Flashbacks & PTSD: What is the reality?

Films, TV shows and other mainstream media will often depict a veteran who is experiencing PTSD being overcome by ‘flashbacks’. Transported back to the past, they appear unable to distinguish memory from actuality, and often act dangerously or violently as a result. But what is the reality?

What constitutes PTSD?

To be diagnosed with PTSD, you must be experiencing each one of four symptom clusters: ‘avoidance’ (of memories. reminders of the past or difficult situations), ‘hyperarousal’ (intense feelings of anxiety, anger, or being in a constant state of ‘fight or flight’), ‘changes in mood and cognition’ (how you perceive yourself, and others), and ‘re-experiencing’. 

What is ‘re-experiencing’?

Re-experiencing, is where an individual will relive images, sounds, smells, emotions or sensations that occurred at the time of a traumatic incident. This is what we associate with the term ‘flashbacks’.

Most commonly, this will take the form of intrusive memories (images or snapshots of images), intrusive thoughts about what happened (always accompanied by distress), or nightmares.

The frequency, and intensity of how this materialises is unique to each individual, and while some may only experience one form, others may experience a combination.

Less commonly, on the acute end of the scale, someone may experience ‘dissociative flashbacks’. Similarly to the media portrayal, the affected individual completely disconnects from the present and entirely believes that the event is happening in that moment. They may, for example, suddenly ‘hit the deck’ if their flashback is one of being under fire.

Regardless of how ‘re-experiencing’ materialises, it can be incredibly distressing for the individual, disrupting their daily life. Involuntary, it is typically triggered or cued by an associative reminder of what happened; a sound (e.g. a firework sounding like an explosion), a sight (e.g. a cobweb looking like a tripwire) or even a smell (e.g. smoke bringing reminders of a burning vehicle).

So why the media portrayal, and is it harmful?

Despite being much less common, it is easier to depict ‘dissociative flashbacks’ and major behavioural changes on screen than attempt to ‘show’ an intrusive thought or memory; where the individual still has one foot in the present and may appear outwardly as unaffected.

However, this can be harmful to those with PTSD who don’t experience ‘flashbacks’ in this way, invalidating their mental health issues, and making them feel unworthy of, or not needing to, seek help.

There is also the risk of adding to the stigma around PTSD. Undesirable behaviours such as violence, as a result of flashbacks, are actually very rare, but adds to the perception of those with PTSD being ‘mad’ or ‘dangerous’ – when in reality they are more likely to be a victim of violence. This can generate feelings of shame and make individuals more reluctant to seek help.

Combat Stress treatment and support

Regardless of how your symptoms present, and regardless of the source of your military trauma, we are here to help you recover.

If you, or someone you know is struggling, please call our free 24-hour helpline (0800 138 1619) for confidential advice and support, referral to our treatment services or assistance in finding the most appropriate support for you.