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When Dreams Become Reality
Dream-Reality Confusion in Borderline Personality Disorder
Introduction
When you look back at today, will you know if the day you lived was real or if it was all a dream? Think about major events in your life: a promotion, the birth of a child, a tragic accident, or the loss of a loved one. What would you do if you discovered these events were just a part of your dreams? What would you do if, suddenly, you can no longer tell which of your memories are real?
Dreams often mimic or reflect our lives, from reenacting a pivotal life achievement to predicting the future or performing monotonous daily life tasks. In most situations, when recalling the memory of an event, it is fairly easy to determine if the memory stems from real-life happenings or was simply imagined in one’s dreams. Typically, the origins of a memory are known without having to put the question into conscious thought. This feature of memory is often taken for granted, only really put into thought when it stops working as it should. When this malfunction occurs, memories from dreams and reality blend together.
While dreaming is an integral part of our well-being, when the line between dream and reality becomes blurred, dreams can become detrimental. In a condition known as dream-reality confusion (DRC), it becomes difficult to determine if events or experiences occurred in the waking or sleeping state of mind. Some experiences affected by DRC can be as simple as making plans with friends, only to find out those plans never happened or doing maintenance around the house, then finding no evidence of the project’s existence later. However, as DRC evolves and dreams get more complex and emotion-driven, the line between dreams and reality continues to blur, warping one’s perception of the world. Those blurred lines become dangerous when people begin to live their nightmares. Not knowing what parts of life are real can devastate one’s sense of self, ability to interact with others, and overall quality of life.
Unfortunately, little is known about the causes and mechanisms surrounding DRC. Most research investigating dream-reality confusion relies on surface-level, noninvasive clinical or psychological studies. However, researchers were able to uncover relationships between DRC and various neurological and psychological disorders, such as narcolepsy, bipolar disorder, post-traumatic stress disorder, schizophrenia, and borderline personality disorder (BPD). There have also been associations made between DRC and reduced cognitive levels, such as mental states brought about by sleep deprivation, stress, exhaustion, and dehydration. Through studying these relationships, researchers are gradually developing their understanding of the disorder. This article will focus on research surrounding the connection between BPD and DRC to provide an introduction to some of the theories surrounding DRC’s risk factors and selective manifestation. But first, let’s break down the topic and explore BPD, dreams, and memory individually.
Borderline Personality Disorder
BPD is defined as a mental illness that causes rapid and extreme mood swings, instability in interpersonal relationships, impulsivity, and difficulty with emotional regulation. This disorder tends to lead to dangerous and self-harming behaviors. BPD is thought to be correlated with patterns of impulsivity, instability in interpersonal relationships, and negative self-image (“Borderline Personality Disorder (BPD)”, 2022). To help people without BPD understand life with the disorder, BPD has often been compared to an “emotional rollercoaster,” as individuals with the disorder typically display extreme and volatile emotional fluctuations (“Everything You Need to Know About Borderline Personality Disorder”). Due to the complexity of the disorder and the variance in its manifestation from person to person, the exact cause of BPD is unknown. While symptoms can be helped with medication and psychotherapy, there is no cure. In the U.S., it is estimated that BP affects approximately 1.4% of adults, with the average age of onset occurring in an individual’s teen years (“Borderline Personality Disorder (BPD)”, 2022).
Dream Formation
The brain is predominantly composed of a type of cell called a neuron. Neurons transmit information about the internal and external environment through the brain by conveying electrical signals from one neuron to the next. When the electrical activity of a large group of neurons becomes synchronized, they can create rhythmic and repetitive voltage oscillations, commonly known as “brain waves,” across regions. (Buskila, et al., 2019). One type of brain wave believed to be involved in the formation of dreams is the ponto-geniculo-occipital (PGO) waveform. These waves occur repeatedly during a stage of sleep classified as rapid-eye movement (REM) sleep, as opposed to non-rapid-eye movement (NREM) sleep, and are recognized as a signature of REM sleep. PGO waves are thought to be involved in generating dreams by activating parts of the brain’s visual system. It is theorized that memory information passing their visual pathway may be interpreted by the brain as visual information, leading to the visual hallucinosis of dreams (Gao, et al., 2023). For more information on sleep stages and the theories behind dream formation, please see our previous article entitled “What Dreams Are Made Of.”)
Blurred Lines Between Dreams & Reality
One theorized function of dreaming is the unlearning and removing of unwanted memories. It is thought that unconscious dreams weaken certain memories by modifying the strength of related synaptic connections needed for neurons to transmit the memory’s neurological information to other neurons. PGO waves are theorized to play a role in unlearning memories by determining which memories are retained and which are erased. If this process of unlearning unwanted memories does not work, experiences such as hallucinations, delusions, and obsessions similar to those seen in schizophrenia may develop (Gao, 2023).
DRC shares a close relationship with hallucinations. While dreams and hallucinations are distinct phenomena, they share many neurophysiological pathways on an anatomical basis. Although it is not necessary for the phenomena to occur, both DRC and hallucinations can be related to reduced cognitive states. Sleep is one form of “reduced consciousness,” as it decreases the individual’s ability to integrate external information. Reduced consciousness can also stem from sleep deprivation, sensory isolation, stress, exhaustion, and dehydration. The main difference between the two lies in their subjectivity. Wake experiences are perceived through a lens of intentionality that is not present in centered dreams. This difference allows the thought processes involved in dreaming to greatly differ from normal wake thought (Gomes da Rocha Neto, 2022).
As previously discussed the exact cause of DRC is unknown. That being said, the similarities between DRC and hallucination phenomena, as well as the correlation between PGO wave activity during dreaming and memory refinement have led many to theorize that dysfunction in the unlearning of memories during dreams may be a source of DRC manifestation.
