After a stressful event at work, I sat in the hall gasping for breath. I rationally knew what had happened. I had been yelled at, which triggered my PTSD. That didn’t stop my body from shaking and going through the panic of feeling helpless to save myself.
Talking about triggers in popular culture sounds like people being so sensitive to little events. You hear it thrown around as a buzzword and politicized as a way to diminish valid emotional reactions.
Trigger refers to an event or experience that reminds you of a traumatic event in your life. It brings up painful emotions.
Many years ago, I thought of triggers as their own PTSD symptoms, separate from flashbacks or other symptoms. Flashbacks were those “video clip” moments where your brain forces you to watch in vivid detail. That’s how they were described in all the resources I could find. I wasn’t familiar with complex trauma at the time.
Then I learned about emotional flashbacks. As the term implies, emotional flashbacks are emotion-focused flashbacks where you experience similar emotions to a traumatic period in time without necessarily getting clear images or somatic experiences.
While sitting in this hallway at work, I was having an emotional flashback triggered by the event. It was like being a child again, helpless and afraid. I likely would have regarded the situation as a panic attack a few years ago. But panic attacks aren’t tied to specific trauma triggers.
I tried looking into the different types of flashbacks further. If there were visual flashbacks and emotional flashbacks, were there other types?
The scientific literature didn’t have much to offer for variations on the “typical” flashback, reliving the moment in detail.
PTSD research has focused on single trauma cases, especially since, in the U.S., the DSM-V doesn’t have a classification for complex trauma. Often when going into a new therapy office, I have to indicate which trauma is my “worst trauma” since many of our therapy models rely on dealing with the singular root trauma. There isn’t room to see trauma as compounding, reducing trauma to very defined events of what can count as trauma.
Since practice falls behind research, it hasn’t caught up with the current understanding of things like minority stress, “social traumas,” or other complex traumas.
So, it’s not terribly surprising that research on types of flashbacks is nonexistent.
With all of that in mind, this is an article on a blog. I can try my best to provide a theory based on the current literature, but that theory is not scientific (yet).
To understand flashbacks, we need to understand the senses.
What are the senses anyway?
Oh! That’s an easy one. We learn this in kindergarten – eyes, ears, mouth, nose, and touch. Later on, we may have been exposed to other senses like vestibular (movement awareness) and proprioception (spatial awareness).
Often these are introduced as an accepted understanding of the world. The issue is that they’re phenomenological. And whenever you’re dealing with classification, it’s really tricky to say with any certainty that your classification system is an accurate representation of the world. As a consequence, a lot of the accepted “science” is a bit hazy, and mostly proposed theories with backing for some of the most major.
For example, Aristotle is credited to have first categorized the five senses. Other neurologists have identified and supported other systems. But depending on who you talk to there can be between 5-53+ senses.
This graph by New Scientist does a good job illustrating what senses are generally accepted in science. It also highlighted what “radical” senses have been proposed and a conservative understanding of the senses.
So, why does this matter to our discussion of flashbacks? Flashbacks are categorized by an individual’s somatic/sensory experiences, which requires a solid agreement on what senses count in that experience.
CW: The following sections contain brief examples containing a variety of traumas.
A study compared flashbacks to regular auto-biographical memory. It found that flashbacks contained more visual, sensory, emotional, and other perceptual content than autobiographical memory. To people that have experienced traumatic flashbacks, this is far from surprising.
From examining the available literature and through my own experience, I’ve divided the types of flashbacks into Primary Sensory, Vestibular, Proprioceptive, Interoceptive/Emotional, Nociceptive, and Cognitive.
While these types of flashbacks may stand alone, most flashbacks are going to contain multiple types. The categories can be thought of as “Sense-Focused” flashbacks instead of as the only sensory experience of the flashback.
Primary sensory flashbacks
These flashbacks are what are most typically studied. They include the five senses as the focus.
The previously mentioned study found that visual information was the most common, followed by auditory for people experiencing flashbacks. Smell and taste were relatively rare. Touch falls under proprioceptive, so I’ll examine that more there.
Primary senses are the easiest to understand regarding flashbacks, so I won’t provide examples.
