Objective
Acute stress disorder (ASD) was introduced into the fourth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM‐IV; American Psychiatric Association, 1994) to identify posttraumatic stress reactions occurring within the first month after a trauma and thus help to identify victims at risk of developing posttraumatic stress disorder (PTSD). Since its introduction, research into ASD has focused on the prediction of PTSD, whereas only a few studies have investigated the latent structure of ASD. Results of the latter have been mixed. In light of the current proposal for the ASD diagnosis in the pending DSM‐5, there is a profound need for empirical studies that investigate the latent structure of ASD prior to the DSM‐5 being finalized.
Design
Based on previous factor analytic research, the DSM‐IV, and the proposed DSM‐5 formulation of ASD, four different models of the latent structure of ASD were specified and estimated.
Method
The analyses were based on a national study of bank robbery victims (N = 450) using the acute stress disorder scale.
Results
The results of the confirmatory factor analyses showed that the DSM‐IV model provided the best fit to the data. Thus, the present study suggests that the latent structure of ASD may best be characterized according to the four‐factor DSM‐IV model of ASD (i.e., dissociation, re‐experiencing, avoidance, and arousal) following exposure to bank robbery.
Conclusions
The results are pertinent in light of the pending DSM‐5 and add to the debate about the conceptualization of ASD.
Practitioner Points
- The present study supports the DSM‐IV conceptualization of ASD and thus underlines the need of further research into the ASD structure before the launching of the DSM‐5.
- Clinical theory and practice may be affected in several ways if future research, such as this study, fails to support the proposed structure of ASD in the DSM‐5 and new proposals of ASD in the DSM‐5 are not set forward and tested.
- Treatment of acute posttraumatic symptoms will likely become less effective if it focuses on an imprecise conceptualization of ASD.
- Although possible, it seems unlikely that the results of the present study may simply reflect properties of the ASDS rather than the ASD diagnosis, because the DSM‐IV model has been supported in prior studies using both a diagnostic interview and the ASDS.
- The results of the present study are based on bank robbery victims and thus should be generalized to other trauma populations with caution.