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F43.0·CIM-10-CM

Acute Stress Reaction

Transient response to exposure to a traumatic stressor lasting from 3 days to 1 month after the trauma. Corresponds to DSM-5-TR Acute Stress Disorder. If symptoms persist beyond 1 month, reconsider as PTSD (F43.10).

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Impact of Event Scale-Revised (IES-R)
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DSM-5-TR diagnostic criteria summary

Acute Stress Disorder requires:

  • Criterion A, Exposure: Actual or threatened death, serious injury, or sexual violence, directly experienced, witnessed in person, learned of in close family/friend, or repeated/extreme exposure to aversive details.
  • Criterion B, Symptoms: Presence of ≥9 of 14 symptoms across five categories:
  • **Intrusion**: distressing memories, dreams, dissociative reactions, intense distress at cues, marked physiological reactions
    • Negative mood: persistent inability to experience positive emotions
    • Dissociative: altered sense of reality, inability to remember key features
    • Avoidance: efforts to avoid memories/thoughts/feelings, efforts to avoid external reminders
    • Arousal: sleep disturbance, irritable behavior, hypervigilance, concentration problems, exaggerated startle
    • Criterion D: Clinically significant distress or impairment.
    • Criterion E: Not attributable to a substance, medical condition, or better explained by another disorder.

    Source: American Psychiatric Association. (2022). Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, Text Revision (DSM-5-TR), p. 313–319.

    Differential diagnosis

    • F43.10 PTSD, symptoms persist beyond 1 month; same trauma criterion but longer duration.
    • F43.21–F43.25 Adjustment Disorders, clinically significant distress in response to a stressor that does NOT meet PTSD's Criterion A (e.g., divorce, job loss, financial stress).
    • F44.x Dissociative Disorders, when dissociative symptoms predominate independent of trauma exposure.
    • F33, F32 Major Depressive Disorder, depressive symptoms after trauma without the full intrusion/avoidance/arousal cluster.
    • Traumatic brain injury, when concussion or TBI co-occurs with trauma; complicates assessment of acute stress symptoms.

    Common comorbidities

    Acute stress reaction commonly co-occurs with depression, substance use, and traumatic brain injury (in physical-trauma contexts). Common comorbidities: Major Depressive Disorder (F33, F32), Substance Use Disorders (F10–F19), Generalized Anxiety Disorder (F41.1), and (when applicable) traumatic brain injury sequelae. Co-administer PHQ-9 and AUDIT alongside trauma-specific screeners.

    Sources

    • American Psychiatric Association. (2022). Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, Text Revision (DSM-5-TR), F43.0 / Acute Stress Disorder, p. 313–319.
    • Weiss, D. S., & Marmar, C. R. (1997). The Impact of Event Scale-Revised. In J. P. Wilson & T. M. Keane (Eds.), Assessing psychological trauma and PTSD.
    • Centers for Disease Control and Prevention. ICD-10-CM Official Coding Guidelines.

    Foire aux questions

    What is ICD-11 code F43.0?

    F43.0 is the ICD-11-CM code for Acute Stress Reaction. It corresponds closely to the DSM-5-TR diagnosis 'Acute Stress Disorder', a transient response to exposure to a traumatic stressor lasting from 3 days to 1 month. If symptoms persist beyond 1 month, the diagnosis is reconsidered as PTSD (F43.10).

    What are the diagnostic criteria for F43.0 / Acute Stress Disorder?

    DSM-5-TR criteria require: (A) exposure to actual or threatened death, serious injury, or sexual violence; (B) presence of ≥9 of 14 symptoms from intrusion, negative mood, dissociative, avoidance, and arousal categories; (C) duration 3 days to 1 month after trauma exposure; (D) clinically significant distress or impairment; (E) not attributable to a substance or medical condition or better explained by another disorder.

    What is the difference between F43.0 and F43.10 (PTSD)?

    F43.0 covers symptoms persisting from 3 days to 1 month after trauma exposure. F43.10 (PTSD, Unspecified) covers symptoms persisting beyond 1 month. The distinction is duration; both share core symptom clusters (intrusion, avoidance, negative cognitions/mood, arousal). About 50% of acute stress disorder presentations transition to PTSD.

    What scale is used to screen for F43.0?

    The Impact of Event Scale-Revised (IES-R) is widely used for acute trauma screening. The Acute Stress Disorder Scale (ASDS) is specifically designed for the 3-day to 1-month window. The PCL-5 (PTSD Checklist for DSM-5-TR) can be administered after the 1-month window to evaluate transition to PTSD. A positive screen warrants a full clinical evaluation.

    When does an acute stress reaction become PTSD?

    When symptoms persist beyond 1 month after trauma exposure. At that point the diagnosis is reconsidered as PTSD (F43.10) using DSM-5-TR PTSD criteria. About half of acute stress disorder presentations remit naturally; the other half meet PTSD criteria at the 1-month mark and require active treatment.

    Is F43.0 a billable ICD-11-CM code?

    Yes, F43.0 is a billable ICD-11-CM code as of the 2025 official tabular list. It is the standard reimbursed code for acute stress reaction or DSM-5-TR Acute Stress Disorder when symptoms have persisted from 3 days to 1 month after trauma. F43.0 stands at maximum specificity in its hierarchy and has no further subdivisions.

    What are the symptoms of acute stress reaction?

    Acute stress reaction produces an intense response to recent trauma exposure, beginning within days and lasting up to one month. Symptoms span five categories and include intrusive memories or distressing dreams of the trauma, persistent inability to feel positive emotions, dissociative symptoms (altered sense of reality, memory gaps), avoidance of trauma reminders, and arousal symptoms such as sleep disturbance, irritability, hypervigilance, and exaggerated startle. At least 9 of 14 symptoms across these categories must be present.

    How is acute stress reaction diagnosed?

    Acute stress reaction is diagnosed by a clinician using DSM-5-TR Acute Stress Disorder criteria, which require trauma exposure plus at least 9 of 14 symptoms persisting from 3 days to 1 month. Diagnosis typically follows a positive IES-R or ASDS screen, structured clinical interview, ruling out medical and substance-induced causes, and assessment for traumatic brain injury when relevant. The PCL-5 is administered after one month to evaluate transition to PTSD.

    What causes acute stress reaction?

    Acute stress reaction is caused by exposure to actual or threatened death, serious injury, or sexual violence, either directly experienced, witnessed, learned of in close family or friends, or encountered through repeated extreme exposure to aversive details. Risk of developing the full reaction is shaped by trauma severity, prior trauma history, lack of social support, peritraumatic dissociation, and pre-existing anxiety or mood conditions.

    How long does acute stress reaction last?

    Acute stress reaction lasts from 3 days to 1 month after trauma exposure by definition. Roughly half of cases remit naturally within four weeks; the other half meet PTSD criteria at the one-month mark and require active treatment. Trauma-focused cognitive behavioral therapy started within weeks of the trauma reduces transition to PTSD. Symptoms persisting beyond one month should be re-evaluated using DSM-5-TR PTSD criteria and recoded as F43.10.

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