Emotional Content in PTSD Nightmares and Its Relation to other PTSD Features: An Exploratory Study

Nightmares are a cardinal symptom of Post-Traumatic Stress Disorder (PTSD), but little is known about the experiential aspects of PTSD nightmares. The present study is a secondary exploration of baseline data collected in a randomized, controlled trial of prazosin in PTSD patients. This study examined affective attributes of nightmares in 20 PTSD patients using visual analogue scales (VAS) rated from “0” (never) to “100” (always) for anger, fear, and sadness. PTSD diagnosis was confirmed by Clinician-Administered PTSD Scale. Sitting pulse, Disturbing Dreams and Nightmare Severity Index (DDNSI), PTSD Checklist (PCL), and other psychiatric measurements were recorded. Analytic approach included Pearson’s r, paired t-tests, and multilinear regression modeling. The mean presence of anger, fear, and sadness in dreams was noted to have been: 54.9 ± 32.0, 76.6 ± 24.3, and 71.5 ± 26.2, respectively. Significant positive correlations were found between anger scores and the relation of a dream to: prior trauma (r= 0.5113), repetitive nature (r= 0.4807), and awakening the dreamer (r= 0.5781). Significant correlations were not seen for fearful or sad affects. In multilinear regression, “PCL minus sleep” scores were predicted by DDNSI and anger scores, after covarying for age and gender (F= 4.5, df = 19, p< 0.02). DDNSI scores and resting pulse were significantly positively correlated (r= 0.5541). These results confirm that PTSD nightmares are negative-affect laden, and specifically, that anger in dreams is correlated with a greater degree of traumatic themes, repetitiveness, and awakenings. Additionally, anger in dreams best indicated the presence of worse global PTSD symptoms. The correlation between resting daytime pulse and DDNSI scores underlines the unifying features of PTSD across day and night.