Understanding Schizophrenic Dreams

Dream content often reflects an individual’s thoughts, emotions, and experiences in the waking world. Like most, individuals with schizophrenia might have dreams involving fragmented narratives, surreal imagery, and heightened emotional intensity. However, the relationship between dreaming and schizophrenia is complex and not fully understood. Some research suggests that people with schizophrenia have more frequent and vivid nightmares than those without the disorder.

Are you experiencing disturbing dreams?

Learn coping skills in online therapy

Existing research

Lucid dreaming may be helpful for some people with conditions like post-traumatic stress disorder (PTSD) and clinical depression. However, research on lucid dreaming and schizophrenia patients often reveals mixed results. For example, a 2016 study published in Frontiers in Psychology found that lucid dreaming can “further empower deliria and hallucinations” in people with psychotic conditions like schizophrenia. Conversely, older studies suggest that links between psychosis and lucid dreaming may provide scientific support for the use of dream therapy in treating psychiatric patients. Based on the availability of research on the topic, further contemporary studies may be required to establish whether there is a relationship between dreaming and schizophrenia.

Brief overview of schizophrenia

To understand the potential influence that schizophrenia may have on dreaming, understanding the condition’s symptoms, phases, and diagnostic criteria may be helpful. Schizophrenia can directly influence how an individual thinks, feels, and behaves. The condition usually presents differently between individuals depending on a variety of factors such as age, background, and environment. Symptoms typically emerge between the ages of 16 and 30 but may present earlier in men than in women.

Symptoms of schizophrenia

Symptoms of schizophrenia are typically grouped into two categories depending on how they present: 

• Positive symptoms (externally expressed changes in thoughts and behaviors): These usually include delusions, hallucinations, disorganized thoughts and speech, and disorganized or abnormal behaviors. 
• Negative symptoms (diminishment in affect or engagement in daily life): Negative symptoms may include, but aren’t limited to, aversion to social interaction, decreased ability to experience pleasure, diminished ability to express emotions, and extreme lack of motivation to complete tasks or responsibilities in daily life. 

Understanding schizophrenia phases

While some symptoms may continue throughout an episode, come and go throughout the phases, or emerge randomly, they often present differently throughout the phases of schizophrenia. These phases include the prodromal phase, the active phase, and the residual phase.

Prodromal phase

This stage usually marks the initial emergence of schizophrenia symptoms. Typically, individuals in the prodromal phase present negative symptoms, such as flat affect, low mood, and demotivation. In many cases, the symptoms occurring during the prodromal phase mirror those of other disorders, like depression and anxiety. This may lead to misdiagnosis in some cases. Nightmares typically emerge during this phase, but this may not always be the case.

Active phase

The core positive symptoms of psychosis normally emerge during this stage, including hallucinations, delusions, and disorganized or confused thoughts and behaviors. 

Residual phase

While not officially a schizophrenia phase, the residual stage generally presents similar symptoms to the prodromal phase. 

Diagnostic criteria

A schizophrenia diagnosis should always be established by a mental health professional trained in psychiatric evaluation and testing. To receive a diagnosis, the individual must display two or more core symptoms most of the time over the course of a month. Other medical or psychological conditions, medications, and substances must be ruled out as causes of symptoms. 

Potential connections between schizophrenia and dreaming

While there isn't necessarily one single connection that conclusively links schizophrenia and dreaming, both states tend to share some common phenomenological and neurobiological features.

Phenomenological features

Altered perceptions of reality

In both dreaming and schizophrenia, there may be a distortion in the perception of reality. For example, core schizophrenia symptoms usually include delusions and hallucinations in which individuals may experience a “blurring” between the realm of what is real and what is not. The same is often true with dreaming, in which bizarre or unrealistic events may occur without question. 

Emotional intensity

Intense emotional experiences are often present in both dreams and schizophrenia symptoms. In schizophrenia, emotional dysregulation can be common, with individuals’ experiences ranging from heightened emotional responses to blunted affect. Dreams can also evoke strong emotions, ranging from joy to fear, often without regard to waking logic or context.

Fragmented thoughts

Disorganized, fragmented thoughts that are disconnected from reality tend to be a common symptom of schizophrenia. Similarly, dreams can sometimes reflect a non-linear, disorganized quality where disparate elements may be combined to form a narrative lacking in coherence.

