Nightmares and PTSD: Characterization, Theories, and Treatment Approaches

Abstract

Twenty-five years ago, the nightmares typically experienced in the course of PTSD were first referred to as a hallmark of the disorder. PTSD-related nightmares share some characteristics with idiopathic nightmares, but the often trauma-replicating nature of disturbing dreams experienced by individuals with PTSD continues to be a key clinical manifestation of PTSD. A number of validated measures have been developed to measure the frequency, intensity, content, and clinical significance of nightmares. The neurobiologic mechanisms underlying the development and persistence of replicative nightmares in PTSD are still being investigated. Two sets of psychological theories of dreaming, threat simulation theory and theories related to emotional adaptation, provide some context for understanding nightmares. Clinically, nightmares in PTSD are associated with significant distress and morbidity. In addition to psychological interventions that may reduce the frequency and intensity of nightmares, numerous medications have been evaluated for the treatment of nightmares with prazosin standing out as the most promising of these pharmacotherapies.