Unusual case report: Do violent dreams cause violent acts?

For most people most of the time nocturnal dreams seem to have a life of their own with little, if any, recognisable relevance to life in the waking state. Freud and other theorists have attempted to relate nocturnal dreams to underlying impulses and conflicts which also affect one's mental state when awake. In only a few mental disorders has the manifest content of dreams achieved widely accepted diagnostic significance. The case presented here demonstrates that a patient's tenuous hold on reality can allow manifest dream content to direct the patient's waking behaviour. In this case the dream content seemed to identify the potential victim and to prime the patient to take violent action. For the astute clinician, careful attention to violent dreams may help to anticipate both violent acts and specific victims and to make appropriate, preventive interventions.