There is a well-established link between frequent nightmares and a greater risk of suicide, but until now, there has been no sense of specifically what to watch for in a client’s dream life to signal that their risk is escalating. However, a group of researchers has just published an article on how dreams change prior to suicide attempts.
I have long been suggesting that clinicians ask about nightmares and offer treatment if warranted. This recent study underscores the importance of asking about dreams – and offers some clarity about specific ways that nightmares escalate prior to a suicide attempt.
The naturalistic study collected dream information from 40 patients that were hospitalized for suicidal crisis, and found that 80 percent of them had experienced changes in their dream lives prior to this crisis. Two-thirds experienced bad dreams, half had nightmares and 22 percent had dreams about suicide.
The researchers also noted a progression in the way dreams changed prior to the suicidal crisis, with bad dreams appearing 4 months’ prior, nightmares 3 months’ prior and suicidal scenarios 1.5 months’ prior. They concluded: “Dream alterations and their progression can be readily assessed and may help to better identify prodromal signs of suicidal behaviors.”
The researchers studied the differences in those whose dream lives changes prior to their suicidal crisis versus those whose dreams stayed much the same, and found that those with altered dreaming had more of a family history of insomnia. Virtually all had symptoms of depression and altered sleep quality prior to their hospitalization.
The bottom line is that when you ask clients about their dream lives, you can also be alert to any changes. An increase in bad dreams that escalates to more frequent nightmares is an important change that may predict a suicidal crisis. Content of the dreams might provide some clues as well, though they are not going to dream about suicide specifically in most cases.
The other important consideration in your treatment of those who dream and sleep disturbance is escalating is that you can treat these as symptoms, not just as warning signs, and you may be able help them course-correct through direct attention to their nightmares. In other words, dream changes are not just diagnostic, but also avenues for treatment that may reduce suicide risk.
For more about what you can do to treat nightmares, I am offering a time-limited nightmare treatment course bundle, an in-depth online training for clinicians which includes a workshop on nightmares and the nervous system. You can check it out here.
References
Geoffroy, P., Borand, R., Ambar Akkaoui, M., Yung, S., Atoui, Y., Fontenoy, E., Maruani, J., & Lejoyeux, M. (2022). Bad Dreams and Nightmares Preceding Suicidal Behaviors.. The Journal of clinical psychiatry, 84(1), 1
