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Flashbacks and PTSD.

Jones et al (2003) claim to provide evidence that flashbacks in post-traumatic stress disorder (PTSD) are culture-bound because they were reported less frequently following earlier conflicts. They discuss the central issue of whether this was due to an underreporting bias either because patients declared them less frequently or because doctors did not ask about them. In this discussion they conclude that this was not probable because the veterans were assessed frequently and because they were financially motivated by the prospect of a war pension. They have ignored the most important counter-argument that veterans of recent conflicts are most likely to overreport flashbacks in order to obtain compensation because: (a) the PTSD criteria are now publicised by the media; and (b) enquiry about flashbacks is now included in the routine clinical assessment of veterans. A systematic study of exaggerating PTSD symptoms for compensation claims (LeesHaley, 1997) indicates that at least 25% of present-day claimants overreport psychological symptoms. In earlier conflicts the post-trauma flashback symptom was mostly unknown by soldiers, clinicians or the media and there is no evidence of a ‘compensation culture’ at that time. Therefore, Jones et al’s finding probably has more to do with the cultural aspects of compensation and malingering than the cultural aspects of PTSD. In failing to deal with this important issue I do not believe the authors have provided sufficiently strong causal evidence for their conclusion ‘that some characteristics of PTSD are culture-bound’.