Acute Stress Disorder
Barney M. Davis Jr., MD, Godspeed Missionary Care

"...And he was afraid and arose and ran for his life and came to Beersheba, which belongs to Judah, and left his servant there. But he himself went a day's journey into the wilderness, and came and sat down under a juniper tree; and he requested for himself that he might die, and said, "It is enough; now, O LORD, take my life, for I am not better than my fathers.”
Kings 19:3,4 NASB

How do we respond when under threat of danger, or when exposed to violent and traumatic events? Even those of great faith, such as Elijah in the verse above, can experience physical and emotional exhaustion when faced with such threats of actual death or serious injury. Elijah so much wanted to distance himself from his traumatic situation that he even asked to die. People do not have to actually experience a traumatic event themselves, but rather may be witness to such an event. Traumatic events may affect an individual (violent personal attack such as sexual assault, robbery, physical attack, kidnapping, being held hostage, or even unintentional events such as severe automobile accidents or being diagnosed with a life-threatening illness), or groups of people (large scale natural disasters, accidents with multiple injuries or deaths, high publicity crimes of violence).

Whether the circumstances involve direct personal experience, or witnessing an event that involves death, injury, or a threat to the physical integrity of another person, either may be accompanied by feelings of intense fear, helplessness, or horror. When exposure to such events occurs, and is accompanied by such feelings, a pattern of reactive symptoms often follows, known as Acute Stress Disorder.

Symptoms of the acute stress disorder typically resolve within four weeks of the traumatic event. When symptoms persist for longer than one month, the symptom disorder known as Post Traumatic Stress Disorder (PTSD) may be made; we will examine PTSD in next month's Medical Moment for Missionaries.

Classical symptoms of Acute Stress Disorder which can occur during the traumatic event, or after experiencing it, may include the following:

• a sense of numbing, detachment, or absence of emotional responsiveness. The person may look and feel "mechanical" in their reactions and responses
• a reduction in awareness of surroundings (sometimes described as "being in a daze")
• feelings of being separate from one's surroundings or even being distant from one's self
• difficulty recalling certain details of the traumatic event
• persistent re-experiencing of the event through thoughts, dreams, mental images, and unwanted memory of reliving the event, and distress on any exposure to reminders of the event
• avoidance of anything that might arouse memory or recollections of the event
• physical and emotional symptoms of anxiety and increased arousal, such as sleep disturbances, poor concentration, increased "startle response", excessive sweating, dizzy spells, and physical restlessness
• distress and impairment of normal functioning as a result of the above symptoms

Such responses to traumatic events can occur at any age, in both men and women. Those who already live under stressful circumstances (such as mission service in remote or politically unstable areas) may be at higher risk for more intense symptoms. While the symptoms of an acute stress reaction typically subside over days or weeks, they can be improved by allowing the person to talk about the event and express their feelings. Trying to "avoid talking about it" actually may increase the likelihood of persistent symptoms.

Very importantly, adequate rest and nutrition will help (see the scriptural record of the angel's response to Elijah's symptoms: 1 Kings 19:5-8).

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