Nightmare Disorder

Nightmares can be frightening experiences for anyone, but they are especially traumatic for children. Any parent who has been awakened in the middle of the night by a child's piercing scream can verify how upsetting nightmares can be.

Children have more frequent nightmares than adults and they can become a serious childhood problem. It's estimated that up to 50% of children 3 - 5 years of age have nightmares that are intense enough to disturb their parents. Nightmares are much more terrifying for young children because they have difficulty telling the difference between things that are possible and "real" and those that are not. They are not able to tell themselves "it was only a dream".

Although much research has been done on dreams, the exact cause of nightmares is unknown. It's most likely a combination of many different factors, including individual experiences, differences and age as well as biological and physiological processes. Certain factors such as severe stress, traumatic events and various medications and drugs can trigger nightmares.

Nightmares are most likely to occur during the second half of the night. Females report about twice as many nightmares as males. Most children outgrow nightmares, but some continue to have problems with them into adulthood.

Most night involve imminent physical danger - pursuit, attack or injury to the person or a loved one. Others may be more subtle and involve personal failure or embarrassment. Some repeat a past traumatic event. Children's nightmares usually involve personal danger, such as "a scary monster coming to get me".

When nightmares occur frequently, such as several times a week, they can cause much distress and concern for both the child and parents. Frequent nightmares can result in lack of sleep, anxiety, depression, irritability, poor concentration and difficulty functioning during the day.

Nightmares that cause serious problems may be diagnosed by a mental health professional as Nightmare Disorder. The Statistical Manual of Mental Disorders, fourth edition (DSM-IV) describes diagnostic criteria for Nightmare Disorder.

1. Repeated awakenings from sleep with detailed recall of extremely frightening dreams, usually involving threats to survival, security or self esteem.
2. On awakening, the person rapidly becomes oriented and alert.
3. The dream experience or the sleep disturbance from awakening causes clinically significant distress or restraint in social, occupational or other important areas of functioning.
4. The nightmares do not occur during another mental disorder, due to the effects of a substance (such as a drug) or due to a general medical condition.

For more information on eating disorders, or other questions or comments, call the Trinity Adolescent Program at 574-6596.

This article was written by Pam Lehman, a counselor with the Trinity Recovery Center at Trinity Regional Hospital. Pam has a Master of Science degree in counseling.