What are nightmares?

Causes and Symptoms

Nightmares have intrigued people for centuries, inspiring a range of explanations about what causes them. It is now known that they occur in all children shortly after the developmental stage of the “terrible twos,” which overlaps but is not the same as the chronological age of two.

Two concurrent developments mark this period of growth. The first is intellectual and cognitive. Children develop the ability to conceptualize, process, and recall information in ways that they could not before and begin reporting that they had dreams the previous night. These dreams usually involve things they wish for, playful fantasies, and daytime activities. The second development is emotional. At this stage, children are growing beyond the autonomy and individuation issues that characterize the infamous “terrible twos.” They start involuntarily to experience strong aggressive feelings and desires to control, and they direct these emotions toward those with whom they have the most trouble in establishing their autonomy: parents and siblings. At the same time, children also experience anxiety from speculating about what would happen if their feelings were ever directly expressed. This intellectual and emotional combination gives rise to vividly intense nightmares, what children commonly refer to as “bad dreams.”

In addition to aggressive impulses, nightmares may involve big dogs, snakes, insects, or other dangerous animals; monsters; giants; a “bad man”; or harm coming to them or someone in their family. During nightmares, children sense their own helplessness and vulnerability, which adds to the awful feelings experienced afterward. Children who dream that they are victorious over the threat—for example, they beat up the monster—usually report that they have had “good dreams” and are not frightened.

Nightmares affect boys and girls equally, although individually children experience, or recall the experience, with wide-ranging frequency. Some will have few nightmares throughout this preschool period; others will have many. Regardless of the baseline, all children will experience an increase in frequency during times of worsening stress. Oftentimes those struggling with post-traumatic stress disorder will experience greater numbers of vivid nightmares. Both a marked increase in the frequency of nightmares and the experience of having a single frequently recurring nightmare have psychological significance and causes. Rapid awakening after any dream is associated with good recall, which is also true with nightmares.

Night terrors also begin around this time; however, unlike nightmares, not all children experience them. They occur with regularity only between the ages of two and six. Night terrors are characterized by screaming and rapid awakening from deep sleep during the first third of the night, with vague or no recollection of the scary dream or image that presumably caused them. The child is terrified, hard to comfort, and difficult to awaken fully. Episodes last from ten to twenty minutes. It is often more upsetting for parents to witness a child thrashing and screaming than it is for the children who experience night terrors, as there is usually no recollection of the episodes the next morning.

Electroencephalogram (EEG) testing during night terrors shows the electrical activity in the brain as similar to that which occurs during small seizures, although night terrors are neither seizures nor caused by seizures and should not be treated as such. Usually, when night terrors occur, either the preceding day or the period right before bedtime has been particularly challenging or difficult. Night terrors may be a way in which children work off the psychological steam that they have built up as a result.

Even with advanced technology, a science does not exist to explain in clear terms the cause and meanings of nightmares. Research has been ongoing, with experts examining the impact and occurrence of nightmares in both children and adults. Some studies have even investigated the difference in subject matter regarding nightmares experienced by women versus men. Others have sought to establish whether nightmares could in fact be a kind of learned behavior.

Treatment and Therapy

Nightmares are often problematic because parents are uncertain about what to do. Do they look under the bed or in the closet for the “bogeyman”? Do they keep the lights on all night? Do they let the child sleep with them after having a nightmare? Parents can help a child who has had a bad dream and who is afraid of monsters by looking under the bed or opening the closet together, while reassuring the child that they both know nothing is there.

All children experience imagined fears like monsters or spiders. These fears need to be taken seriously because they are real to the children having them. It is important that parents not scold or embarrass already frightened children or tell them that they should not feel the way they do. Parents should not discount or dismiss fears of imaginary and fantasized threats. Children need to feel that when their fantasies and worries get out of control, as in nightmares, someone can take charge and provide safety, security, and reassurance. Children must know that their worries and fears are important to their parents and caregivers.

When nightmare frequency begins to signal an underlying adjustment problem, nightmares should be thought of as an expression of intense anxiety caused by something or someone. In such cases, professional help in the form of a child therapist should be sought.

Night terrors, as disturbing as they can be, usually do not require professional intervention. In most cases, a calm, reassuring parent is all that a child needs to be comforted, to settle down, and to resume the sleep cycle. When the frequency of night terrors becomes problematic, parents should consult a sleep disorder specialist, whose professional discipline is usually medicine or psychology. In both disciplines, sleep disorders constitute a specialized area of clinical practice, and most physicians and psychologists are not trained to treat them.

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