In Partial Fulfilment of the

Requirement In the subject

Psychology 109
Abnormal Psychology
(3:30-4:30 MWF)

Submitted By:
Iah Elijah A. Mayyam
 Table of Contents

I. Case History

A. Background Information

B. Description of the Presenting Problem

C. Diagnosis

II. Intervention

III. Reflection

IV. References
I. Case History

A. Background Information

I ‘am Iah Elijah A. Mayyam, 20 year old Filipino

male. I live with my parents and I have lived in Baguio
City for most of my life. I ‘am a college student studying
Psychology, due to the scheduling of college classes,
my sleep schedule changes every semester to adjust to
my class schedules. However due to my habits, I usually
goes to bed at around 2 or 3 am.

Due to my habits I usually doesn’t get the

prescribed amount of sleep for my age. I usually goes
to bed after everyone else in the house goes to bed,
because I prefer to try to go to sleep when everyone
else at the house is done with their nightly practices.
Because of this, I have low energy for my days and feel
little motivation to join extracurricular, social or even
family functions unless necessary.

As for my daily life, it revolves around doing all

thing required of me while exerting as little effort as I
possibly can. I rarely eats outside and I do little to
socialize outside talking to people at school. Most of my
social life since high school has deteriorated due to me
not being more outgoing and meeting with my old
friends for social functions, like I said, I only attend social
functions when totally necessary. Most of the people I
talk to are either through online games or the people I
talk to at school.

I have acquaintances smoke and drink and

whenever they do, I feel like I needs to do the things
they do too to gain their approval. However, I instead
avoids these thoughts by not joining my peers when
they go smoking or drinking.
B. Description of the Presenting Problem

While reflecting on what actually caused my bad

sleeping habits, I remembered that during my young
years, specifically the years before the onset of
puberty, I began having nightmares and that I would
wake up in the middle of the night sweating and
sometimes even crying. Due to this, instead of sleeping
and having nightmares, I preferred staying up and
reading. When my parents came to check on me I
would pretend to be asleep so as not to warrant their
anger.

My dreams were usually vivid involving me doing

some sort of crime. Usually the victims of such crimes
are people close to me. Though when I was younger, in
my dreams usually found myself in strange situations for
example, climbing a mountain with no clothes on or
being in really awkward situations like going to school
with the wrong uniform on. However as I got older and I
learned more things, my nightmares began revolving
around socially unacceptable things. Most nights, 2 to 3
nights a week I get these nightmares that wake me up
in the wee hours of the morning. Usually due to fatigue I
fall back to sleep which causes me to wake up later
than I plan to wake up.
It used to be worse when I was younger and
could not control my imagination when I wake up at
night, I felt like the nightmare would follow me to the
real world and I would stay up at night too afraid to get
up and turn the lights on. I would stay in bed and wait
for morning or for someone else to wake up so I can tell
them what happened.

Most of the time it was dismissed by my parents

as nothing more than my imagination running wild,
because of that I learned to not tell them about the
nightmares and to just roll with it. However even now I
still sometimes have trouble going back to sleep after
waking up from the nightmare.

Unlike when I was younger, there are no monsters

in my dreams, instead I found that I ‘am the monster
doing things to people, usually people that I know
personally, and when I see them during the day I try to
avoid engaging them as to avoid any awkwardness on
my part. At some point during my recent years I have
learned to cope by sleeping when I’m tired but due to
my school schedule I find that I don’t get enough
sleep. This is because I usually only feel tired enough to
sleep late at night.

This usually affected my schooling as most of the

time I cannot concentrate even if I look like I’m listening
in class my body just feels too tired to try to listen. And
when I finally go home, I can’t study as I can’t focus my
attention on my notes or reading material given to us. I
instead find myself concentrating on not falling asleep
so I don’t get into an awkward situation. School might
be a huge factor in my current condition due to the
fact that my parents give such importance in getting
an education, which I do understand, however I admit I
am quiet laid back with my schooling causing me to do
a lot of cramming making for quizzes.

The situation gets worse most of the time when

exam days are near because I usually stress out over
exams and reviewing does little to put me at ease so I
find myself staying up later and getting less sleep than I
already get trying to put my mind at ease by doing
what I can to feel prepared for exams.

My dreams could also be influenced by my

choice of films and video games to the TV shows I
watch. With the content of most shows I watch being
violent and sometimes disturbing emotionally causing
me stress despite the fact that I know it’s only a show
and not real life. Videogames on the other hand cause
me to stress over things that won’t benefit me in the
 long run, such as playing with my friends to get in game
items even if I find the game boring and stressful.

C. Diagnosis

In line with my experiences as a child up to now,

after some careful reading of the DSM V and other
literature regarding mental problems I can perhaps
make an educated guess at what ails me and my sleep.
Due to the apparent symptoms, I’ve made the
conclusion that perhaps I ‘am suffering from a sleep
related disorder, specifically Nightmare Disorder.

Based on the criteria of DSM V, symptoms such as

vivid and surreal nightmares, waking up sweating,
anxiety due to disturbing dreams, and waking up
because of your dream all point to Nightmare Disorder.

