The Difference Between Acute Stress and PTSD
Reviewed by Melissa Kremer, PsyD
In the weeks after a traumatic event such as an active shooting incident or the wildfires burning across Idaho, Oregon, and Washington, it’s common to have trouble sleeping, notice unwanted memories surfacing, feel irritable or emotionally numb, struggle to focus, or feel more on edge than usual. These reactions can be alarming, but they don’t automatically mean someone has PTSD.
“Post-traumatic stress is totally normal,” says Dr. Melissa Kremer, PsyD, Trauma Treatment Program Director and Trauma (PTSD) Psychologist at Idaho Neuropsychology. “We would expect that in everyone.”
What Early Trauma Reactions Look Like
After a traumatic event, most people have many types of reactions, and they can experience all of them at different times. A person may feel strong emotions including guilt or self-blame and might replay the event in their mind wondering what they could have done differently. Intrusive memories or thoughts can surface, whether as unwanted thoughts and mental images when awake or through nightmares during sleep. And the nervous system might go on high alert, resulting in jumpiness, a strong startle response, or feeling “strung too tight.”
These reactions are not a sign that something is broken; they’re the mind and body’s normal response to an abnormal event.
Why Most People Gradually Recover
For most people, these reactions ease over time. The intense emotions around the event tend to settle, intrusive thoughts and nightmares become less frequent, and the nervous system’s alarm response calms down. People are able to process what happened and carry it forward as part of their story, rather than something that continues to derail their daily life. The recovery could be a matter of days or a number of weeks, but often within a month the person will begin to feel like their old self again.
This is why a PTSD diagnosis is never made in the immediate aftermath of a traumatic event. Clinically, a person needs to be at least 30 days past the traumatic event before PTSD can be diagnosed. Before that point, if someone is struggling, the clinical term is acute stress disorder, not PTSD.
When a Reaction Signals a Need for Support
According to Dr. Kremer, the shift from a normal stress response to something that may need treatment comes down to how a person is functioning. The question isn’t whether someone feels shaken or continues to feel upset or grief. It’s whether their ability to work, maintain relationships, and go about daily life is impaired to the point that they can’t be the person they used to be.
At that point, people often start relying on escape and avoidance to cope. That can take many forms: anger or irritability, withdrawing from people or situations that are reminders of the event, numbing out, leaning on alcohol or other substances, or throwing themselves into work in a way that leaves no room to process what happened. Even such as focusing all one’s energy on helping others, are problematic if they are being used to avoid feeling anything at all.
Many people who don’t have a formal PTSD diagnosis benefit from talking to a professional. Some people come to Idaho Neuropsychology because they know something feels different and they want clarity on what it is. Others have been through an impactful event or series of events and are struggling—and would like to resolve what’s happening to them.
What Recovery Tends to Look Like
For those who may need more structured support, Dr. Kremer notes that engagement in evidence-based treatment tends to produce noticeable improvement within three to six months. If someone is actively participating in treatment and isn’t seeing progress after that stretch of time, it’s often a sign the current course of treatment isn’t the right fit, not a sign that the patient can’t be helped.
A Note on Resilience
It’s worth remembering that most people who experience a frightening or traumatic event do not go on to develop PTSD. Distress in the days and weeks after an event like a shooting or a wildfire is expected, and for most people, it eases with time, support, and the normal process of making sense of what happened.
If reactions are not easing, or if they are starting to interfere with work, relationships, or daily life, that is worth talking to a professional about. Idaho Neuropsychology’s Trauma Treatment Program, directed by Dr. Kremer, offers prompt intake appointments for anyone who wants clarity on what they’re experiencing and what kind of support could help.