Vestibular-focused flashbacks are flashbacks that focus on the experience of movement. Motion can relate to the position and speed of you, people, or things around you.
Examples of vestibular-focused flashbacks may feel like hypervigilance, where you feel like your aggressor is following you. It may be like feeling the speed of a car coming at you, the feeling of body parts moving towards you, or your own body moving. It could also explain physiological descriptions of flashbacks like feeling dizzy, nauseous, off-balance, or like you’re falling.
Proprioceptors are nerve endings present throughout your whole body that identify things like touch, pressure, and your body in space.
Proprioceptive flashbacks may feel like someone or something touching you, like your body is present in that traumatic moment, weight on your body, or your skin crawling. It can also happen when someone touches you somewhere triggering, causing an acute sensation like being back in that moment.
Interoception is a wide array of internal experiences, including emotions, sense of time, and internal processes like blood pressure or hunger.
Primary emotions like fear, helplessness, etc., are more common in flashbacks than secondary emotions like guilt or anger.
Interoceptive flashbacks may feel like you’re experiencing the emotions from the trauma. In triggering your fight or flight, it may feel similar to the pounding heart and higher blood pressure you experienced at that moment. It commonly affects your sense of time, like moments are disconnected like a dream. Feeling like you’re in that time is also an interoceptive response.
Nociceptive is the system that senses pain. A study found that individuals who went through a traumatic event experienced pain after the event. They also experienced pain later when recalling the event.
Nociceptive flashbacks are characterized by pain in areas that may have been affected by the trauma or stress-related pain. It can appear unexplained and may be written off as “psychosomatic.” If you only started having pain following a traumatic event, it’s worth considering that the trauma likely affected your nociceptive system.
It could also relate to other descriptions of pain during a flashback, like feeling like you’re burning, shocked, or being pulled apart.
Cognitive flashbacks are not a sensation so much as a pattern of behavior. A CBT therapist might tell you to examine cognitive distortions after a traumatic event, like feeling like people are out to get you, etc.
I think it is worth considering that this is a type of flashback. You may have distinct thoughts and related behaviors that you experienced during the trauma. It may also describe compulsive actions like trauma re-enactment, which may result in thinking you’re gaining control or can prevent the trauma.
Cognitive flashbacks may also affect your mental understanding of a situation like you’re back in the trauma or thoughts like “I deserve this.”
How autism interacts with trauma
With all the different systems involved in flashbacks, it’s important to note that autistic people have a much higher likelihood of over 40% (this varies greatly across samples, but all agree that it’s much higher than the gen pop) vs. 4% in the general population to have probable PTSD.
The reasons for this are unclear, but it’s theorized that autistic individuals encounter a lot more traumatic social situations and non-DSM-V traumas. Non-DSM-V traumas are any events an individual feel was traumatic but are not currently considered traumatic under diagnostic criteria. Bullying, mental health problems, and cumulative minority stress may be considered non-DSM-V traumas.
Since assessment for PTSD is not built around autistic communication, there can also be an underdiagnosis of PTSD in autistic individuals.
Autism is characterized by an “abnormal” perception of sensory information. It also has many co-occurring conditions that affect perception, like alexithymia, hyperphantasia, and synesthesia.
A recent study indicated that Grapheme-Color Synesthesia, where individuals associate numbers or letters with colors or images, is associated with PTSD. Sensory systems play into the way PTSD symptoms affect an individual.
I couldn’t find any literature indicating whether autism affects the severity of PTSD symptoms, but there was evidence indicating PTSD affected autism symptom severity. Things like social skills and other emotional regulation skills were affected by PTSD, creating the appearance of more pronounced autistic symptoms as a result.
There needs to be more research into how the somatic experience of autism interacts with the experience of PTSD. Until we have more research, it is unclear how being autistic may affect flashbacks.
An exercise for flashbacks
While many coping skills can be helpful in dealing with flashbacks, I’ll leave you with my favorite.
The technique is called “what’s different?”. In the flashback, you ask yourself, “what’s different?”. You keep naming different things about the room until your body returns to the present. It can be anything like “it’s colder”, “there’s this person with me”, “the walls are a different color”, “I’m laying down”, etc.
While it sounds simple, it can be beneficial during flashbacks to remind yourself where you are.