STUDY OBJECTIVES: The relationship between nightmare prevalence, nightmare distress, and self-reported psychological disturbance was assessed prospectively. DESIGN: Differences in self-reported psychological disturbance as a function of nightmare prevalence was investigated by MANCOVA's with non-nig

STUDY OBJECTIVES: The relationship between nightmare prevalence, nightmare distress, and self-reported psychological disturbance was assessed prospectively. DESIGN: Differences in self-reported psychological disturbance as a function of nightmare prevalence was investigated by MANCOVA's with non-nightmare dreams as the covariate as well as Pearson correlations. The relative contribution of nightmare prevalence and distress to the prediction of psychological disturbance was investigated through multiple regression analyses. SETTING: N/A. PARTICIPANTS: 116 participants (mean age = 20 years) completed self-report indices of depression, anxiety, dissociation, psychosis-proneness, and a psychiatric symptom checklist and kept a nightmare log for 21 consecutive nights. INTERVENTIONS: N/A. MEASUREMENTS AND RESULTS: Frequent nightmares were associated with higher levels of psychological disturbance. Individuals who reported 3 or more nightmares across the 3 weeks reported more dissociation, psychosis-proneness and psychiatric symptoms than participants reporting 2 nightmares or less. However, nightmare prevalence and distress were not significantly correlated and differentially predicted to different types of waking psychological disturbance. Multiple regressions further indicated that nightmare distress accounted for much of the unique explanatory variance in predicting clinical states associated with high negative affect (anxiety and depression). Last, there was no evidence for a specific relationship between nightmares and psychosis-proneness. CONCLUSIONS: The findings suggest that it is not the incidence of nightmares which is associated with poorer waking psychological functioning, especially anxiety and depression states, but the reported distress associated with the nightmare experience which is the critical variable in predicting higher psychological disturbance.

Nightmares are a prevalent parasomnia associated with a range of psychiatric conditions and pathological symptoms. Current knowledge about how nightmares are produced is still influenced by neo-psychoanalytic speculations as well as by more recent personality, evolutionary and neurobiological models

Nightmares are a prevalent parasomnia associated with a range of psychiatric conditions and pathological symptoms. Current knowledge about how nightmares are produced is still influenced by neo-psychoanalytic speculations as well as by more recent personality, evolutionary and neurobiological models. A majority of these models stipulate some type of emotionally adaptive function for dreaming, e.g., image contextualization, affect desomatization, mood regulation or fear extinction. Nightmares are widely seen to be either an intensified expression of an emotionally adaptive function or, conversely, as evidence of its breakdown. Our recent, affective network dysfunction (AND) model, integrates the tenets of many prior models in proposing that nightmares reflect problems with the fear extinction function of dreaming. This new model accounts for a wide range of dysphoric dream imagery (bad dreams, idiopathic nightmares, post-traumatic nightmares) and incorporates recent findings in the areas of brain imaging, sleep physiology, PTSD, anxiety disorders and the consolidation and extinction of fear memories.