Nightmare disorder, dream anxiety, and subjective sleep quality in patients with borderline personality disorder

Abstract

Aims: The aims of the present study were to examine the rate of nightmare disorder (ND) and to determine the levels of dream anxiety and subjective sleep quality in patients with borderline personality disorder (BPD). Another aim was to determine whether dream anxiety was associated with childhood trauma, dissociative experiences, and subjective sleep disturbance in BPD patients. Finally, the hypothesis as to whether BPD patients with ND exhibited a more severe clinical profile than those without ND, was also tested. Methods: A total of 88 borderline patients and 100 age‐ and sex‐matched healthy control subjects were assessed using the Structured Clinical Interview for DSM‐III‐R Personality Disorders, Structured Clinical Interview for DSM‐IV Axis I Disorders, Van Dream Anxiety Scale, Pittsburgh Sleep Quality Index, Dissociative Experiences Scale, and Traumatic Experiences Checklist. Subjects with codiagnoses that could affect sleep were not included. Results: BPD patients suffered a significantly greater rate of nightmares, elevated levels of dream anxiety, and disturbed sleep quality than did controls. In the borderline group, heightened dream anxiety was correlated with higher rates of early traumatic experiences and dissociative symptoms, and impaired sleep quality. Furthermore, borderline patients with ND exhibited greater psychopathology as compared to those without ND in terms of several clinical characteristics. Conclusions: The present study provides support for a strong association between BPD, distressing nightmares, and subjective sleep quality. Recognition and management of dream and sleep disturbances in BPD patients might lead to improvements in their global clinical picture.

The sleep phenotype of Borderline Personality Disorder: A systematic review and meta-analysis

“…Again, associations appear independent of comorbid depression. Complex associations between trauma, nightmares, and BPD are indicated (Claridge et al, 1998;Lereya et al, 2016;Semiz, Basoglu, Ebrinc, & Cetin, 2008). Recent prospective evidence suggests that nightmares could exacerbate reactions to early trauma increasing risk of subsequent BPD .…”

“…Sleep problems may not only worsen symptom course in BPD but also heighten risk of suicide (Balestrieri et al, 2006;Winsper & Tang, 2014) and self-harm (Semiz et al, 2008) in this vulnerable population. Hence, mental health professionals should routinely assess the degree to which patients with BPD are experiencing sleep difficulties.…”

Borderline Personality Pathology, Polysomnography, and Self-Reported Sleep Problems: A Review

“…Semiz and colleagues [33] were the first to examine BPD and sleep without PSG recordings in their study of nightmare disorder, dream content, and sleep quality in a large clinical sample of BPD patients. They reported that 96 % of their group of 88 (48 female, 40 male) nondepressed BPD patients self-identified as poor sleepers, as compared to 12 % of controls.…”

Sleep disturbances and circadian CLOCK genes in borderline personality disorder

“…The prevalence of BPD is approximately 1-2 % in the general population; BPD is more often diagnosed in women than in men and often co-occurs with Axis I disorders such as depression (96 %), anxiety disorders (64 %), posttraumatic stress disorder (65 %), substance abuse or substance dependency (64 %), ADHD (39 %), and eating disorders (53 %) (Bohus 2009). Interestingly, patients with BPD often report subjective sleep problems, especially insomnia, nightmares and dream anxiety (Bastien et al 2008;Semiz et al 2008). Furthermore, it has been suggested that the disturbed sleeping behaviour may alter the regulation of emotion in these patients (Harty et al 2010), thus shaping the phenotype of the disorder.…”