Risk Factors for DRC Found in BPD
It has been theorized that individuals with various psychological and physiological traits seen in patients with BPD, though not exclusive to BPD, make them more susceptible to experiencing DRC. Some qualities in BPD patients that have been theorized to increase susceptibility to DCR include disturbances in sleep, dissociative symptoms, negative dream content, and cognitive disturbances (Skrypinka and Szmigielska, 2015).
Sleep Disturbances
One factor that is believed to contribute to DRC is disturbances in sleep. In people with BPD, it is common for individuals to take greater amounts of time to fall asleep, sleep for shorter durations of time at night, have lower sleep efficiency, and experience frequent awakenings throughout the night (Skrypinka and Szmigielska, 2015). During these frequent and unsteady alterations between sleep and wake states, the level of consciousness between the two states becomes similar. In this, just after waking, the mind typically experiences a state of reduced consciousness, meaning the individual is awake and aware of their environment, but the amount of awareness and their ability to interact with the world are reduced, resembling an amount of awareness just greater than that of light, restless sleep. This similarity in consciousness can make it more difficult for the brain to process whether a memory that occurred during the individual’s reduced consciousness awake periods was real or imagined during their sleep (Gomes da Rocha Neto, 2022). This altered wake cycle may lead to feelings of depersonalization and negatively affect memory by promoting intrusions of dreamlike experiences into the waking consciousness and favoring the creation of false memories. This blurs the line between dreams and reality, making it difficult later to determine whether events or experiences truly occurred (Skrypinka and Szmigielska, 2015).
In addition, patients with BPD have also been shown to spend irregular amounts of time in NREM and more time in REM sleep, with changes in their neural activity including higher voltage waveforms. Similar changes in REM have also been seen to affect DRC. DRC has been associated with irregular time spent in NREM and various changes in REM, including a longer latency, longer first episode, high REM density, and changes in the neurological waveforms picked up via EEG, suggesting a change in information processing or modulation. It is theorized that similar changes in REM and NREM activity are why people diagnosed with narcolepsy are more likely to develop DRC (Skrypinka and Szmigielska, 2015). However, while the relationship between the changes in the sleep stages and DRC occurrence has been observed, the mechanisms behind these changes are still being explored.
Dissociative Symptoms
Dissociation refers to the disruption or disconnect from one’s thoughts, feelings, memories, or surroundings. It affects one’s perception of the world as well as one’s own identity. Approximately ⅔ of patients diagnosed with BPD experience dissociative states (Korzekwa and Pain, 2009). These types of dissociative symptoms are correlated with the presence of DRC. It is thought that “derealization is a compromise between dreaming and waking.” Therefore, it is theorized that individuals in a dissociative state are more susceptible to having their dreams leak into their waking memory, making the two increasingly more difficult to differentiate (Skrypinka and Szmigielska, 2015).
Negative Dream Content
It is widely believed that dreams often reflect the dreamer’s waking experience, including people, events, beliefs, and emotions. As a result, when a person’s perception of life becomes more negative or they experience intense emotional distress, the content of their dreams often becomes more negative as well and they are more prone to nightmares. Nightmares are an example of a sleep disturbance and are characterized by vivid dreams charged with intense negative emotions, powerful enough to wake a person from their sleep. People diagnosed with BPD have difficulty regulating their emotions, along with heightened emotional sensitivity and emotional instability, making them more susceptible to negative emotions (Skrypinka and Szmigielska, 2015). As a result, they are more prone to nightmares, with patients with BPD being approximately 4-10 times more likely to experience a nightmare than those without (Levin and Nielsen, 2007; Simor, 2010). Nightmares and strong, negative emotions have been linked to an increased susceptibility to DRC. But while many theories have been proposed, more research must be done to fully understand the correlation between the phenomena (Skrypinka and Szmigielska, 2015).
Cognitive Disturbances
Another potential cause of DRC is theorized to be difficulty in “reality monitoring”. Reality monitoring is thought to be conducted in the temporoparietal cortex and the medial prefrontal cortex, with the medial prefrontal cortex being responsible for discriminating internal information (such as dreams) from external information (real-life experiences). During dreaming and waking fantasy, the processes monitoring the source of incoming information are temporarily suspended, reducing the ability of the individual to respond to sensory stimuli. People with higher levels of waking fantasy increase the disturbance of the reality monitoring process, making recall of the origin of events more difficult to place.
In addition, people with cognitive disturbances in these reality-processing regions, such as people with BPD, are more prone to problems with testing if a situation is reality. It is theorized that this problem builds on itself over time. For instance, if an individual is unsure if their reality is correct or unsure about the source of events or experiences, they are less likely to trust their cognitive skills in the future, amplifying their confusion as time progresses and the frequency of cognitive mistakes increases and increasing the severity of DRC (Skrypinka and Szmigielska, 2015).
Conclusion
Overall, DRC is a dangerous condition that warps the mind and destroys the lives of those it touches. Memories of reality and dreams become one, causing enduring daily life to become a perplexing, strenuous, and frightful endeavor. For people with BPD, an already often mentally crippling disorder, the increased prevalence of sleep disturbances, dissociative symptoms, negative dream content, and cognitive disturbances heighten the prevalence of DRC. However, no one is completely safe from its clutches. So now that you know more about DRC, ask yourself this; are you sure your memories aren’t just dreams?
References
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Borderline Personality Disorder (BPD). (2022). Cleveland Clinic. https://my.clevelandclinic.org/health/diseases/9762-borderline-personality-disorder-bpd
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