Summary: New research indicates that nightmares — more than other sleep disturbances — are associated with an increased risk of nonsuicidal self-injurious behavior, and emotional dysregulation appears to explain this link.
Source: Florida State University
Nightmares linked to self-injury, Florida State University study finds
Researchers at Florida State University report a specific connection between nightmares and self-injurious behaviors such as cutting, burning, or scraping the skin. While a range of sleep disturbances have been tied to depression and suicidal behavior in past research, this study identifies nightmares as uniquely associated with nonsuicidal self-injury (NSSI).
Chelsea Ennis, a psychology doctoral student and lead author of the paper published in the journal Comprehensive Psychiatry, notes that sleep problems are linked to many psychological disorders. “We found only nightmares were related to self-injury,” Ennis said, after analyzing data that controlled for depressive symptoms.
Ennis works as a therapist at FSU’s Psychology Clinic and has seen varied forms of self-injury among patients. Many individuals who harm themselves do so to manage intense negative emotions or situations they feel unable to cope with. The study tested whether general sleep problems — especially nightmares and insomnia — relate to self-injurious behavior.
The research drew on two samples: clinical patients from the FSU Psychology Clinic and undergraduate students. In both groups, more frequent and intense nightmares were linked to an increased likelihood of engaging in NSSI, even when accounting for depression. In contrast, symptoms of insomnia and other general sleep complaints did not show the same association with self-injury.
Ennis explains one possible reason for the link: dreams play a role in regulating and processing emotions. When nightmares occur, that emotional-processing function can break down. “Nightmares disrupt the normal processing of emotion,” she said. That disruption may lead to emotional dysregulation — extreme mood swings, anger outbursts or aggressive behaviors — which in turn can increase the risk of self-injury.
Importantly, the study found that emotional dysregulation fully mediated the relationship between nightmares and self-injury. In other words, nightmares appear to raise the risk for self-injury by contributing to problems regulating emotions.
Quantitatively, participants who experienced more intense and frequent nightmares showed a modest increase in risk — about 1.1 times higher — for self-injury in this study. Ennis acknowledges the effect size is small, though larger studies have found stronger effects. She emphasizes that the mechanism likely stems from nightmares’ interference with healthy emotion processing during sleep.
Nightmares vary widely in content but often reflect a person’s experiences and stressors. Some recurring nightmares follow traumatic events and can awaken a person with a racing heart, while other distressing themes include sensations of falling or attempting to run but moving slowly. When nightmares occur only occasionally, they are less likely to be problematic. However, frequent, vivid, and disruptive nightmares — for example, those occurring several times a week and interfering with sleep or causing anxiety about going to bed — are a clinical concern.
Ennis recommends seeking help when nightmares become frequent and disruptive. Effective treatments exist, including cognitive behavioral therapy approaches that address both nightmares and broader sleep problems. These therapies are available in many university and community clinics, including FSU’s Psychology Clinic and the FSU Anxiety and Behavioral Health Clinic.
The study also highlights the broader public-health context. Approximately 17 percent of teenagers and 13 percent of young adults report self-injurious behaviors each year, and suicide remains a leading cause of death. Given these realities, research that clarifies modifiable risk factors — such as nightmare frequency and the resulting emotional dysregulation — can inform prevention and treatment efforts.
The research, titled “Nightmares and nonsuicidal self-injury: The mediating role of emotional dysregulation,” examined clinical and university samples to test whether nightmares and insomnia symptoms are associated with NSSI and whether emotional dysregulation explains those links. Findings indicate nightmares, but not insomnia symptoms, are associated with NSSI when controlling for depressive symptoms, and that emotional dysregulation fully mediates the relationship between nightmares and self-injury. The study provides support for the idea that dreams have an emotion-regulation function.
The paper reports two cross-sectional studies: Study 1 included 313 clinical patients and Study 2 included 152 university students. Analyses tested associations among nightmares, insomnia symptoms, depressive symptoms, emotional dysregulation, and nonsuicidal self-injury. Results were consistent across both samples, strengthening confidence in the finding that nightmares — specifically — relate to NSSI via disrupted emotion regulation.
Researchers call for additional longitudinal research to clarify temporal relationships. Longitudinal studies could determine whether nightmares lead to subsequent emotional dysregulation and later self-injury, helping to establish causal pathways and identify targets for early intervention.
Ennis, C. R., Short, N. A., Moltisanti, A. J., Smith, C. E., Joiner, T. E., & Taylor, J. “Nightmares and nonsuicidal self-injury: The mediating role of emotional dysregulation.” Comprehensive Psychiatry. Published online April 18, 2017. DOI: 10.1016/j.comppsych.2017.04.003