Aetiology and treatment of nightmare disorder: State of the art and future perspectives.

This consensus paper provides an overview of the state of the art in research on the aetiology and treatment of nightmare disorder and outlines further perspectives on these issues. It presents a definition of nightmares and nightmare disorder followed by epidemiological findings, and then explains existing models of nightmare aetiology in traumatized and non-traumatized individuals. Chronic nightmares develop through the interaction of elevated hyperarousal and impaired fear extinction. This interplay is assumed to be facilitated by trait affect distress elicited by traumatic experiences, early childhood adversity and trait susceptibility, as well as by elevated thought suppression and potentially sleep-disordered breathing. Accordingly, different treatment options for nightmares focus on their meaning, on the chronic repetition of the nightmare or on maladaptive beliefs. Clinically, knowledge of healthcare providers about nightmare disorder and the delivery of evidence-based interventions in the healthcare system is discussed. Based on these findings, we highlight some future perspectives and potential further developments of nightmare treatments and research into nightmare aetiology.

Is there an association between insomnia symptoms, aggressive behavior, and suicidality in adolescents?

PURPOSE: Sleep disturbances are a common problem during adolescence. Often there is a relationship with the mental health of the affected person. The existing literature concerning the link between sleep disturbances and aggressive behavior and sleep disturbances and suicidality during adolescence shows no clear results. The present study tested a mediation model to prove the relation between sleep problems, aggressive behavior, and suicidality during adolescence. To take the link between suicidality and depression into account, the amount of depressive symptoms was included into the mediation model. METHODS: A sample of 93 adolescents aged 14-18 years (30% male) was studied. A survey was conducted to interview the adolescents about their mental health, sleep-related behaviors, aggressive behavior, and suicidality. RESULTS: Sleep problems and suicidality measures were significantly related to each other. Furthermore, aggressive behavior and suicidality showed a significant relationship. The expected link between sleep problems and aggressive behavior was not significant. For the mediation model, no significant influence of aggressive behavior on the relationship between the amount of sleep problems and suicidality was found. However, the impact of depressive symptoms on the relationship between sleep problems and suicidality was significant. CONCLUSION: Sleep problems and overall suicidality in adolescents are significantly connected, even after adjusting for several possible influencing factors. Aggressive behavior could not be confirmed as a mediator for the association between sleep problems and suicidality in adolescents. Further studies to examine the link between insomnia symptoms, aggressive behavior, and suicidality in adolescents are necessary.