Post-traumatic stress disorder (PTSD) is a mental health condition that some people develop after experiencing or witnessing a traumatic event. The condition can cause intense, disturbing symptoms that affect your day-to-day life. When you’re having a PTSD episode or “flashback,” you may feel like you’re reliving the traumatic experience. Episodes can come on suddenly and feel very real and frightening. This article will provide an in-depth look at what it’s like to experience a PTSD episode.
What are the symptoms of PTSD?
People with PTSD often experience various symptoms that are grouped into four main categories:
- Re-experiencing symptoms – Flashbacks, nightmares, intrusive thoughts or memories about the trauma that pop into your mind unexpectedly.
- Avoidance symptoms – Avoiding places, activities, people or other reminders of the trauma because they are triggers.
- Negative changes in thinking and mood – Feeling very negative about yourself or the world, feeling detached or estranged from others, difficulty experiencing positive emotions.
- Arousal and reactivity symptoms – Being easily irritated or angered, reckless behavior, difficulty concentrating, being easily startled.
These PTSD symptoms can range from mild to severe and come and go over time. Many people with PTSD have “good days” where they experience few or mild symptoms, and “bad days” where symptoms are more intense.
What happens during a PTSD episode or flashback?
A PTSD flashback occurs when someone suddenly feels like they are reliving their trauma. It happens because a trigger in the environment sets off the brain’s threat response, and the person is flung back into the emotional and physiological experience of their past trauma.
Here is what a PTSD episode or flashback may feel like:
- You suddenly feel an intense surge of fear, anxiety, dread, panic or despair, as if you’re in immediate danger right now.
- You re-experience sensory details like sounds, smells, images, or physical sensations associated with the trauma.
- You feel detached from your surroundings, like you’re in a dream or nightmare.
- You have intense physical reactions like a racing heart, rapid breathing, shaking, sweating, feeling faint or numb.
- You lose track of where you are or what’s going on around you.
- You react as if the trauma is happening again by crying, screaming, hiding, or fighting off an attacker.
- You have vivid flashbacks, reliving the traumatic experience through vivid images, sounds, physical sensations that feel extremely real.
In the moment, the flashback feels so real and consuming that you believe the trauma is actually happening again. Some people even experience temporary blackouts or dissociation, where they don’t remember what happened during the flashback.
What causes a PTSD flashback?
PTSD flashbacks are caused by triggers – things that remind your brain of the past trauma so that it activates the old fear response. Triggers are often sensory based, related to sights, sounds, smells, touches or tastes associated with the trauma. Here are some examples of potential flashback triggers:
- Smelling something that was present during the trauma, like an attacker’s cologne or scent of burning buildings
- Hearing loud noises like gunshots, explosions, or screams
- Seeing locations or scenes that remind you of the trauma
- Seeing someone who resembles or dresses like the attacker
- Touch sensations like being grabbed or feeling pressure on certain body parts
- Tasting a food or beverage you had when the trauma occurred
- Weather events like major storms
- Dates or times associated with traumatic events, like the anniversary
- Conversations, movies, or news stories about trauma
Sometimes the triggers are obvious, but in other cases they can be subtle and not easily noticed or identified. Many times the flashback happens without any obvious trigger at all.
How long does a PTSD flashback last?
The duration of PTSD flashbacks can vary greatly, from just a few seconds to much longer episodes:
- Brief flashbacks may last just seconds or minutes when a trigger quickly reminds the brain of the trauma but doesn’t fully recreate the experience.
- Prolonged flashbacks can last several minutes, hours, or even days, especially without proper treatment. The person remains engulfed in the traumatic experience until the brain resets itself.
- The most extreme flashbacks are dissociative states where the person relives the trauma very intensely and may lose touch with reality for a time. These states typically require intervention to end.
On average, most PTSD flashbacks tend to last from a few minutes up to half an hour when experienced regularly without treatment. But there is great variation among individuals and specific episodes.
What are the stages of a PTSD flashback?
PTSD flashbacks tend to unfold in stages as the fear response escalates then dissipates:
1. Trigger phase – The person encounters a trigger that initiates the flashback by reminding the brain of the past trauma.
2. Escalation phase – PTSD symptoms rapidly escalate as the person re-experiences the emotions and sensations of the trauma. Fear, panic, or despair intensify along with body sensations like rapid heart rate.
