awareness of emotional reactions (e.g., excessive alcohol use when reminded of the ex-
perience). This behavioral avoidance may include avoiding watching news coverage of
the traumatic experience, refusing to return to a workplace where the trauma occurred, or
avoiding interacting with others who shared the same traumatic experience.
It is very common for indivi duals with acute stress disorder to experience problems
with sleep onset and maintenance, which may be associated with nightmares or with gen-
eralized elevated arou sal that prevents adequate sleep. Individuals with acute stress dis-
order may be quick tempered and may even en gage in aggressive verbal and/or physical
behavior with little provocation. Acute stress disorder is often characterized by a height-
ened sensitivity to potential th reats, including those that are related to the traumatic ex-
perience (e.g., a motor vehicle accident vict im may be especially sensitive to the threat
potentially caused by any cars or trucks) or those not related to the traumatic event (e.g.,
fear of having a heart attack). Concentration difficulties, including difficulty remembering
daily events (e.g., forg etting one’s telephone number) or attending to focused tasks (e.g.,
following a conversation for a sustained period  of time), are commonly reported. Individ-
uals with acute stress disorder may be very re active to unexpected stimuli, displaying a
heightened startle response or jumpiness to loud noises or unexpe cted movements (e.g.,
the individual may jump markedly in the response to a telephone ringing). 
Associated Features Supporting Diagnosis
Individuals with acute stress disorder common ly engage in catastrophic or extremely neg-
ative thoughts about thei r role in the traumatic event, th eir response to the traumatic ex-
perience, or the likelihood of future harm. For example, an individual with acute stress
disorder may feel excessively guilty about not having prevented the traumatic event or