Evaluation of dream content in combat-related PTSD

Nightmares that replicate traumatic events are among the criteria that define posttraumatic stress disorder (PTSD); however; there has been limited systematic assessment of the content of dreams in PTSD. A PTSD dream rating instrument was developed to operationalize features attributed to dreams associated with combat-related PTSD that incorporated dimensions from the dream content analysis literature, and its reliability was assessed. Then the instrument was used to characterize dream reports in 18 Vietnam combat veterans diagnosed with PTSD. Approximately half of the group's target dreams contained features characteristic of combat, and all but 3 (17%) were moderately to highly threatening. Fifty-three percent were set at least partially in the present and 79% contained distorted elements. We therefore conclude that target dreams of combat veterans with PTSD vary with regard to replication of trauma and elements normally associated with dreaming, but typically are threatening.