282 Trauma- and Stressor-Related Disorders
violence, physical attack, active combat, mugging, childhood physical and/or sexual vio-
lence, being kidnapped, being taken hostage, terrorist attack, tortur e), natural or human-
made disasters (e.g., earthquake, hurricane, airplane crash), and severe accident (e.g.,
severe motor vehicle, industrial accident). For children, sexually traumatic events may
include inappropriate sexual experiences with out violence or injury. A life-threatening
illness or debilitating medical condition is no t necessarily consider ed a traumatic event.
Medical incidents that qualify as traumatic even ts involve sudden, cata strophic events (e.g.,
waking during surgery, anaphylactic shock). St ressful events that do not possess the severe
and traumatic components of ev ents encompassed by Criterion A may lead to an adjust-
ment disorder but not to  acute stress disorder.
The clinical presentation of acute stress disorder may vary by individual but typically
involves an anxiety response that includes some  form of reexperiencing of or reactivity to
the traumatic event. In some individuals, a dissociative or detached presentation can pre-
dominate, although these individuals typically  will also display strong emotional or phys-
iological reactivity in response to trauma re minders. In other individuals, there can be a
strong anger response in which reactivity is characterized by irritable or possibly aggres-
sive responses. The full symptom picture must be  present for at least 3 days after the trau-
matic event and can be diagnosed only up to 1 month after the event. Symptoms that occur
immediately after the event but resolve in less than 3 days would not meet criteria for
acute stress disorder.
Witnessed events include, but are not limited  to, observing threatened or serious in-