According to DSM V, stress/anxiety, trauma, sleep

deprivation, medications, substance abuse, and other
disorders can lead cause Nightmare Disorder.

This particular parasomnia leads to excessive

sleepiness during the day which can lead to difficult at
school or work, and can affect the mood causing
depression and anxiety from dreams that bother you.

The criteria for a person to be diagnosed with

Nightmare Disorder according to DSM V are the
following:

 The individual has recurrent distressful dreams that

typically involve threats to his or her safety or
wellbeing, which he or she attempts to avoid,
generally occurring during the second half of the
major sleep cycle.
 Upon awakening from the nightmare, the individual
becomes alert and oriented rather quickly
  The nightmare causes significant distress or
impairment in important areas of life (e.g., social or
occupational)
 The nightmares are not due to physiological effects
of a certain substance (e.g., an abusive drug, a
medication)
 Another disorder does not sufficiently explain the
prime complaint of distressful dreams.

Nightmare Disorders can vary from person to

person, such as how often the nightmares over what
period of time they have been occurring. Therefore,
the following should be specified about the distressful
dreams: If they occur during sleep onset, if they are
associated with a non-sleep disorder, if they are
associated with other medical conditions, if they are
associated with another sleep disorder.

Severity of Nightmare disorder also varies. Mild,

the dreams occur less than once per week on
average. Moderate, the dreams occur once or more
per week but less than nightly. Severe, the dreams
occur nightly.

With the symptoms I have observed, I may have

moderate Nightmare Disorder, but again I must stress
that as a student I cannot accurately diagnose even
myself. Again though, with my limited knowledge I may
make this educated guess.

Risks and Diagnostic Factors:

Temperamental:

Due to lack of sleep, daily tasks such as chores

around the house as well as studying is made more
difficult. Mood is sour due to low energy levels.
Genetic and Physiological:

Nightmares are more common when family

members have a history of nightmares or other sleep
parasomnias, such as talking during sleep.

Onset:

Nightmares may begin in children between 3

and 6 years old and tend to decrease after the age of
10. During the teen and young adult years, girls appear
to have nightmares more often than boys do. Some
people have them as adults or throughout their lives.

Prevalence:

Sleep disorders, or parasomnias, occur in 35-45%

of children aged 2-18 years.

Women (n = 120; 33.4%) suffered more often from

nightmare disorder than men (n = 29; 20.9%;)

Functional Consequences:

Not only does one perform poorly academically

due to lack of focus, but the risk of getting in an
accident involving daily work.

The need for sleep also leads for one to look for
another source of energy by consuming various food
and food supplements to boost energy which could
lead to unforeseen consequences regarding ones
health (e.g., gastrointestinal disorders, cardiovascular
disease, diabetes, cancer) as well as the possibility that
one may begin to use and possibly abuse substances
to help stay awake which could lead to poor mental
health (e.g., depression, substance use disorders,
alcohol use disorders.)
 Attending and participating in social functions
becomes a struggle to stay awake and appear to be
paying attention, when in reality people with
parasomnias are focusing all their attention in staying
awake to not be rude, however this causes strains in
interpersonal relationships.

Comorbidity:

Nightmares may be comorbid with medical

conditions such as coronary heart disease, cancer,
parkinsonism. Nightmares are also frequent comorbid
other mental disorders, including PTSD; insomnia
disorder; schizophrenia; psychosis; mood, anxiety,
adjustment, and personality disorders.

With all the symptoms I have observed, I cannot

say that I have nightmare disorder because I am not
equipped with the appropriate knowledge to give such
a diagnosis. However, with the limited knowledge I do
have, I can say that with some of the symptoms I have
observed I may be suffering from this particular disorder
warranting even minimal treatment.
II. Intervention

Nightmare Disorder Treatment is often

unnecessary in children because Nightmare Disorder
usually fades as a child grows, unless it is causing
debilitating effects, such as disturbed sleep and
significant distress and/or it affects the child’s daily
performance owing to increased day time sleepiness
after a significant sleep deprivation at night.

A. Cognitive-Behavioral

This approach assumes that changing

maladaptive thinking leads to change in affect and
behavior. The goal of cognitive-behavioral therapy is to
teach patients that while they cannot control every
aspect of the world around them, they can take control
of how they interpret and deal with things in their
environment. This approach is effective for people who
are aware of their situation and are ready to make a
change to begin treatment for their mental illness.

Sleep disturbances following exposure to a

traumatic experience are often considered to be
secondary to PTSD. However, recent empirical findings
suggest a much more complex relationship between
posttraumatic nightmares, insomnia symptoms, and
PTSD. In fact, sleep difficulties in the aftermath of a
trauma predict both the onset and the maintenance of
PTSD symptoms. Moreover, sleep difficulties often persist
even after an effective psychological treatment for
PTSD, suggesting that they are not entirely secondary to
PTSD. Effective psychological treatments have been
developed to directly address trauma-related sleep
difficulties. Imagery rehearsal therapy and cognitive-
behavioral therapy for insomnia are currently the
psychological treatments of choice to address
nightmares and insomnia, respectively. A blend of
imagery rehearsal therapy and cognitive-behavioral
therapy for insomnia interventions appears to be the
best clinical approach.

