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Joyce Boaz & Dr. Frank Ochberg, M.D.

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PTSD Symptoms: Flashbacks.

Q: Dear Frank, Here is a question about flashbacks.

"I would like to know what a flashback consists of. I have heard or read that they are visual experiences only. Other people include body sensations and other senses. I often experience smells from the past and occasionally body sensations. Each smell is linked to a trauma. Prior to remembering my abuse I was told I was psychotic and hallucinating. Is there a difference between a flashback and hallucinations? And if so, what is it?" Thank you.

A: Dear Joyce, Flashbacks are memories that come suddenly and with such intensity that they feel as though they are in the present, rather than the past. They are usually visual, but they may include all the senses. Hallucinations are perceptions that are not real and may not have ever been real. So a rape victim who enters a room that resembles the room in which she was assaulted and smells her assailant's odor and feels his hand and sees his face is having a flashback rather than a hallucination. But if she hears him saying things he never said, it is an auditory hallucination and not a flashback. Psychosis or being psychotic means that the person is out of touch with reality. Having a flashback and knowing it is a flashback rather that believing the event is actually recurring is not psychotic. It is frightening and a likely sign of PTSD. It may have the force of a hallucination. But if it is a replay of an actual traumatic event, it is not a sign of schizophrenia, mania or other psychotic states.

PTSD Symptoms: Flashbacks.

Q: Dear Frank, Here is question from a support pal about flashbacks.

" Although knowing that I have PTSD is fairly new for me, I have had flashbacks for some time now. What I am curious to know, is what people are left with i.e. their feelings, after a flashback? For me the following day and even days, are especially sad for me. Flashbacks most always come while I am sleeping. I awaken either with a pounding heart or I could find myself out of my bed "escaping" etc. Do most people have these lasting feelings of sadness after re-experiencing their trauma? How long do flashbacks go on?"
A: Dear Joyce, PTSD always causes some form of unwanted, disturbing "flash" from the past. But when it comes during sleep, it is really not a "flashback." The term, flashback, should be reserved for intense experiences during wakefulness when the mind relives a traumatic event and does so with such intensity and immediacy that it seems less like a memory and more like a hallucination. The trauma appears to be occurring again. Now this may happen as a person awakens, or as a person falls asleep. The twilight zone between sleep and wakefulness is called "hypnogogic" going from awake to asleep and "hynopopic" going from asleep to awake. Even without a trauma history, these times can be frightening, trance-like states of mind. So I wonder if our questioner is experiencing a form of trauma memory as she awakens - half nightmare, half-flashback. This could be the case. She doesn't mention the content of the re-experiencing, but I assume it involves an abuser and a dream-like need to escape before harm is done, or after some harm is done and more is threatened. The pounding heart is surely evidence of fear, possibly panic, from anticipation of being victimized.

But this writer asks specifically about sadness. Is her sadness common? Is it part of her PTSD? How much longer will it last? In all probability, the sadness has to do with loss. And the loss that GFW community members often experience is the loss of a parent who cannot or will not understand abuse. In the classic incest situation, the abuser is a father figure, known and trusted by the mother. The abusing parent tells the little girl, "No one will believe you if you reveal this secret - and you will suffer if you tell." Incest is all about secrets.

The loss of trust and intimacy with the mother is often a more profound and disturbing outcome than the abuse by the father-figure. In any case, secret child abuse is a sad, sad burden that too often gets re-enacted and re-experienced through no fault of the victim. I just spoke with a survivor today who was coerced into degrading sexual activity by a prison guard. But worse than that was the triggering of terrifying and helpless feelings from age 5 and 6 when an 18 year old step-uncle, living in the home, forced himself on her over and over. I could see the sadness as she spoke. Her heart may have been pounding, but she learned to control her fear. She functions fairly well now, with a good partner, an excellent job and a resilient appearance.

The duration of flashbacks, true flashbacks, is usually less than a year. But certain life burdens are never completely laid aside. We are sad. Sadder and wiser. And we can, if we are lucky enough to find true friends, recover a sense of safety, hope and ability to help others.

Webcast: Nightmares Versus Flashbacks

In this webcast, Dr. Frank Ochberg talks about PTSD and the differences
between flashbacks and nightmares.

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Page created on 28 January 2010
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