Characteristics of chronic nightmares in a trauma-exposed treatment-seeking sample.

Chronic nightmares pose a significant problem for many individuals affected by trauma. The present study attempts to extend current knowledge on the nature, characteristics, and associated sequelae of chronic nightmares. Data were collected from 94 trauma-exposed, treatment-seeking participants (74 women and 20 men). These data suggest that most participants reported their nightmares to be similar or dissimilar to their traumatic experience rather than exact replications (replicative). Not surprisingly, though, nightmare-related distress was positively related to the degree of similarity between their nightmare and their trauma, with replicative nightmares eliciting the greatest distress. Persons with a current diagnosis of posttraumatic stress disorder (PTSD) were more likely to report problems related to nightmares and sleep disturbance than persons without current PTSD. Nonetheless, even after controlling for PTSD-related symptomatology, frequency and severity of nightmares significantly predicted some distress outcomes (e.g., poor sleep quality), suggesting that nightmares contribute to psychological distress above and beyond PTSD symptoms. Implications for future research, and for the treatment of nightmares and PTSD, are discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

TV viewing, computer game playing and nightmares in school children.

Often the question arises whether TV viewing or playing computer games, especially those of violent and aggressive content, has negative effects on children's sleep patterns and dreaming. Empirical data on this topic, however, are scarce. Two hundred fifty-two schoolchildren (range: 9 to 13 years) completed a questionnaire about media use and nightmares. The findings indicates that interindividual differences in nightmare frequency were not explained by interindividual differences in TV viewing or computer game playing habits. In addition, no effect of the TV films the evening before completing the questionnaire on the dreams the subsequent night could be demonstrated. Since the approach could not rule out an effect of media use habits on nightmares, the next step will be a longitudinal study eliciting the media use habits and the occurrence of nightmares by applying self-rated scales as well as information obtained by parents. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Nightmares Among Cambodian Refugees: The Breaching of Concentric Ontological Security

This article explores the nightmares of Cambodian refugees in a cultural context, and the role of nightmares in the trauma ontology of this population, including their role in generating post-traumatic stress disorder (PTSD). Among Cambodian refugees attending a psychiatric clinic, we found that having a nightmare was strongly associated with having PTSD (χ² = 61.7, P < 0.001, odds ratio = 126); that nightmares caused much distress upon awakening, including panic attacks, fear of bodily dysfunction, flashbacks and difficulty returning to sleep; that nightmare content was frequently related to traumatic events; that nightmares resulted in a decrease in the sense of “concentric ontology security” (i.e., in an increased sense of physical and spiritual vulnerability in a culture that conceives of the self in terms of concentric, protective layers), including fears of being attacked by ghosts; and that nightmares frequently led to the performance of specific practices and rituals aiming to extrude and repel attacking forces and to create “protective layers.” Cases are presented to illustrate these findings. The Discussion considers some treatment implications of the study.

One's sex,sleep, and posttraumatic stress disorder

Women are approximately twice as likely as men to develop posttraumatic stress disorder (PTSD) after trauma exposure. Mechanisms underlying this difference are not well understood. Although sleep is recognized to have a critical role in PTSD and physical and psychological health more generally, research into the role of sleep in PTSD sex differences has been only recent. In this article, we review both animal and human studies relevant to sex differences in sleep and PTSD with an emphasis on the roles of sex hormones. Sleep impairment including insomnia, trauma-related nightmares, and rapid-eye-movement (REM) sleep fragmentation has been observed in individuals with chronic and developing PTSD, suggesting that sleep impairment is a characteristic of PTSD and a risk factor for its development. Preliminary findings suggested sex specific patterns of sleep alterations in developing and established PTSD. Sleep maintenance impairment in the aftermath of trauma was observed in women who subsequently developed PTSD, and greater REM sleep fragmentation soon after trauma was associated with developing PTSD in both sexes. In chronic PTSD, reduced deep sleep has been found only in men, and impaired sleep initiation and maintenance with PTSD have been found in both sexes. A limited number of studies with small samples have shown that sex hormones and their fluctuations over the menstrual cycle influenced sleep as well as fear extinction, a process hypothesized to be critical to the pathogenesis of PTSD. To further elucidate the possible relationship between the sex specific patterns of PTSD-related sleep alterations and the sexually dimorphic risk for PTSD, future studies with larger samples should comprehensively examine effects of sex hormones and the menstrual cycle on sleep responses to trauma and the risk/resilience for PTSD utilizing various methodologies including fear conditioning and extinction paradigms and animal models.     