3. Peak phase – PTSD symptoms peak and become all-consuming. The person is immersed in the flashback, disconnected from their surroundings. They may cry, scream, or thrash violently.
4. Plateau phase – The most intense symptoms persist for a time while the person remains in the flashback experience. They are detached from reality.
5. Decline phase – The body cannot sustain the high-alert state and starts coming out of it. Fear and body sensations slowly diminish.
6. Recovery phase – The flashback has ended. The person becomes re-oriented to the present, but may still feel shaken afterwards. The body recovers back to normal mode.
Some flashbacks may not follow this exact progression, but overall they tend to build, peak, remain intense briefly, then come back down until the person returns to the present. The stages illustrate how the brain and body react during these reliving experiences.
What are some common examples of PTSD flashbacks?
While flashbacks are highly personalized based on someone’s specific trauma history, here are some examples of what flashbacks may feel and look like in PTSD:
Combat flashback example:
A loud bang suddenly triggers a combat flashback for a war veteran with PTSD. He feels overwhelmed by anxiety as vivid images of battle flood his mind. Gunshots and explosions sound real and nearby. He smells smoke and sees images of being ambushed by enemy troops. He drops to the ground and reaches for a weapon to defend himself. He is immersed in the combat until the sounds fade and he realizes he is actually at home, where a door slamming shut triggered the episode.
Sexual assault flashback example:
A woman with PTSD from sexual assault smells her attacker’s cologne on someone at a party, triggering a flashback. She suddenly feels paralyzed with terror and unable to breathe. She can vividly hear the attacker’s voice and feel him grabbing her. She sees the room where she was assaulted. She screams and pushes people away, feeling like she is fighting him off again until she finally comes out of the flashback several minutes later.
Natural disaster flashback example:
Someone with PTSD around tornadoes hears loud thunder and sees dark storm clouds gathering. They are suddenly immersed in feelings of panic, loss of control, and doom. They frantically want to hide and feel in danger. Wind seems deafening. For several hours, they repeatedly relive memories of being trapped under debris during a past tornado until the storm passes and the flashback finally ends.
These examples illustrate how smells, sounds, sights, or other triggers can instantly transport PTSD sufferers back into their trauma, making them re-experience it vividly in the present. The episodes are intensely real and frightening for them.
Why do flashbacks happen?
There are several theories as to why flashbacks happen in PTSD:
- Fear conditioning – The brain learned to associate certain triggers with danger during the trauma. Triggers automatically activate the fear response, including flashbacks.
- Disruption of memory mechanisms – Stress hormones released during trauma may disrupt the brain’s ability to properly process memories. Memories get stuck in vivid flashback mode.
- Unprocessed memories – Flashbacks help the brain re-process memories of trauma that were inadequately processed during the actual event.
- Fragmented memories – Trauma can cause fragmented memories that flare up as flashbacks and intrusive recollections when triggered.
- Brain chemical changes – Alterations in neurotransmitters, hormones, and neurochemicals after trauma make the brain more reactive to triggers.
In essence, the combination of a sensitized fear response and disrupted memory mechanisms in the aftermath of trauma contribute to reasons why flashbacks occur. The brain gets stuck in reactive mode.
What makes flashbacks worse?
Certain factors can make PTSD flashbacks more frequent or severe when a person is struggling:
- High stress levels
- Lack of sleep
- Substance abuse
- Isolation or lack of social support
- Anniversary of the trauma
- Being re-exposed to trauma reminders
- Hormonal changes
- Physical discomfort or pain
- Medication changes
- Poor coping abilities
Making healthy lifestyle changes like getting enough sleep, reducing stress, avoiding drugs/alcohol, and learning coping strategies can help minimize flashback intensity or frequency. But psychotherapy and medications are often needed to significantly improve them.
How are flashbacks different across PTSD, depression, and panic attacks?
| Type | PTSD Flashbacks | Depressive Rumination | Panic Attack Flashbacks |
|---|---|---|---|
| Cause | Reminders of a traumatic event | Depressive thoughts and feelings | Reminders of past panic attacks |
| Content | Re-experiencing a trauma | Negative thoughts about oneself | Feelings of anxiety/doom from a prior panic attack |
| Triggers | Sensory reminders of trauma | Low mood, self-criticism | Physical symptoms or situations where one panicked before |
| Purpose | Reprocessing traumatic memories | Rumination over problems | Hypervigilance about having another panic attack |
While flashbacks in these conditions share some qualities like feeling immersed in the past, PTSD flashbacks are uniquely caused by trauma reminders that make someone re-experience the trauma vividly. The content and triggers differ across conditions.
