Saving lives by treating nightmares and insomnia in borderline personality disorder.

Chronic nightmares and insomnia are present in approximately 50% of individuals diagnosed with BPD and are a significant risk factor for self-injury and suicide. Here's what you can do about it:

Dec 14, 2021
Saving lives by treating nightmares and insomnia in borderline personality disorder.

By Brian Curtis, Ph.D.

"How is your sleep?"

If you experience ongoing difficulties regulating intense emotions, perhaps having received a diagnosis of borderline personality disorder (BPD), these four words can be life-saving.

Research suggests that if you've been diagnosed with BPD, there's a 50% chance that you regularly experience nightmares and insomnia.

Chronic nightmares and insomnia in individuals diagnosed with BPD have been associated with higher rates of self injury and suicide attempts.

But fortunately, there is hope. There are treatments that work!

Getting dialectical.

Dialectical Behavior Therapy (DBT) is a comprehensive treatment developed to help individuals diagnosed with BPD to more effectively regulate their emotions.

Currently, DBT has the most research support for treating individuals diagnosed with BPD.

DBT is one of the few evidence-based psychotherapies that specifically acknowledges insomnia and nightmares as treatable risk factors to improve our ability to regulate intense emotions and keep ourselves safe.

Treatment options for insomnia and nightmares in DBT currently consist of a one-page sleep hygiene protocol and one-page nightmare protocol.

However, these protocols are abbreviated versions of the full, evidence-based treatments for chronic insomnia (Cognitive Behavioral Therapy for Insomnia; CBT-I) and nightmare disorder (Imagery Rehearsal Therapy; IRT) and are ordinarily not reviewed in DBT skills training groups unless you're in the group specifically to treat your nightmares or insomnia.

"Let's talk about my sleep!"

If you experience ongoing difficulties regulating intense emotions and have frequent nightmares or insomnia, please talk to a DBT therapist or sleep specialist about your sleep.

These conversations can be life-saving.


Semiz, U. B., Basoglu, C.,Ebrinc, S., & Cetin, M. (2008). Nightmare disorder, dream anxiety, and subjective sleep quality in patients with borderline personality disorder. Psychiatry and Clinical Neurosciences, 62(1), 48–55.

Simor, P., Csóka, S., &Bódizs, R. (2010). Nightmares and bad dreams in patients with borderline personality disorder: Fantasy as a coping skill? The European Journal of Psychiatry, 24(1), 28–37.

Linehan, M. M. (1993). Cognitive-behavioral treatment of borderline personality disorder. The Guilford Press.

Choi-Kain, L. W., Finch, E. F., Masland, S. R., Jenkins, J. A., & Unruh, B. T. (2017). What works in the treatment of Borderline Personality Disorder. Current Behavioral Neuroscience Reports, 4(1), 21–30.

Stoffers, J. M.,Vollm, B. A., Rucker, G., Timmer, A., Huband, N., & Lieb, K. (2012). Psychological therapies for people with borderline personality disorder. Cochrane Database of Systematic Reviews, 8.

Linehan, M. M.(2015). DBT Skills Training Handouts and Worksheets (Second Edition). The Guilford Press.

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