Not All Flashbacks Are Created Equal

The classic features of posttraumatic flashbacks described in DSM-5-TR imply that (a) the event(s) occurred in the past (‘memories’), (b) the experiencer is ‘flashing back’ to or experiencing dreams about a past event that they recognize as actually having occurred, and (c) the experience is fully involuntary, phenomenologically isolated (i.e., a discrete event), and ‘non-interactive’ - it does not, itself, possess motivation or intention. EMDR, in its standard protocol form, has been shown to be effective in treating the sequelae of posttraumatic stress, including flashbacks and nightmares, without the need to integrate other approaches. The adaptive information processing model and most EMDR therapy practices seem to assume these are the conditions under which EMDR therapy methods will be employed. However, when discrete self-states are present, as is the case in dissociative disorders, there are added dimensions of flashbacks that may, at the surface, resemble a ‘typical’ posttraumatic stress disorder (PTSD) presentation but confound the use of EMDR treatment-as-usual. This chapter will name and elaborate on four ways that more complex flashbacks may manifest, using Karpman&s;s Drama Triangle to contextualize each, as well as discuss the implications for EMDR therapy conceptualization and treatment of each ‘kind’ of flashback.