Dissociative Flashbacks — MRCPsych Paper B MCQ

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ModerateAnxiety & Stress-Related DisordersDissociative FlashbacksMRCPsych Paper B

A 25-year-old woman with post-traumatic stress disorder describes sudden episodes while awake in which she feels and acts as though the traumatic event is recurring in real time. During these episodes, she becomes unaware of her current surroundings. Which psychopathological phenomenon is the most precise description?

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Correct answer: B — Dissociative reaction (flashback)

The correct answer is B, a dissociative reaction (flashback). The discriminating features are the sense that the traumatic event is recurring in real time and loss of awareness of the present environment. This is more than an intrusive memory and represents a dissociative form of PTSD re-experiencing. Depersonalisation is detachment from oneself, whereas derealisation is a sense that the external world is unreal; neither necessarily involves reliving a trauma. A hallucination is a perception without an external stimulus but does not by itself describe this trauma-linked alteration in present awareness. An illusion is the misinterpretation of a real external stimulus. NICE recognises both re-experiencing and dissociation in PTSD, while the Royal College of Psychiatrists specifically describes this presentation as a dissociative reaction or flashback.

Reference: Royal College of Psychiatrists. Post-traumatic stress disorder (PTSD), section 'Re-experiencing, or intrusion symptoms'. March 2026. https://www.rcpsych.ac.uk/mental-health/mental-illnesses-and-mental-health-problems/post-traumatic-stress-disorder