Jones et al (Reference Jones, Vermaas and Beech2003b ) appears to have missed the point of my letter (Reference Burges WatsonBurges Watson, 2003). They define flashbacks as ‘a form of dissociative state’ (Reference Jones, Vermaas and McCartneyJones et al, 2003a ). This is the way the term flashback is used in the DSM-IV; ‘dissociative flashback episodes’ (American Psychiatric Association, 1994). They appear as an example of one of five ways in which ‘the traumatic event is persistently re-experienced’. Only one is necessary for the diagnosis. As such they are not ‘a core symptom’ of post-traumatic stress disorder. As defined in DSM-IV, flashbacks themselves are no more than ‘a recurrence of a memory, feeling or perceptual experience from the past’. This definition may well have been introduced because of the popularity of the term ‘flashback’ and necessary because its original meaning had been changed by popular usage. Jones et al are probably right when they hypothesise that this popularity was encouraged by the use of flashbacks in films and television programmes.

The changing presentation of symptoms associated with the extreme stress of war is indeed interesting. Bizarre dissociative states with physical manifestations, while very common in the First World War, were comparatively rare in the Second World War and very uncommon in Vietnam veterans. Thus, in line with the focus on physical symptoms in earlier wars, it would seem that the presentation of dissociative states has also moved from the physical to the psychological.