Table of Contents

F42 : Reaction to Stress

F43 Reaction to severe stress, and adjustment disorders

F43.0 Acute stress reaction

A. A transient disorder of significant severity which develops in an individual without any apparent mental disorder in response to exceptional physical and / or mental stress, and which usually subsides within hours or days

B. There must be an immediate and clear relationship between the impact of an emotional stressor and the onset of symptoms

C. Onset is usually within a few minutes, if not immediately

D. The symptoms:

a) show a mixed and usually changing picture; in addition to the initial state of 'daze', depression, anxiety, despair, overactivity, and withdrawal may all be seen, but none predominates for long

b) resolve rapidly (within a few hours at the most); in cases where the stress continues or cannot be reversed, the symptoms usually begin to diminish after 24-48 hrs and are usually minimal after about 3 days

F43.1 Post­traumatic stress disorder

A. Arises as a delayed and / or protracted response to a stressful event or situation of an exceptionally threatening or catastrophic nature, which is likely to cause pervasive distress in almost anyone

B. The event usually involves the threat of severe injury or death, or a threat to physical integrity

C. Should not be diagnosed unless it arises within 6 months of the traumatic event

D. The symptoms fall into three categories:

  1. Re-experiencing of the traumatic event

  2. a) recurrent and intrusive distressing recollections of the event, including images, thoughts, and perceptions

  3. b) recurrent distressing dreams of the event
  4. c) acting or feeling as if the event was reoccurring
  5. d) intense physiological distress / reactivity at exposure to internal or external cues that represent the traumatic event

  6. Persistent avoidance of stimuli associated with the trauma, and numbing of general responsiveness

  7. a) efforts to avoid thoughts, feelings, or conversations associated with the trauma
  8. b) efforts to avoid activities, places, or people that arouse recollections of the trauma
  9. c) inability to recall an important aspect of the trauma
  10. d) markedly diminished interest or participation in significant activities, and a feeling of detachment from others
  11. e) restricted range of affect, and a sense of foreshortened future ("doom)

  12. Persistent symptoms of increased arousal

  13. a) difficulty falling or staying asleep
  14. b) irritability or outbursts of anger
  15. c) hypervigilance
  16. d) difficulty concentrating
  17. e) exaggerated startle response

F43.2 Adjustment disorders

A. A maladaptive reaction to a psychosocial stressor - it is maladaptive because it interferes with the affected person's social or occupational functioning B. The disorder is expected to remit when the stressor recedes C. Onset is usually within one month of the stressful event or life change D. Duration is not longer than six months

a) Brief depressive reaction: - transient mild depression - duration < 1 month

b) Prolonged depressive reaction: - mild depression in response to chronic stressor - duration < 2 years

c) Mixed anxiety and depressive reaction