpatrick, D. G., Resnick, H. S., Milanak, M. E., Miller, M. W., Keyes, K. M., & Friedman, M. J. (2013). National estimates of exposure to traumatic events and PTSD prevalence using DSM‐IV and DSM‐5 criteria. Journal of Traumatic Stress, 26(5), 537-547.

Lancaster, C. L., Melka, S. E., & Rodriguez, B. F. (2014). An examination of the differential effects of the experience of DSM-IV defined traumatic events and life stressors. Journal of Anxiety Disorders, 28(6), 547-555.

Luthar, S. S., Cicchetti, D., & Becker, B. (2000). The construct of resilience: A critical evaluation and guidelines for future work. Child Development, 71(3), 543-562.

Norris, F. H., & Slone, L. B. (2013). Understanding research on the epidemiology of trauma and PTSD. PTSD Research Quarterly, 24(2-3), 1-13.

Ozer, E. J., Best, S. R., Lipsey, T. L., & Weiss, D. S. (2003). Predictors of posttraumatic stress disorder and symptoms in adults: A meta-analysis. Psychological Bulletin, 129(1), 52-73.

Pietrzak, R. H., Goldstein, R. B., Southwick, S. M., & Grant, B. F. (2011). Prevalence and Axis I comorbidity of full and partial posttraumatic stress disorder in the United States: Results from Wave 2 of the National Epidemiologic Survey on Alcohol and Related Conditions. Journal of Anxiety Disorders, 25(3), 456-465.

Robert, S., Rosenheck, R. A., Desai, R., & Stefanovics, E. (2012). Receipt of pharmacotherapy for PTSD by veterans with and without co-occurring psychotic disorders. Psychiatric Services, 63(5), 461-467.

Roelofs, K., & Spinhoven, P. (2007). Trauma and medically unexplained symptoms towards an integration of cognitive and neuro-biological accounts. Clinical Psychology Review, 27(7), 798-820.

Sareen, J. (2014). Posttraumatic stress disorder in adults: Impact, comorbidity, risk factors, and treatment. The Canadian Journal of Psychiatry, 59(9), 460-467.

Shalev, A. Y., Ankri, Y. L. E., Peleg, T., Israeli-Shalev, Y., & Freedman, S. (2019). Barriers to receiving early care for PTSD: Results from the Jerusalem Trauma Outreach and Prevention Study. Psychiatric Services, 70(8), 617-624.

Shalev, A., Freedman, S., Peri, T., Brandes, D., Sahar, T., Orr, S. P., & Pitman, R. K. (1998). Prospective study of posttraumatic stress disorder and depression following trauma. American Journal of Psychiatry, 155(5), 630-637.

Shapiro, F. (2001). Eye movement desensitization and reprocessing: Basic principles, protocols and procedures (2nd ed.). Guilford Press.

Stewart, S. H. (1996). Alcohol abuse in individuals exposed to trauma: A critical review. Psychological Bulletin, 120(1), 83-112.

Vøllestad, J., Nielsen, M. B., & Nielsen, G. H. (2012). Mindfulness- and acceptance-based interventions for anxiety disorders: A systematic review and meta-analysis. The British Journal of Clinical Psychology, 51(3), 239-260.

Yehuda, R. (2002). Post-traumatic stress disorder. New England Journal of Medicine, 346(2), 108-114.