What should you do during a flashback?
If you’re experiencing a PTSD flashback, here are some tips for getting through it:
- Remind yourself that you’re having a flashback and these are just memories – the trauma is not happening again.
- Focus on your breathing or do a grounding exercise, like looking around to notice your real surroundings.
- Don’t try to fight or stop the flashback, just acknowledge it’s happening without judgment.
- Call someone you trust and talk to them about what’s happening in a calming voice.
- Hold onto an object like a pillow or blanket to help ground you in the present.
- Listen to comforting music that brings your mind into the current moment.
- Don’t make big decisions or drive until you start feeling present again.
- Reassure yourself that the flashback will pass, even if it feels overwhelming in the moment.
The key is using coping strategies that help ground you rather than getting swept up in the PTSD symptoms. But if flashbacks are ongoing, pursuing treatment should help reduce their intensity and frequency.
What can you do after a flashback ends?
Once a PTSD flashback passes, here are some things you can do to help yourself recover:
- Continue using grounding strategies to stay focused on the present moment.
- Do a self-soothing activity like taking a warm shower, listening to music, or having a cup of tea.
- Talk to someone supportive about what you experienced.
- Write about the flashback in a journal to help process it.
- Do light exercise to release tension and boost endorphins.
- Engage in a hobby you enjoy to calm down.
- Remind yourself that you are safe now.
- Avoid drugs/alcohol which can make symptoms worse.
- Consider contacting a PTSD specialist if the flashback was severe.
- Be compassionate with yourself and allow time to recover.
Re-establishing feelings of safety, control, and social connections after a flashback can help your nervous system calm back down in the aftermath. Don’t ignore repeated or lengthy flashbacks.
When to seek emergency help for flashbacks
In most cases, flashbacks will resolve on their own after a period of time. But some PTSD episodes require emergency medical care:
- You feel unable to stop reliving the trauma or come out of the flashback after several hours or days.
- You’re at risk of harming yourself or others during the flashback.
- You experience intense physical symptoms like pain, weakness, dizziness or breathing issues.
- You have suicidal thoughts triggered by the flashback.
- You feel detached from reality for an extended time after the flashback.
- You experience severe agitation and inability to calm down.
- You have another health condition that is being exacerbated.
Emergency medical care like sedation or getting to a safe environment may be required in these cases. Don’t hesitate to call emergency services or your doctor if a flashback becomes truly dangerous or unmanageable.
Long-term treatment options for PTSD flashbacks
To address recurring flashbacks in the long run, comprehensive PTSD treatment is recommended. Treatment options may include:
- Psychotherapy – Options like cognitive processing therapy, prolonged exposure therapy, and EMDR help process trauma memories and change thought patterns.
- Medications – Antidepressants, anti-anxiety meds, and prazosin can help minimize flashback intensity.
- Brainspotting – This therapeutic technique uses bilateral stimulation to help process trauma that’s stuck in the brain.
- Memory reconsolidation – Techniques to help the brain properly consolidate traumatic memories so they stop triggering flashbacks.
- Mindfulness practices – Meditation helps strengthen the ability to stay grounded in the present moment.
- Avoiding triggers – Reducing exposure to known flashback triggers can lessen frequency.
- Service dogs – Specially trained dogs can support PTSD management and provide comfort.
A combination of psychotherapy, medications, self-help strategies, and support systems is often most effective to gain control over PTSD flashbacks in the long run.
Conclusion
Reliving a trauma through flashbacks is a frightening experience that happens in PTSD when the brain gets stuck in the past. Triggers in the environment provoke these vivid, consuming episodes that make it feel like the trauma is unfolding again in the present. While very distressing for the sufferer, flashbacks are ultimately manifestations of an injured, reactive nervous system trying to process trauma. Various treatment approaches are available to help survivors heal and gain control over these intrusive symptoms. With professional help, compassionate support, and daily self-care, it’s possible to experience fewer and less intense flashbacks until they no longer dominate your life.