Nightmares in mental disorders: A review.

Abstract

No review has specifically focused on the experience of nightmares in individuals with a mental disorder. With a better understanding of nightmares in this population, clinicians will be more inclined to investigate for the presence of chronic nightmares, to consider nightmares for prognosis, and to treat this sleep difficulty independently from other mental disorders. Therefore, this narrative review aims to summarize the most relevant literature on the experience of nightmares in posttraumatic stress disorder (PTSD), depressive disorders and bipolar disorders, anxiety disorders and obsessive-compulsive disorder, attention-deficit/hyperactivity disorder, schizophrenia spectrum disorders, substance use disorders, autism spectrum disorder, eating disorders, and personality disorders. Differences in the experience of nightmares between mental disorders are also addressed. Expectedly, the positive relationship between nightmares and PTSD is the most empirically supported. Empirical data generally support a positive relationship between nightmares and other mental disorders, with the autism spectrum disorder being an exception. Moreover, the presence of nightmares in individuals with a mental disorder is often associated with poorer mental health, poorer sleep, and a greater risk for suicide. In conclusion, this review highlights the importance for clinicians to investigate for the presence of chronic nightmares along with other sleep difficulties (most commonly, insomnia and sleep apnea), to consider the potential influence of nightmares on the course of the primary mental disorder, and to be prepared to grant access to treatments targeting nightmares.

Disturbing Dreams and Psychosocial Maladjustment in Children: A Prospective Study of the Moderating Role of Early Negative Emotionality

“…First, DD frequency is associated with other sleep-related problems including insomnia, sleepwalking, bruxism, sleep talking, sleep terrors, nighttime awakenings, and unwillingness to go to bed ( 29 – 37 ). Second, DDs have also been linked to a range of specific mental health symptoms and psychosocial problems, including low prosociality ( 37 , 38 ), academic problems ( 33 ), emotional excitability and being easily emotionally hurt ( 39 ), emotional symptoms ( 37 , 38 , 40 ), psychotic experiences ( 41 , 42 ), borderline personality disorder ( 40 ), other mental health disorders ( 43 ), as well as suicidal ideation and suicide attempts ( 44 – 46 ). A prospective study found that DD frequency at 12 years of age was related to symptoms of psychosis during adulthood ( 47 ).…”

Nightmares in Children with FASD, ASD and Their Typically Developing Peers

“…In one narrative review by Lemyre et al [37], nightmare frequency was reported to be positively related to psychiatric outcomes such as posttraumatic stress, depressive, bipolar, anxiety and obsessive compulsive disorders, but not in ASD where they report the association between nightmares and psychometric outcomes is less clear. In this narrative review, adults with ASD were reported to have significantly fewer nightmares than controls and there appeared to be no relationship between ASD and nightmares in children and adolescents [37]. Inconsistent to previously reported data on nightmares in children with ASD, our study reports that children with ASD experienced a significantly higher number of nightmares than their TD peers.…”

“…However the phenotypic presentation of nightmares in this population is less clear. Adults with ASD are reported to experience fewer nightmares than controls [37] whilst in paediatric ASD populations the incidence of parasomnias is higher [29], but nightmare frequency is variable in comparison to controls [37], with one study by Chou and colleagues [38] assessing 345 children with ASD, controls and siblings finding that siblings were more likely to experience nightmares than controls or the clinical population [38].…”

Nightmares in Children with Foetal Alcohol Spectrum Disorders, Autism Spectrum Disorders, and Their Typically Developing Peers

“…However, the phenotypic presentation of nightmares in this population is less clear. Adults with ASD are reported to experience fewer nightmares than controls [ 37 ], whilst in paediatric ASD populations the incidence of parasomnias is higher [ 29 ] but nightmare frequency is variable in comparison to controls [ 37 ]. One study with 345 children with ASD, controls and siblings demonstrated that siblings were more likely to experience nightmares than controls or the clinical population [ 38 ].…”