Nightmare disorder symptoms include repeated awakenings from the major sleep period or naps with detailed recall of extended and extremely frightening dreams, usually involving threats to survival, security, or self-esteem. The awakenings generally occur during the second half of the sleep period.

On awakening from the frightening dreams, the person rapidly becomes oriented and alert (in contrast to the confusion and disorientation seen in sleep terror disorder and some forms of epilepsy).

The dream experience, or the sleep disturbance resulting from the awakening, causes clinically significant distress or impairment in social, occupational, or other important areas of functioning.

The nightmares do not occur exclusively during the course of another mental disorder (e.g., a delirium, posttraumatic stress disorder) or any coexisting (sleep or non-sleep) mental or medical disorder cannot adequately explain the predominant complaint of dysphoric dreams. These dreams are not due to the direct physiological effects of a substance (e.g., a drug of abuse, a medication).

A clinician will add specifiers to the diagnosis according to its duration and severity.

  • Acute: Duration of period of nightmares is 1 month or less.
  • Subacute: Duration of period of nightmares is greater than 1 month but less than 6 months.
  • Persistent: Duration of period of nightmares is 6 months or greater.

Severity is rated by the frequency with which the nightmares occur:

  • Mild: Less than one episode per week on average.
  • Moderate: One or more episodes per week but less than nightly.
  • Severe: Episodes nightly.

DSM-5 diagnostic code 307.47.