Affective and Personality Characteristics in Function of Nightmare Prevalence, Nightmare Distress, and Interference Due to Nightmares.

This study analyzes the relationships among nightmare frequency, nightmare distress, and interference due to nightmares, sleep quality, psychopathology (anxiety and depression), and personality (neuroticism, psychoticism, and boundaries). The nightmare parameters were evaluated with the Nightmare Frequency Questionnaire (B. Krakow et al., 2000; see also record 2000-16731-002), the Nightmare Distress Questionnaire (K. Belicki, 1992b; see also record 1993-08389-001), and the Nightmare Effects Survey (Krakow et al., 2000). The sample was composed of 147 healthy students. The results demonstrated that the 2 measurements of distress (subjective distress associated with nightmares and, especially, deterioration of psychosocial functioning) were the dimensions that best related to the variables studied, although the relationships were modulated by nightmare frequency. The parameter of nightmare frequency was found to be useful as an indicator of certain personality characteristics rather than psychological perturbation. Having nightmares on a weekly basis was strongly associated with depressed mood. The knowledge about these relations is relevant not only theoretically but also as a practical guide. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Nightmare frequency as a function of age, gender, and September 11, 2001: Findings from an Internet questionnaire.

Retrospective estimates of nightmare frequency for a sample of 23,990 respondents to an Internet questionnaire (female: N = 19,367, mean age = 24.9 ± 10.14 years; male: N = 4,623; mean age = 25.5 ± 10.81) were evaluated as a function of age, gender, and pre- versus post-September 11, 2001. Female respondents reported more frequent monthly nightmares (4.44 ± 6.71) than did male respondents (3.39 ± 6.07), and this result was seen for all age strata younger than 60. Also, for female respondents, nightmare frequency increased from ages 10-19 to 20-39 then decreased monotonically to ages 50-59. For male respondents, nightmare frequency was stable from ages 10-19 to 30-39 then decreased to ages 50-59. An increase in nightmare frequency was observed post-September 11 only for male respondents-particularly for 10- to 29-year-olds. This increase was sustained 2 years later. These effects were maintained when dream recall was held constant. Results replicate, in a single sample, previously published gender and age effects and provide new evidence that the nightmares of males may be differentially sensitive to traumatic events for which victims and/or perpetrators are primarily male. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Lucid Dreaming Treatment for Nightmares: A Series of Cases

Goal of this series of cases was to investigate lucid dreaming treatment for nightmares. Hypotheses were that lucid dreaming treatment would decrease nightmare frequency and state/trait anxiety, and improve the quality of sleep. Eight participants received a one-hour individual session, which consisted of lucid dreaming exercises and discussing possible constructive solutions for the nightmare. Nightmare frequency and sleep quality were measured by a sleep questionnaire, anxiety was measured by the Spielberger State and Trait Anxiety Inventory. At the follow-up two months later the nightmare frequency had decreased, while the sleep quality had increased slighty. There were no changes on state and trait anxiety. Lucid dreaming treatment seems to be effective in reducing nightmare frequency, although the effective factor remains unclear.     

Differences in the relationship between nightmares and coping with stress for Asians and Caucasians: A brief report.