Distorted or disrupted sense of self

Schizophrenia can be associated with disturbances in self-awareness and self-referential processing. Dreams often involve altered perceptions of self and reality. Some researchers propose that these similarities may reflect common underlying disturbances in self-monitoring and self-representation.

Neurobiological features

Dopaminergic dysfunction

Both schizophrenia and dreaming can be associated with altered dopamine neurotransmission. In schizophrenia, studies point to dopamine dysregulation as a potential cause of positive symptoms like hallucinations and delusions. During REM sleep (when dreaming most commonly occurs), a similar increase in dopamine activity tends to be present, suggesting a potential role in the connection between dream experiences and schizophrenia symptoms.

Aberrant connectivity

Studies have shown disruptions in connectivity between and within the executive control network and salience network in schizophrenia and during dreaming. In schizophrenia, some of these aberrant connectivity patterns may contribute to symptoms like hallucinations and disorganized thinking. Similarly, during dreaming, there can be a decoupling of brain regions involved in cognitive control and reality monitoring, potentially leading to the bizarre and immersive nature of dreams.

Default mode network (DMN)

The default mode network, a network of brain regions involved in introspection and self-referential processing, has been implicated in both schizophrenia and dreaming. In schizophrenia, there can be alterations in the activity and connectivity of the DMN, which may contribute to self-related disturbances and the emergence of delusions. During dreaming, the DMN usually remains active, suggesting a continuity of self-awareness across waking and dreaming states.

Understanding schizophrenic dreams: Other factors to consider

Sleep dysfunction

Research suggests that people with schizophrenia may experience abnormalities in rapid eye movement (REM) sleep, the stage of sleep associated with vivid dreaming. Some studies have found alterations in REM sleep patterns in individuals with schizophrenia that appear to make them more susceptible to sleep disturbances such as sleep paralysis, insomnia, and REM sleep behavior disorder (RBD). The exact mechanism responsible for this connection isn’t yet understood, but such sleep disturbances can significantly impact the nature of one’s dreams and overall mental health. 

Memory consolidation

Dreaming is believed to play a role in memory consolidation, emotional processing, and learning. Dysfunction in these processes may contribute to the cognitive deficits and emotional dysregulation seen in schizophrenia.

Psychodynamic dream interpretation and meaning

Some psychoanalytic theories suggest that the content of dreams reflects unconscious conflicts and desires. Similarly, symptoms of schizophrenia may be interpreted as symbolic expressions of unconscious conflicts. However, the validity of psychodynamic interpretations in the context of schizophrenia is debated within the scientific community.

Dream content

Dreams experienced by individuals with schizophrenia may contain elements related to their symptoms, such as hallucinations, delusions, or disorganized thoughts. These dreams can be vivid, intense, and sometimes disturbing.

Medication effects 

Antipsychotic medications commonly used to treat schizophrenia can influence sleep patterns and dreaming. Some medicines may increase or decrease dream activity, alter the content of dreams, or affect REM sleep. These effects can vary depending on the specific medication and how it impacts the individual.

Stress and trauma

Stressful life events and trauma can influence both the content and frequency of dreams. Individuals with schizophrenia may be more prone to experiencing stress and trauma, which could affect their dreaming patterns. 

Seeking support for troubling dreams and nightmares

Often, talking about upsetting dreams with a licensed mental health professional can help individuals cope with them more effectively. While many individuals enjoy meeting with therapists face-to-face in their local area, this may not always be feasible. Some people experience obstacles around affordability, availability, and time constraints that may deter them from seeking mental health support in person. While those experiencing acute psychosis may need in-person support, some find that online therapy can address those obstacles and may have advantages over traditional treatment. 

Benefits of online therapy for understanding schizophrenic dreams

Virtual therapy generally allows you to speak with a counselor on a schedule that best suits your lifestyle and responsibilities. Online therapy platforms usually offer flexible options for choosing a therapist with a background and experience that fits your unique needs, and if you believe that someone else would be a better fit, you may switch therapists at any time. Additionally, online therapy is often more affordable than conventional treatment without insurance. Studies suggest that online therapy normally produces the same client outcomes as traditional in-office therapy and may effectively treat a variety of mental health disorders and challenges.