Abstract
The enduring and contentious hypothesis that sleepwalking and night terrors are symptomatic of a protective dissociative mechanism is examined. This is mobilised when intolerable impulses, feelings and memories escape, within sleep, the diminished control of mental defence mechanisms. They then erupt but in a limited motoric or affective form with restricted awareness and subsequent amnesia for the event. It has also been suggested that such processes are more likely when the patient has a history of major psychological trauma. In a group of 22 adult patients, referred to a tertiary sleep disorders service with possible sleepwalking/night terrors, diagnosis was confirmed both clinically and polysomnographically, and only six patients had a history of such trauma. More commonly these described sleepwalking/night terrors are associated with vivid dream-like experiences or behaviour related to flight from attack. Two such cases, suggestive of a dissociative process, are described in more detail. The results of this study are presented largely on account of the negative findings. Scores on the dissociation questionnaire (DIS-Q) were normal, although generally higher in the small "trauma" subgroup. These were similar to scores characterising individuals with post-traumatic stress disorder. This "trauma" group also scored particularly highly on the anxiety, phobic, and depression scales of the Crown-Crisp experiential index. In contrast the "no trauma" group scored more specifically highly on the anxiety scale, along with major trends to high depression and hysteria scale scores. Two cases are presented which illustrate exceptional occurrence of later onset of sleepwalking/night terrors with accompanying post-traumatic symptoms during wakefulness. It is concluded that a history of major psychological trauma exists in only a minority of adult patients presenting with sleepwalking/night terror syndrome. In this subgroup trauma appears to dictate the subsequent content of the attacks. However, the symptoms express themselves within the form of the sleepwalking/night terror syndrome rather than as rapid eye movement sleep related nightmares. The main group of subjects with the syndrome and with no history of major psychological trauma show no clinical or DIS-Q evidence of dissociation during wakefulness. The proposition that, within the character structure of this group, the mechanism still operates but exclusively within sleep remains a possibility. Keywords: sleepwalking; night terrors; dissociation; post-traumatic stress disorder
Full Text
The Full Text of this article is available as a PDF (122.2 KB).
Selected References
These references are in PubMed. This may not be the complete list of references from this article.
- Broughton R. J. Sleep disorders: disorders of arousal? Enuresis, somnambulism, and nightmares occur in confusional states of arousal, not in "dreaming sleep". Science. 1968 Mar 8;159(3819):1070–1078. doi: 10.1126/science.159.3819.1070. [DOI] [PubMed] [Google Scholar]
- Calogeras R. C. Sleepwalking and the traumatic experience. Int J Psychoanal. 1982;63(Pt 4):483–489. [PubMed] [Google Scholar]
- Chu J. A., Dill D. L. Dissociative symptoms in relation to childhood physical and sexual abuse. Am J Psychiatry. 1990 Jul;147(7):887–892. doi: 10.1176/ajp.147.7.887. [DOI] [PubMed] [Google Scholar]
- Crisp A. H., Matthews B. M., Oakey M., Crutchfield M. Sleepwalking, night terrors, and consciousness. BMJ. 1990 Feb 10;300(6721):360–362. doi: 10.1136/bmj.300.6721.360. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Crisp A. H. The sleepwalking/night terrors syndrome in adults. Postgrad Med J. 1996 Oct;72(852):599–604. doi: 10.1136/pgmj.72.852.599. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Fisher C., Kahn E., Edwards A., Davis D. M., Fine J. A psychophysiological study of nightmares and night terrors. 3. Mental content and recall of stage 4 night terrors. J Nerv Ment Dis. 1974 Mar;158(3):174–188. doi: 10.1097/00005053-197403000-00002. [DOI] [PubMed] [Google Scholar]
- Hefez A., Metz L., Lavie P. Long-term effects of extreme situational stress on sleep and dreaming. Am J Psychiatry. 1987 Mar;144(3):344–347. doi: 10.1176/ajp.144.3.344. [DOI] [PubMed] [Google Scholar]
- Kales A., Soldatos C. R., Bixler E. O., Ladda R. L., Charney D. S., Weber G., Schweitzer P. K. Hereditary factors in sleepwalking and night terrors. Br J Psychiatry. 1980 Aug;137:111–118. doi: 10.1192/bjp.137.2.111. [DOI] [PubMed] [Google Scholar]
- Kales J. C., Cadieux R. J., Soldatos C. R., Kales A. Psychotherapy with night-terror patients. Am J Psychother. 1982 Jul;36(3):399–407. doi: 10.1176/appi.psychotherapy.1982.36.3.399. [DOI] [PubMed] [Google Scholar]
- Ross R. J., Ball W. A., Morrison A. R. Revising the differential diagnosis of the parasomnias in DSM-IIIR. Sleep. 1989 Jun;12(3):287–289. [PubMed] [Google Scholar]
- van der Kolk B. A., van der Hart O. Pierre Janet and the breakdown of adaptation in psychological trauma. Am J Psychiatry. 1989 Dec;146(12):1530–1540. doi: 10.1176/ajp.146.12.1530. [DOI] [PubMed] [Google Scholar]
- van der Kolk B., Blitz R., Burr W., Sherry S., Hartmann E. Nightmares and trauma: a comparison of nightmares after combat with lifelong nightmares in veterans. Am J Psychiatry. 1984 Feb;141(2):187–190. doi: 10.1176/ajp.141.2.187. [DOI] [PubMed] [Google Scholar]