Nightmare Disorder: Causes, Symptoms and Treatment DSM-5 307.47 (F51.5)

Individuals who suffers from nightmare disorder have frequent dreams that induce anxiety, fear, and other negative feelings. These nightmares usually involve the individuals being in dangerous situations, ones which they attempt to escape. Once the nightmares have awoken them, the individuals can readily and easily remember and recall these dreams.

Nightmares may be characterized by sweating, tachycardia, and tachypnea. Body movements and sleep-talking, which do not characterize nightmares, may also occur during times of emotional stress and sleep fragmentation, but once initiated often end the dream and awaken the individual.

Criteria for Nightmare Disorder DSM-5 307.47 (F51.1)

The following are used to diagnose nightmare disorder, as set forth by the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5):

• The individual has recurrent distressful dreams that typically involve threats to his or her safety or wellbeing, which he or she attempts to avoid, generally occurring during the second half of the major sleep cycle.
• Upon awakening from the nightmare, the individual becomes alert and oriented rather quickly
• The nightmare causes significant distress or impairment in important areas of life (e.g., social or occupational)
• The nightmares are not due to physiological effects of a certain substance (e.g., an abusive drug, a medication)
• Another disorder does not sufficiently explain the prime complaint of distressful dreams.

Specifications for Nightmare Disorder DSM-5 307.47 (F51.1)

Nightmare disorders can vary from person-to-person, such as how often the nightmares occur and over what period of time they have been occurring. Therefore, the following should be specified about the distressful dreams:

• If they occur…
• during sleep onset
• If they are associated with…
• a non-sleep disorder (e.g., substance use disorders)
• If they are associated with other medical conditions
• If they are associated with another sleep disorder
• If they are…
• acute: have lasted 1 month or less
• subacute: have lasted longer than 1 month but less than 6 months
• persistent: have lasted 6 months or longer
• If the severity is…
• mild: the dreams occur less than once per week on average
• moderate: the dreams occur once or more per week but less than nightly
• severe: the dreams occur nightly

Who Is at Risk of Developing This Disorder?

The frequency of nightmares increases though childhood into adolescence, increasing majorly from ages 10 to 13—for both males and females—and again from ages 20-29, only this time exclusively in females. And although the gender difference remains, this prevalence decreases at a steady pace, as both men and women continue to age. Additionally, individuals who suffer from sleep deprivation or inconsistent sleep-wake schedules may be at a higher risk of developing nightmare disorder.

Treatment for Nightmare Disorder

Treatment typically isn’t necessary unless one may be experiencing long periods of extreme distress or sleep disturbance, which may also interfere with daytime functioning. Before seeking or determining the right route for treatment, it’s important to consider the cause of the nightmare disorder. Once this has been considered, treatment may include:

• Medical Treatment: If an underlying medical problem is determined, medical treatment can target the underlying condition.
• Stress or Anxiety Treatment: If stress or anxiety appears to be contributing to the distressful dreams, stress-reduction methods and/or therapy may help
• Imagery Rehearsal Therapy: Those who have nightmares due to PTSD may benefit from imagery rehearsal therapy, as it works to change the ending of a remembered threat or nightmare while awake, in order to remove the threat.
• Medication: Though it is rarely used to treat nightmare disorder, medication may be recommended to help those with PTSD, suffering from severe nightmares.

The Role of Horror Movies

When we were younger, we were always told to not watch scary movies before bed. If we did, we took the risk of falling victim to sleepless nights due to fear of a monster hiding in our closet or a ghost haunting our house. And while science says scary movies aren’t super likely of inciting nightmares, it is possible and it does happen. Below are a few of the most well-known, horror films, definitely capable of triggering some bad dreams:

• Scream: A psychopath, who is always shown wearing a black gown and white mask, taunts his victims with phone calls and knocks on their doors before taking their lives. Some find the storyline and acting comical, but the movie definitely has the potential of sparking some paranoia in you as you climb into bed.
• The Exorcist: The original movie is about a priest performing an exorcism on a young girl he believes had become possessed by the devil. The disturbing exorcism scene certainly has the power to linger in your head at night.
• Halloween: A young boy, Michael Myers, is locked away for 15 years after murdering his 17-year old sister; however, on October 30 a few years later, he escapes and returns to his hometown where he continues to hunt down other victims. Many who watch this grow fearful of crazy killers like Michael.
• It: Those who aren’t too fond of clowns should probably steer clear of this movie: it’s all about a scary, mysterious clown tormenting young children.

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