Nightmare Disorder

Nightmare Disorder is a condition that involves repeated awakenings from the major sleep period or naps with detailed recall of extended and extremely frightening dreams, usually involving threats to survival, security, or self-esteem. The awakenings generally occur during the second half of the sleep period.

On awakening from the frightening dreams, the person rapidly becomes oriented and alert (in contrast to the confusion and disorientation seen in Sleep Terror Disorder and some forms of epilepsy).

The dream experience, or the sleep disturbance resulting from the awakening, causes clinically significant distress or impairment in social, occupational, or other important areas of functioning.

The dream experience, or the sleep disturbance resulting from the awakening, causes clinically significant distress or impairment in social, occupational, or other important areas of functioning.

The nightmares do not occur exclusively during the course of another mental disorder (e.g., a delirium, Posttraumatic Stress Disorder) and are not due to the direct physiological effects of a substance (e.g., a durg of abuse, a medication) or a general medical condition.

During a Typical Episode

Nightmares typically occur in a lengthy, elaborate dream sequence that is highly anxiety provoking or terrifying. Dream content most often focuses on imminent physical danger to the individual (e.g., pursuit, attack, injury).

In other cases, the perceived danger may be more subtle, involving personal failure or embarrassment. Nightmares that occur after traumatic experiences may replicate the original dangerous or threatening situation, but most nightmares do not recount actual events.

On awakening, individuals with this disorder can describe the dream sequence and content in detail. Individuals may report multiple nightmares within a given night, often with a recurrent theme. Nightmares arise almost exclusively during rapid eye movement (REM) sleep. Because REM episodes occur periodically throughout nocturnal sleep (approximately every 90–110 minutes), nightmares may also occur at any time during the sleep episode.

Diagnostic criteria summarized from:

American Psychiatric Association. (1994). Diagnostic and statistical manual of mental disorders, fourth edition. Washington, DC: American Psychiatric Association.