The relationship between nightmares and psychotic experiences in young adults.

BACKGROUND: There is indication that frequent nightmares are an early indicator of psychotic disorders in adolescents and young adults. Yet which aspects of nightmares are relevant and how they contribute to psychotic experiences has remained unclear. METHODS: We conducted a cross-sectional online survey in a community sample of young adults between the ages of 18 and 27 (n = 486) to identify aspects of nightmares (nightmare frequency (NF), nightmare distress (ND), nightmare contents), that are related to specific psychotic experiences (paranoid thoughts, hallucinations, negative symptoms) after controlling for sleep quality, and examined factors that potentially mediate this relationship (stress, depression). RESULTS: Nightmare frequency and -distress were significantly associated with paranoid thoughts, hallucinations and negative symptoms (NF: rs = 0.293 - 0.139; ND: rs = 0.411 - 0.166). Nightmares significantly added to explaining paranoid thoughts and hallucinations, over and above sleep quality, but not to explaining negative symptoms. The relations between nightmare distress and psychotic experiences were partially mediated by stress (percentage mediated for paranoid thoughts: 38.20%; for hallucinations: 11.77%) and depression (percentage mediated for paranoid thoughts: 56.61%; for hallucinations: 28.02%). The most commonly reported nightmare contents revolved around being chased, falling and losing a close relative and specific contents were significantly related to the frequency of hallucinations (eg, threatening surroundings, OR = 1.73) or paranoia (eg, workspace bullying, OR = 2.02). CONCLUSIONS: Thorough assessments of nightmares and sleep disturbances in young individuals could facilitate early detection of those at risk and help to target preventive treatments. However, longitudinal studies are needed to test for a causal relationship between nightmares and the development of psychotic symptoms.

The role of guilt in Posttraumatic Stress Disorder.

Background: A growing body of evidence supports the notion that the emotional profile of Posttraumatic Stress Disorder (PTSD) may be more diverse than traditional accounts presume. PTSD's image as an anxiety-based disorder is undergoing change as the significance of other emotions in its development becomes more evident. Experimental research is needed in order to expand the understanding of underlying processes driving the development of PTSD. Objective: Experimentally test the influence of stressor-related guilt on the occurrence of PTSD symptomatology. Method: A non-clinical student sample faced an analogue trauma, a stressor in the form of a computer crash and related loss of data. We either personally blamed participants for causing the incident (blame group) or told them that it was a technical failure and therefore not their fault (no-blame group). Levels of guilt before and after the incident as well as number and associated distress of incident-related intrusions were assessed using a one-day diary and compared between groups. Results: The guilt manipulation was successful: feelings of guilt significantly increased in the blame group but not in the no-blame group. Furthermore, the blame group showed a significantly higher number of intrusions and associated distress compared to the no-blame group at one-day follow-up. Conclusions: These laboratory findings indicate that feelings of guilt may lead to increased PTSD symptomatology, supporting the view that guilt experienced in reaction to a traumatic event may be part of a causal mechanism driving the development of PTSD.

Planteamiento: Un creciente conjunto de evidencias apoya la noción de que el perfil emocional del Trastorno por Estrés Postraumático (TEPT) puede ser más diverso de lo que suponen las consideraciones tradicionales. La imagen del TEPT como un trastorno basado en la ansiedad está experimentando cambios a medida que se hace más evidente la importancia de otras emociones en su desarrollo. Se necesita investigación experimental para ampliar la comprensión de los procesos subyacentes que fomentan el desarrollo del trastorno por estrés postraumático. Objetivo: Probar experimentalmente la influencia de la culpa relacionada con el factor de estrés en la ocurrencia de la sintomatología del TEPT. Método: Una muestra no clínica de estudiantes se enfrentó a un trauma análogo, que es un factor de estrés en forma de fallo informático y la consiguiente pérdida de datos. O bien culpamos personalmente a los participantes por causar el incidente (culpan al grupo) o les dijimos que se trataba de un fallo técnico y, por lo tanto, no era su culpa (no culpan al grupo). Se evaluaron los niveles de culpabilidad antes y después del incidente, así como la cantidad de intrusiones relacionadas con el incidente y la angustia asociada usando un diario de 1 día y se compararon entre ambos grupos. Resultados: La manipulación de la culpa tuvo éxito, ya que los sentimientos de culpa aumentaron significativamente en el grupo al que se culpó, pero no en el grupo al que no se culpó. Además, el grupo de la culpa mostró un número significativamente mayor de intrusiones y de angustia asociada en comparación con el grupo sin culpa en el seguimiento 1 día después. Conclusiones: Estos hallazgos de laboratorio indican que los sentimientos de culpa pueden conducir a una mayor sintomatología del TEPT, lo que respalda la opinión de que la culpa experimentada en reacción a un evento traumático puede ser parte de un mecanismo causal que fomenta el desarrollo del TEPT.