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A link between nightmares and suicidal behavior

Nightmare bed

Image credit goes to: Joshua Hoffine

A new study is the first to report that the relationship between nightmares and suicidal behaviors is partially mediated by a multi-step pathway via defeat, entrapment, and hopelessness. Results show that suicidal thoughts, plans or attempts were present in 62 percent of participants who experienced nightmares and only 20 percent of those without nightmares.

Multiple analysis’ suggest that nightmares may act as a stressor in people with post-traumatic stress disorder (PTSD). The nightmares may trigger specific types of negative cognitive thoughts — such as defeat, entrapment, and hopelessness — which reinforce suicidal thoughts and behaviors. The pathways between nightmares and suicidal behaviors appear to operate independently of comorbid insomnia and depression.

“PTSD increases the risk of suicidal thoughts and behavior, and our study shows that nightmares, a hallmark symptom of PTSD, may be an important treatment target to reduce suicide risk,” said principal investigator Donna L. Littlewood, PhD.

“This study emphasizes the importance of specifically assessing and targeting nightmares within those individuals experiencing PTSD. In addition, monitoring and targeting levels of negative cognitive appraisals such as defeat, entrapment, and hopelessness, may reduce suicidal thoughts and behaviors.”

The American Academy of Sleep Medicine reports that nightmares are vivid, realistic and disturbing dreams typically involving threats to survival or security, which often evoke emotions of anxiety, fear or terror. A nightmare disorder may occur when repeated nightmares cause distress or impairment in social or occupational functioning.

Nightmares beginning within three months of a trauma are present in up to 80 percent of patients with PTSD, and these post-traumatic nightmares may persist throughout life.

Data for this study was collected from 91 participants who had experienced traumatic events, 51 of whom met criteria for PTSD currently, and an additional 24 of whom reported a prior diagnosis of PTSD. Nightmares were measured by summing the frequency and intensity ratings of relevant items on the clinician-administered PTSD scale.

Participants also completed questionnaire measures of suicidal behavior, hopelessness, defeat, and entrapment. Given the interactions between insomnia, PTSD, and suicide, a measure of insomnia was included as a covariate. Analysis was also conducted with and without those participants who had comorbid depression.

The authors suggest there are additional pathways underpinning the relationship between nightmares and suicide that should be identified through further research.

Sources:
Littlewood, D., Gooding, P., Panagioti, M., & Kyle, S. (2016). Nightmares and Suicide in Posttraumatic Stress Disorder: The Mediating Role of Defeat, Entrapment, and Hopelessness Journal of Clinical Sleep Medicine, 12 (03), 393-399 DOI: 10.5664/jcsm.5592

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