In contrast to posttraumatic nightmares, some nightmares can also be idiopathic. Previous research indicates that nightmares may serve a beneficial function as there is a positive relationship between nightmares and “waking” coping strategies. As a result, nightmares may fit into a continuity of coping throughout the sleep/wake cycle. In the present analysis, the relationship between nightmares and one measure of coping was only significant for those who identified themselves as Asian when compared those who identified themselves as Caucasian. These results represent one of the first differences in nightmares between ethnic groups. Such research is important for understanding the role of idiopathic nightmares in coping and understanding the importance of ethnicity when presented with patients complaining of nightmares. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Behavioral Effects of Nightmares and Their Correlations to Personality Patterns

Factors affecting or inducing nightmares have been investigated repeatedly. However, little research is carried out on the behavioral consequences of nightmares. The present study thus served to investigate behavioral effects of nightmares in correlation to personality variables. 41 non-clinical participants, who suffer from about 2 nightmares per month recorded their dreams and nightmares over a 4-week period. A nightmare was defined as a dream that frightens the dreamer and could be recalled in detail on awakening. Anxiety and mood were monitored every morning. All nightmares and their behavioral consequences were noted on a questionnaire. Personality traits and life events were assessed at the beginning of the investigation. 100 nightmares were reported by the subjects over the 4-week period (range: 0–8). Following a nightmare, the subjects were significantly more anxious and were of a less stable mental condition compared to nights without nightmares. Additionally, nightmares induced physical complaints. This was considered to be an indicator that something was wrong in their lives and induced them to solve personal problems. The behavioral effects were most pronounced in subjects scoring high on neuroticism and on the number of physical complaints and low on achievement orientation and openness. The results suggest that sufferers of nightmares intend to change their lives, especially those with a neurotic-like personality.     

Comparison of dream anxiety and subjective sleep quality between chronotypes

Morning and evening-type individuals differ on a number of psychological and biological variables. In this study, we aimed to investigate the relationship between sleep quality, dream anxiety, and chronotypes. A sample of 264 university students, aged between 17 and 26 years, completed the Morningness-Eveningness Questionnaire, the Pittsburgh Sleep Quality Index, and the Van Dream Anxiety Scale for assessing nightmare frequency and the dream anxiety caused by frightening dreams. Main findings indicated that evening-type individuals were significantly more likely to suffer from poor sleep quality, daytime dysfunction, nightmares, and nightmare-related disturbances as compared to either intermediate- or morning-type individuals. Previous studies have pointed out the possible connections of irregular sleep-wake habits and circadian dysregulation with a tendency to reveal eveningness chronotypical characteristics. Current findings suggest that evening-type individuals are more prone to experience psychologically deteriorating nightmares and sleep-related anxiety. Poor sleep quality is also a significant antecedent of dream anxiety after controlling for age and gender.

     

Nightmares as a Coping Mechanism for Stress

The cause of nightmares remains unclear. However, previous research suggests that stress may play a key role and that nightmares may actually serve a beneficial function. Thus, the purpose of this study was to examine the overall relationship between these two variables and assess the hypothesis that nightmares serve as a coping mechanism for stress. To accomplish these goals, a group of 412 psychology students were separated into low, medium, and high nightmare frequency groups as well as low, medium, and high nightmare intensity groups. Comparisons were then conducted for daily stressors, life stressors, social support, and coping. Most notably, this study demonstrated a positive association between nightmares and coping with stress. The overall pattern seen in the analyses reflect the significant relationship between nightmares and stress, while the finding that nightmares were positively associated with coping bolsters the supposition that nightmares may help to alleviate stress.     

Sleeping Patterns of Afghan Unaccompanied Asylum-Seeking Adolescents: A Large Observational Study

Unaccompanied asylum-seeking children (UASC) have experienced multiple traumas and are a high-risk group for posttraumatic stress disorder (PTSD). The effects of trauma are known to be associated with sleep problems; indeed sleeping problems are core features of PTSD. However, there has been no systematic research examining the sleep of this high risk group of children. This study presents the first evidence on the sleeping patterns of Afghan UASC living in the UK. A total of 222 male Afghan children, aged 13–18, were interviewed using validated self-report questionnaires measuring sleeping patterns and PTSD. Overall, UASC patterns for bed time and rise time appear acculturated to the country of asylum. Mean UASC sleep onset latency scores were approximately 20 minutes greater compared with normative scores, which may be a reflection of UASC pre-migration and post-migration experiences. As expected, UASC who screened above the clinical cut-off for PTSD reported significantly greater sleep onset latency, increased nightmares, and less total sleep time compared to the non-PTSD group. The results may be of particular interest to clinicians given that, compared to screening for PTSD, screening for sleep problems may be a less culturally disputed form of initial assessment indicating distress in UASC. Similarly, the field of UASC and refugee child interventions is largely focused on trauma, yet sleep may provide a novel avenue for equally or more effective treatment.     

