Chronic nightmares after severe burns: risk factors and implications for treatment

Although patients frequently experience sleep disturbances and nightmares in the first weeks after a severe burn, information is scarce on the course and prevention of this problem. Prolonged experience of nightmares in adults is one of the symptoms of posttraumatic stress disorder. The aim of this work was to determine risk factors for developing chronic nightmares after severe burns. Personality traits and coping strategies were assessed. As part of a follow-up study of patients treated at the Burn Center at Uppsala University Hospital, Uppsala, Sweden, between 1980 and 1995, the questionnaires of 166 patients (34 females, 132 males, average age 50 years, average burn size 25% TBSA, full-thickness burn size 10% TBSA, average time since burn 11.4 years) were analyzed. The effects of individual personality traits and coping strategies on the frequency of nightmares were evaluated by regression analysis. Nightmares were reported by 43% of the patients, by females more frequently than males. The frequency of nightmares was shown to be associated with the size of the full-thickness burn. The use of Avoidance or Revaluation/Adjustment scales as coping strategies and the presence of Somatic Trait Anxiety as a personality trait were associated with a higher frequency of nightmares after correction for gender. In contrast, persons seeking Emotional Support as a coping strategy reported significantly fewer nightmares. Certain personality traits and coping strategies apparently increase the risk of having nightmares after a severe burn. Helping persons at risk develop different coping strategies may be a possible means of prevention or treatment.