Nightmares and bad dreams in patients with borderline personality disorder: Fantasy as a coping skill?

Abstract

Background and Objectives: Previous studies reported a high prevalence of nightmares and dream anxiety in Borderline Personality Disorder (BPD) and the severity of dream disturbances correlated with daytime symptoms of psychopathology. However, the majority of these results are based on retrospective questionnaire-based study designs, and hence the effect of recall biases (characteristic for BPD), could not be controlled. Therefore our aim was to replicate these findings using dream logs. Moreover, we aimed to examine the level of dream disturbances in connection with measures of emotional instability, and to explore the protective factors against dream disturbances. Methods: 23 subjects diagnosed with BPD, and 23 age and gender matched healthy controls were assessed using the Dream Quality Questionnaire, the Van Dream Anxiety Scale, as well as the Neuroticism, Assertiveness and Fantasy scales of the NEO-PI-R questionnaire. Additionally, subjects were asked to collect 5 dreams in the three-week study period and to rate the emotional and phenomenological qualities of the reported dreams using the categories of the Dream Quality Questionnaire. Results: Dream disturbances (nightmares, bad dreams, night terror-like symptoms, and dream anxiety) were more frequent in patients with BPD than in controls. Dream disturbances correlated positively with Neuroticism, while Fantasy proved to be a negative correlate of dream disturbances. Conclusions: Our study provides further support for the association between dream disturbances and BPD, links the presence of dream disturbances to the levels of emotional instability, and suggests that fantasy is a potential protective factor against dysfunctional dreaming.