Nightmares and Nonsuicidal Self-Injury: The Mediating Role of Emotional Dysregulation

Compr Psychiatry. 2017 Jul;76:104-112. doi: 10.1016/j.comppsych.2017.04.003. Epub 2017 Apr 18.


Introduction: Nonsuicidal self-injury (NSSI) is a transdiagnostic behavior associated with significant psychopathology. Research has shown a positive association between sleep disturbances, (e.g., nightmares and insomnia), and suicidal behavior, however, the relation between NSSI and sleep disturbances has yet to be examined. Sleep disturbances have been found to have a causal role in problems with emotional dysfunction. Specifically, sleep disturbances inhibit the emotion processing function of sleep. Importantly, a majority of individuals engage in NSSI to regulate intense emotions, and it is possible that sleep disturbances increase propensity for NSSI by contributing to dysregulated emotions.

Methods: In two cross-sectional studies, the present research examined whether insomnia symptoms and nightmares were related to NSSI in a clinical sample (Study 1, N = 313) and in a university sample (Study 2, N = 152). Furthermore, the hypothesis that emotional dysregulation would atemporally mediate the relationship between sleep disturbances and NSSI was tested in Study 2.

Results: Findings showed that nightmares, but not insomnia symptoms, were associated with NSSI while controlling for depressive symptoms. This pattern of findings was consistent across both clinical and university samples, which underscores the robustness of the finding. Further, the relationship between nightmares and NSSI was fully mediated by emotional dysregulation.

Conclusion: The present research provides initial evidence that nightmares are atemporally associated with an increased propensity for NSSI by contributing to emotional dysregulation, and provides support for the emotion regulation function of dreams.

MeSH terms

  • Adolescent
  • Adult
  • Aged
  • Cross-Sectional Studies
  • Emotions*
  • Female
  • Humans
  • Male
  • Middle Aged
  • Night Terrors / complications
  • Night Terrors / psychology*
  • Self-Injurious Behavior / complications
  • Self-Injurious Behavior / psychology*
  • Sleep Initiation and Maintenance Disorders / complications
  • Sleep Initiation and Maintenance Disorders / psychology*
  • Young Adult