What are nightmares?
Nightmares refer to elaborate dreams that cause high levels of anxiety or terror. In general, the content of nightmares revolves around imminent harm being caused to the individual (e.g., being chased, threatened, injured, etc.). When nightmares occur in the context of posttraumatic stress disorder (PTSD), they tend to involve the original threatening or horrifying set of circumstances that was involved during the traumatic event. For example, someone who was in the Twin Towers on September 11, 2001, might experience frightening dreams involving
terrorists, airplane crashes, collapsing buildings, fires, people jumping from
buildings, etc. A rape survivor might experience disturbing dreams about the
rape itself or some aspect of the experience that was particularly frightening
(e.g., being held at knifepoint).
Nightmares can occur multiple times in a given night, or one might
experience them very rarely. Individuals may experience the same dream
repeatedly, or they may experience different dreams with a similar theme. When
individuals awaken from nightmares, they can typically remember them in detail.
Upon awakening from a nightmare, individuals typically report feelings of
alertness, fear, and anxiety. Nightmares occur almost exclusively during rapid
eye movement (REM) sleep. Although REM sleep occurs on and off throughout the
night, REM sleep periods become longer and dreaming tends to become more
intense in the second half of the night. As a result, nightmares are more
likely to occur during this time.
How common are nightmares?
The prevalence of nightmares varies by age group and by gender.
Nightmares are reportedly first experienced between the ages of 3 and 6 years. From 10% to 50% of children between the ages of 3 and 5 have nightmares that are severe enough to cause their parents concern. This does not mean that children with nightmares necessarily have a psychological disorder. In fact, children who develop nightmares in the absence of traumatic events typically grow out of them as they get older. Approximately 50% of adults report having at least an occasional nightmare. Estimates suggest that between 6.9% of the adult population suffer from chronic nightmares.
Women report having nightmares more often than men do. Women report two to
four nightmares for every one nightmare reported by men. It is unclear at this
point whether men and women actually experience different rates of nightmares,
or whether women are simply more likely to report them.
Nightmares and cultural differences
The interpretation of and significance given to nightmares varies
tremendously by culture. While some cultures view nightmares as indicators of
mental health problems, others view them as related to supernatural or
spiritual phenomena. Clinicians should keep this in mind during their
assessments of the impact that nightmares have on clients.
How are nightmares related to PTSD?
As a Vietnam Veteran myself, I take this matter very seriously!
Nightmares are 1 of 17 possible symptoms of PTSD. All of these symptoms are described in the DSM-IV - Diagnostic and Statistical Manual of Mental Disorders.
One does not have to experience nightmares in order to have PTSD. However,
nightmares are one of the most common of the 're-experiencing' symptoms of PTSD, seen in approximately 60% of individuals with
PTSD. A recent study of nightmares in female sexual assault survivors found
that a higher frequency of nightmares was related to increased severity of PTSD symptoms. Little is known about the typical frequency or duration of nightmares in individuals with PTSD.
Are there any effective treatments for nightmares?
Yes. There are both psychological treatments (involving changing thoughts
and behaviors) and psychopharmacological treatments (involving medicine) that
have been found to be effective in reducing nightmares. You may also find many helpful professional psychiatric manuals concerning the diagnosis and treatment of PTSD online at
Go to treatment.