This paper reports conclusions and implications of a seven-year study of posttraumatic nightmares in an inpatient psychiatric population. In every case, the patient's account of the nightmare scenario differed significantly from that person's account of the trauma, but the discrepancy was kept from consciousness by secondary revision. The posttraumatic nightmares screened predisposing, coexisting, and subsequent trauma in the dreamers' lives. These posttraumatic nightmares, acute or chronic, were instigated by shame and fragmentation in the day preceding the dream. Psychoanalytically informed treatment of trauma patients should consider shame conflicts related to the disorganized posttraumatic state as well as the conflicts in the manifest content of the nightmare.