So for this particular parasomnia, I read online

articles on the importance of sleep and its effects on the
body, and I found out that during sleep the body
restores damaged blood vessels as well as your heart.
On-going sleep deficiency is linked to increased risk of
heart disease, kidney disease, high blood pressure,
diabetes, and stroke. Too much or too little sleep is
associated with a shorter lifespan. Although it’s not clear
if it’s a cause or effect. Illnesses may affect sleep
patterns too. In a 2010 study of women ages 50 to 79,
more deaths occurred in women who got less than five
hours or more than six and a half hours of sleep per night.
Sleep also affects quality of life. That if you sleep better,
you can certainly live better.
An interesting form of treatment I also
found online was Light Treatment. Light treatment
involves the shining of light into the eyes for a certain
pattern and period of times at night. The light therapy is
also useful in treating seasonal affective disorders and
depression. The light therapy involves a brain
mechanism that can help transform one’s nightmare
into a lucid dream where the person is capable of
being aware of their dreams and is able to somewhat
control the events in their dreams. Most nightmares in
Nightmare Disorders have a repetitive pattern and
often give the person an inevitable feeling of distress,
however the sense of being able to control one’s
dream through the help of light therapy gives the
sufferer better confidence that their nightmares can be
controlled and are manageable, thus helping them
overcome their fear and anxiety about their Nightmare
Disorder.

Among the most common factors that trigger

Nightmare Disorder is stress, which can be alleviated
through different relaxation techniques, stress reduction
techniques, and proper stress management. The
treatment approach on stress reduction techniques
can be a helpful complementary treatment to other
major treatments for Nightmare Disorders, such as
psychotherapy. Exercise, meditation and yoga can
help relieve the sense of stress.

For individuals with an underlying psychiatric

disorder cause is approached with psychological
counseling. The person is taught to deal with the
recurring themes of their Nightmares. The Nightmare
Disorder Treatment is also focused on dealing with the
other associated psychiatric conditions to help
manage these factors that can magnify the condition
of one’s Nightmare Disorder.

One technique for treatment I stumbled upon

that caught my attention is Desensitization for chronic
nightmares, this method uses an instruction about
rehearsing the nightmare and imagining a different
ending to the dream. Of course this method would
need professional supervision and willing participants to
roleplay and recreate the disturbing events in a dream
that would wake and leave a person in a state of
anxiety. This method of treatment, in my humble
opinion, would require a great deal of courage from
the participant. For bringing a disturbing dream to life
even in the hopes to help a person could actually do
some damage, however the fact that it would require
the patient to think of good ending further solidifies my
belief that it requires a great deal of courage from the
patient and that the reward of undergoing such
treatment could be worth the risk of reliving a moment
of fear for a potential lifetime of good dreams and
sleep.
III. Reflection

This project has helped me understand myself

more even if to a minor degree. As now I understand
that my lifestyle is a huge influence on how my dreams
influence me and that in order for change to occur in
one aspect of my life, all aspects must change.

I have always knows sleep is important and that it

plays a huge role in how someone functions, however
this projects has helped me understand that it plays a
bigger part, in that I need sleep in order for social,
cognitive, emotional, physical and even moral aspects
to function at correctly.

This project also helped me to appreciate how

far I have come as a person, having inadvertently
helped myself in the hopes that I get more sleep
despite multiple factors that hinder this simple goal. This
simple fact gives me hope that perhaps even I could
help people in the future if I get the proper education
and if my passion for psychology still drives me to that
direction.

The knowledge I have gained from reading and

digesting online articles has also given me a little
glimpse at the potential threat that mental illnesses that
we deem unimportant could potentially do to damage
the lives to people who choose to ignore or, even
worse, hide their disorder for fear of being discriminated
by their peers. Perhaps a little off topic but this project
has helped me to be more sensitive to the fact that
everyone has a problem and that these problems are
relevant and should recognized and treated.

With this project giving light to the fact that I do

have some sort of disorder, even though I may or may
not have diagnosed it correctly, I now realize I may
need help and that I cannot rely solely on the fact that
I can help myself and now understand that we all need
professional help, help we cannot give to ourselves.
And that this help is worth the trouble getting and that
it is worth the years of education to be able to one day
help people with the same disorders.

I also now understand that in order for most of

the treatments I researched to work a great deal of
trust between client and psychiatrist must be present.
So in line with this I feel as a future psychologist I must
do my best to be trustworthy. Despite the hard work
that has to be put into becoming a licensed
psychologist, the ability to ease the pains of people
with similar illnesses gives me hope that perhaps
helping people in the future will be rewarding.
IV. References
http://thriveworks.com/blog/nightmare-disorder/

http://www.ietherapy.com/nightmare-disorder/treatments/nightmare-disorder-
treatments.php

http://www.mayoclinic.org/diseases-conditions/nightmare-disorder/home/ovc-
20324919

https://www.researchgate.net/publication/301551236_Nightmare_Disorder_Psyc
hopathology_Levels_and_Coping_in_a_Diverse_Psychiatric_Sample