treme levels of anxiety that may be associa ted with acute stress disorder may interfere
with sleep, energy levels, and capacity to a ttend to tasks. Avoidance in acute stress dis-
order can result in generalized withdrawal from many situations that are perceived as
potentially threatening, which can lead to nonattendance of medical appointments, avoid-
ance of driving to important appointments, and absenteeism from work. 
Differential Diagnosis
Adjustment disorders. In acute stress disorder, the stress or can be of any severity rather
than of the severity and type required by Criterion A of acute stress di sorder. The diagnosis of
an adjustment disorder is used when the response to a Criterion A event does not meet the cri-
teria for acute stress disorder (o r another specific mental diso rder) and when the symptom pat-
tern of acute stress disorder occurs in response to a stressor that does not meet Criterion A for
exposure to actual or threatened death, serious injury, or sexual  violence (e.g., spouse leaving,
being fired). For example, severe  stress reactions to life-threate ning illnesses that may include
some acute stress disorder symptoms may be more appropriately desc ribed as an adjustment
disorder. Some forms of acute stress response do not include acute stress disorder symptoms
and may be characterized by anger, depression, or guilt. These responses are more appro-
priately described as primarily an adjustment disorder. Depressive or anger responses in an
adjustment disorder may involve rumination ab out the traumatic event, as opposed to invol-
untary and intrusive distressing memories in acute stress disorder.
Panic disorder. Spontaneous panic attacks are very common in acute stress disorder.
However, panic disorder is diagnosed only if panic attacks are unexpected and there is
anxiety about future attacks or  maladaptive changes in behavior associated with fear of
dire consequences of the attacks.