Nightmares in borderline personality disorder - narrative review

Borderline personality disorder (BPD) patients commonly suffer from nightmares. Still, the prevalence of this issue does not match the little clinical attention it usually receives. Nightmares impact sleep and daily functioning and may play a role in BPD symptomatology, including suicidality. Since BPD has been linked with high rates of suicide, the potential connection with suicidality is crucial to address.

To create an up-to-date review of current knowledge on nightmares in BPD and to explore the links between nightmares, insomnia, and suicidality or self-harm in BPD patients.

This narrative review was conducted using the PubMed, Web of Science, and Google Scholar databases to search for articles published between January 1990 and October 2022, using the following key terms: 'borderline personality disorder' and 'nightmares' or 'insomnia' and 'suicidality' or 'self-harm' or 'self-injuring'. The final list consisted of 99 publications.

Sleep disturbances often occur in BPD patients. The prevalence of nightmares in BPD is higher than in general or clinical populations. Nightmares influence borderline personality traits and vice versa through emotional dysregulation, poorer sleep quality, nightmare anxiety, higher arousal, and worsened self-control. A link between nightmares and suicidal behaviour was established in some psychiatric conditions (depression, insomnia); studies on BPD are lacking in this area. Studies comparing nightmares in BPD to other disorders are also missing. There are some suggestions for pharmaceuticals or psychotherapy in treating nightmares, but their application to BPD needs more research.

Sleep disturbance and nightmares are common among individuals with BPD yet underrepresented in research. Nightmares have been linked with suicidality in other conditions (depression, PTSD) but only indirectly in BPD. More clinical studies are needed to explore the phenomenon further.