Acute Stress Disorder 283
Some individuals with the disorder do not ha ve intrusive memories of the event itself,
but instead experience intense psychological distress or physiological reactivity when
they are exposed to triggering events that re semble or symbolize an aspect of the traumatic
event (e.g., windy days for child ren after a hurricane, entering an elevator for a male or fe-
male who was raped in an elevator, seeing  someone who resembles one’s perpetrator).
The triggering cue could be a physical sensation (e.g., a sense of heat for a burn victim, diz-
ziness for survivors of head tr auma), particularly for individuals with highly somatic pre-
sentations. The individual may have a persistent  inability to feel positive emotions (e.g.,
happiness, joy, satisfaction, or emotions asso ciated with intimacy, tenderness, or sexual-
ity) but can experience negative emotions su ch as fear, sadness, anger, guilt, or shame.
Alterations in awareness can include depersonalization,  a detached sense of oneself (e.g.,
seeing oneself from the other side of the room), or derealization,  having a distorted view of
one’s surroundings (e.g., perceiving that thin gs are moving in slow motion, seeing things
in a daze, not being aware of events that on e would normally encode ). Some individuals
also report an inability to remember an impo rtant aspect of the tr aumatic event that was
presumably encoded. This symp tom is attributable to dissoc iative amnesia and is not at-
tributable to head inju ry, alcohol, or drugs.
Stimuli associated with the trauma are persistently avoided. The individual may refuse
to discuss the traumatic experience or may engage in avoidance strategies to minimize
awareness of emotional reactions (e.g., excessive alcohol use when reminded of the ex-