What Is a Flashback in Borderline Personality Disorder?

Flashbacks aren't uncommon in BPD, but they may not be what you expect.

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Question: What is a flashback in borderline personality disorder?

A few months ago I started therapy for borderline personality disorder. In my session yesterday, my therapist told me that she thinks I may be experiencing flashbacks. I have a history of childhood trauma and I do have periods of time when I feel confused about where I am — but I don't completely "lose it" or start cowering on the ground or anything. Is this a flashback?


Flashbacks are defined in the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders as a “recurrence of a memory, feeling, or perceptual experience from the past.” This phenomenon is usually seen in individuals with posttraumatic stress disorder (PTSD), but because of the overlap between borderline personality disorder (BPD) and PTSD, it is also often seen in people with BPD.

An individual experiencing a flashback will describe feeling as if they are not fully in the present moment, but instead are in a past (usually traumatic) event. They may describe actually seeing things that happened in that past event and experiencing the event as if it were happening now.

Flashbacks: Not Like You See on TV

Many people are confused about flashbacks because of how they are portrayed in movies or on television.

For example, in the movies you may see images of combat veterans "hitting the deck" and acting out combat traumas, completely unaware of where they are.

While this kind of flashback (called a "full immersion flashback") can happen, usually people will still maintain some awareness of the present moment while they are in a flashback.

So don't let the movie or television portrayal fool you: even if you are experiencing a milder version, you may still be having a flashback.

Flashbacks are closely related to a class of symptoms called dissociative symptoms. Your therapist can help you determine whether you are experiencing other dissociative symptoms of BPD.

Treatment for Flashbacks

Treatment for borderline personality disorder involves psychotherapy. If you are experiencing flashbacks as a symptom of your condition, your clinician will address those as part of your therapy.

Although psychotherapy is the first-line treatment for BPD, your psychiatrist may add medication, such as an antipsychotic drug or a mood stabilizer, if she believes it could be helpful to you.

One very small clinical trial conducted in the late 1990s tested the drug naltrexone — which blocks the effects of opioids in your system and is used to treat alcohol or drug dependence — to treat flashbacks in borderline personality disorder.

A total of nine patients took naltrexone for at least two weeks as part of the study, and six of the nine reported a decrease in the mean number of flashbacks they experienced each day.

However, that study has never been replicated, and few physicians use naltrexone to treat borderline personality disorder.


Bohus MJ et al. Naltrexone in the treatment of dissociative symptoms in patients with borderline personality disorder: an open-label trial. Journal of Clinical Psychiatry. 1999 Sep;60(9):598-603.

Allen JG. Coping With Trauma: Hope Through Understanding. American Psychiatric Association, 2004.

Brewin CR. "Memory processes in Post-traumatic Stress Disorder." International Review of Psychiatry. 13(3):159-163, 2001.

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