Trait–state interactions in the etiology of nightmares.

Various personality and psychopathology traits are associated with nightmare frequency. This study investigated whether trait variables might also account for individual differences in the longitudinal relationship between daily mood and nightmare incidence each night. Forty-two participants (35 women, 7 men; mean age = 40.10 years) reported having nightmares at least once per month and completed a 14-day dream and mood (anxiety and depression) log. Within-subject correlations between state anxiety and nightmare incidence or absence the following night and between state depression and nightmare incidence or absence were computed. None of the trait measures had significant correlations with these within-subject correlations. However, when only participants scoring above the group median on Hartman’s thin boundariness were analyzed, thin boundariness, Symptom Checklist—Global Severity, adverse life events, and childhood adversity were associated with the incidence of nightmares as a function of state anxiety or depression on a night-by-night basis, with correlation coefficients between .43 and .52. This supports the hypothesis of trait predispositions for a nightmare reaction to daily state anxiety or depression. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Nepali Concepts of Psychological Trauma: The Role of Idioms of Distress,Ethnopsychology and Ethnophysiology in Alleviating Suffering and Preventing Stigma

In the aftermath of a decade-long Maoist civil war in Nepal and the recent relocation of thousands of Bhutanese refugees from Nepal to Western countries, there has been rapid growth of mental health and psychosocial support programs, including posttraumatic stress disorder treatment, for Nepalis and ethnic Nepali Bhutanese. This medical anthropology study describes the process of identifying Nepali idioms of distress and local ethnopsychology and ethnophysiology models that promote effective communication about psychological trauma in a manner that minimizes stigma for service users. Psychological trauma is shown to be a multifaceted concept that has no single linguistic corollary in the Nepali study population. Respondents articulated different categories of psychological trauma idioms in relation to impact on the heart-mind, brain-mind, body, spirit, and social status, with differences in perceived types of traumatic events, symptom sets, emotion clusters and vulnerability. Trauma survivors felt blamed for experiencing negative events, which were seen as karma transmitting past life sins or family member sins into personal loss. Some families were reluctant to seek care for psychological trauma because of the stigma of revealing this bad karma. In addition, idioms related to brain-mind dysfunction contributed to stigma, while heart-mind distress was a socially acceptable reason for seeking treatment. Different categories of trauma idioms support the need for multidisciplinary treatment with multiple points of service entry.     

Personal Boundaries and Nightmare Consequences in Frequent Nightmare Sufferers

According to the boundary concept of Hartmann (1991), the occurence of nightmares was repeatedly shown to be correlated to thin personal boundaries. The present study investigated the relationship between boundary thinness and emotional, cognitive, and behavioral consequences of nightmares in frequent nightmare sufferers. Occurence of nightmares and their respective consequences were recorded daily during a 4-week period by diaries and questionnaires. Confirming previous results, frequent nightmare sufferers had significantly thinner personal boundaries than occasional nightmare sufferers, and nightmare frequency was positively correlated to boundary thinness. In frequent nightmare sufferers, the emotional and cognitive consequences of a nightmare as well as its possible explanations were correlated to boundary thinness; mainly the personal total score and the Boundary Questionnaire scales sleep/wake/dreams, thoughts/feelings/mood and sensitivity. The results indicate that although nightmare frequency is positively correlated to thin personal boundaries, only particular aspects of the concept of personal boundaries are correlated to emotional and cognitive consequences of the nightmares.     

Psychological adjustment in children after traumatic disfiguring injuries: a 12-month follow-up

The psychological adjustment of 57 children (age range, 3 to 12 years) who sustained mutilating traumatic injuries to the face or upper or lower extremities was assessed over a 12-month interval. The injuries had occurred as a result of boating, lawn mower, or home accidents or dog bites. Within 5 days of the traumatic event, 98 percent of the children were symptomatic for posttraumatic stress disorder, depression, or anxiety. One month after the injury, 82 percent were symptomatic. Symptom frequency had declined by the time of the 3-month and 6-month evaluations, but 44 percent of the children continued to report symptoms at 12-month follow-up visits, and 21 percent met the diagnostic criteria for posttraumatic stress disorder. Typical symptoms included flashbacks, fear of re-injury, mood disorders, body-image changes secondary to disfigurement, sleep disturbances, and anxiety. These findings support the importance of psychological evaluation and treatment of children who suffer mutilating injuries that require the attention of plastic surgeons.     

