10. Sleep disturbance (e.g., difficulty falling or staying asleep, restless sleep).
11. Irritable behavior and angry outbursts (with little or no provocation), typically ex-
pressed as verbal or physical aggression toward people or objects.
12. Hypervigilance.
13. Problems with concentration.
14. Exaggerated startle response.
C. Duration of the disturbance (symptoms in Criterion B) is 3 days to 1 month after trauma
exposure.
Note: Symptoms typically begin immediately after the trauma, but persistence for at
least 3 days and up to a month is needed to meet disorder criteria.
D. The disturbance causes clinically significant distress or impairment in social, occupa-
tional, or other important areas of functioning.
E. The disturbance is not attributable to the physiological effects of a substance (e.g.,
medication or alcohol) or another medical c ondition (e.g., mild traumatic brain injury)
and is not better explained by brief psychotic disorder.
Diagnostic Features
The essential feature of acute stress disorder  is the development of characteristic symp-
toms lasting from 3 days to 1 month following exposure to one or more traumatic events.
Traumatic events that are expe rienced directly include, but are not limited to, exposure
to war as a combatant or civilia n, threatened or actual violen t personal assault (e.g., sexual