Narrative Length and Speech Rate in Battered Women

Narrative length and speech rate of traumatic recollections have been previously associated with different emotions and adjustment trajectories after trauma. However, the evidence is limited and the results are mixed. The present study aimed to evaluate length (i.e., word count) and speech rate (i.e., words per minute) in narratives of events with different valence (i.e., neutral, positive, and negative/traumatic) by 50 battered women (trauma group) and 50 non-traumatized women (controls). The results showed that traumatic narratives by the trauma group were longer than those by the control group. Moreover, they were inversely related to time since the event and anxiety during disclosure, whereas the speech rate was also inversely associated with anxiety, as well as with peritraumatic dissociation and avoidance. The shorter narratives for positive events and a decelerated speech pattern for traumatic experiences predicted psychological symptoms. Additionally, the individual’s emotional state predicted narrative aspects, with bidirectional effects. Our findings showed that linguistic characteristics of traumatic narratives (but also of narratives of positive events) revealed information about how the victims elaborated autobiographical memories and coped with the trauma.     

Trauma-Associated Tinnitus: Audiological,Demographic and Clinical Characteristics

Background

Tinnitus can result from different etiologies. Frequently, patients report the development of tinnitus after traumatic injuries. However, to which extent this specific etiologic factor plays a role for the phenomenology of tinnitus is still incompletely understood. Additionally, it remains a matter of debate whether the etiology of tinnitus constitutes a relevant criterion for defining tinnitus subtypes.

Objective

By investigating a worldwide sample of tinnitus patients derived from the Tinnitus Research Initiative (TRI) Database, we aimed to identify differences in demographic, clinical and audiological characteristics between tinnitus patients with and without preceding trauma.

Materials

A total of 1,604 patients were investigated. Assessment included demographic data, tinnitus related clinical data, audiological data, the Tinnitus Handicap Inventory, the Tinnitus Questionnaire, the Beck Depression Inventory, various numeric tinnitus rating scales, and the World Health Organisation Quality of Life Scale (WHOQoL).

Results

Our data clearly indicate differences between tinnitus patients with and without trauma at tinnitus onset. Patients suffering from trauma-associated tinnitus suffer from a higher mental burden than tinnitus patients presenting with phantom perceptions based on other or unknown etiologic factors. This is especially the case for patients with whiplash and head trauma. Patients with posttraumatic noise-related tinnitus experience more frequently hyperacousis, were younger, had longer tinnitus duration, and were more frequently of male gender.

Conclusions

Trauma before tinnitus onset seems to represent a relevant criterion for subtypization of tinnitus. Patients with posttraumatic tinnitus may require specific diagnostic and therapeutic management. A more systematic and – at best - standardized assessment for hearing related sequelae of trauma is needed for a better understanding of the underlying pathophysiology and for developing more tailored treatment approaches as well.     

Response variation following trauma: a translational neuroscience approach to understanding PTSD

Exposure to traumatic stress is a requirement for the development of posttraumatic stress disorder (PTSD). However, because the majority of trauma-exposed persons do not develop PTSD, examination of the typical effects of a stressor will not identify the critical components of PTSD risk or pathogenesis. Rather, PTSD represents a specific phenotype associated with a failure to recover from the normal effects of trauma. Thus, research must focus on identifying pre- and posttraumatic risk factors that explain the development of the disorder and the failure to reinstate physiological homeostasis. In this review, we summarize what is known about the clinical and biological characteristics of PTSD and articulate some of the gaps in knowledge that can be addressed by basic neuroscience research. We emphasize how knowledge about individual differences related to genetic and epigenetic factors in behavioral and brain responses to stress offers the hope of a deeper understanding of PTSD.