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Maladaptive daydreaming: when fantasizing becomes compulsive

Maladaptive daydreaming has the same effect as an addiction Foto di Juan Pablo Serrano Arenas on Pexels

Maladaptive daydreaming (MD), also known as excessive daydreaming1 is a psychopathological condition characterized by “Extensive fantasy activity that substitutes for human interaction and/or interferes with academic, interpersonal, or occupational functioning“.2
It is a true form of behavioral addiction, a spectrum of conditions only recently included in the list of official psychiatric diagnoses.3
The difference between maladaptive daydreaming and simple daydreaming, in fact, lies precisely in the addiction to the behavior. The daydreamer cannot do without his fantasies, to the point of reacting angrily if he is deprived or interrupted by them.

Table of Contents

Maladaptive daydreaming diagnosis

The identification of maladaptive daydreaming is relatively recent: the first to recognize it was Prof. Eli Somer in 2002.4 To date, maladaptive daydreaming is still not included in the list of recognized disorders within the Diagnostic and Statistical Manual of Mental Disorders.5
It was Prof. Somer himself, in 2016, who proposed the MDS-16 test, still in use today, to diagnose the disorder (Somer 2016).6
MSD-16 is a 16-point self-diagnosis which can be downloaded here as a pdf.
The self-diagnostic modality, often criticized in medicine, is, however, acceptable in excessive daydreaming because, unlike other disorders, such as schizophrenia, daydreamers are aware of their malaise, and able to recognize it.7

Maladaptive Daydreaming symptomatology

The common traits of maladaptive daydreaming are 3:8

  1. Difficulty in controlling the desire to fantasize. While sometimes subjects slip into daydreaming unconsciously, such as when trying to focus on something else, more often than not it is a voluntary activity
  2. Concern that the amount of time spent fantasizing is such that it will impair social life
  3. Intense shame and willingness to keep this behavior hidden from others

In one study, 79% of participants reported manifesting kinaesthetic activity during dreaming, which is not surprising given that moving helps make imagination more vivid. Movement can either be the trigger or manifest during reverie.910

Another MD-related activity is listening to music.11

An interesting factor is that the majority of those affected by excessive daydreaming appear to be female.
This fact, however, according to Valeria Franco, president of the association “Maladaptive Daydreaming Italia,” could be due to the greater propensity of women to seek help in case of psychological distress.
A typical case of maladaptive daydreaming, Dr. Franco continues, is the following: a girl likes a boy but, rather than starting a relationship, she locks herself away, imagining what it would be like to be with him. Gradually, the fantasy takes shape, occupies more and more space in daily life, and comes to compromise the normal flow of activity.

MD Causes

As already mentioned in the “Diagnosis” section, maladaptive daydreaming is not yet included in the handbook of pathologies officially recognized as psychiatric disorders. There are two main reasons for this:

  1. Its discovery is relatively recent
  2. It often occurs in the presence of other recognized pathologies (as we will analyze in more detail in the appropriate section “MD Comorbidity with other pathologies“).

However, it is important to emphasize that there is no triggering pathology: those who suffer from MD, do not necessarily have another prior pathology, and vice versa.

In general, excessive daydreaming is a strategy to escape painful moods and complicated emotions. By taking refuge in one’s imagination, the subject is able to avoid the discomfort of a negative mood.12

Very often, moreover, although not always, the cause seems to lurk in traumatic unhappy memories. In one study, 42% of the investigated subjects fantasized about idealizing a better relationship with their family. It also emerged how there was a significant correlation with episodes of childhood abuse.13

MD Comorbidity with other pathologies

Some recognized psychiatric disorders may co-manifest with maladaptive daydreaming. However, for none of them is there an unambiguous correlation: in other words, none can be considered the only cause of excessive daydreaming.

Obsessive-compulsive disorder (OCD)

The strongest correlation seems to be between maladapive daydreaming and obsessive-compulsive disorder (OCD), although the mechanism underlying the association remains unclear.14
In one study15 of MD subjects were evaluated for symptoms related to: depression, anxiety, social anxiety, OCD, and dissociation. The symptomatology of all disorders worsened after daydream episodes, while OCD was the only pathology showing a different pathway: OCD was the only anticipator of the fantasies, suggesting a reinforcement loop between maladaptive daydreaming and OCD itself.

Attention deficit hyperactivity disorder (ADHD)

In one study, it was found that 77% of the examined weights with MD also suffered from ADHD;16 however, subsequent studies showed that, in contrast, only 20% of those examined, all ADHD; suffered from MD.17
Therefore, from these data, it is MD that appears to be a risk factor for ADHD, and not the other way around.

Narcissism

Separate mention deserves narcissism.
As early as the third edition of the DSM, one of the criteria identified for narcissistic personality disorder is the production of grandiose fantasies, which ensure the fulfillment of the narcissistic desire for greatness.
In 1991, it was identified that narcissistic subjects subjected to stressful situations increased fantasy production, giving empirical support to the theory that narcissism breeds daydreaming.18
This view would confirm the theory that sees maladaptive daydreaming as a mode of escape from emotionally uncomfortable situations, avoiding reality instead of facing it. The narcissist avoids the discomfort of not having the life he or she would like by imagining one satisfying enough to keep his or her ego at bay, while the daydreamer uses reveries as a safe haven from trauma, unpleasant emotions, and a sense of inadequacy.

Maladaptive daydreaming treatment

Treatment options for MD are limited, as it is a newly discovered and not yet officially recognized condition.

  • There are communities on the web aimed at connecting people who suffer from it, either for listening or for direct advice.
  • Meditation can also help. In one study, some maladaptive daydreaming sufferers practiced mindfulness on a daily basis; they also wrote down how they spent their time. At the end of the 8-week period, 1/4 were able to return to a normal occupation of their time, while the control group showed no improvement, highlighting a beneficial role of mindfulness and self-monitoring diary.19This should not be surprising, as both activities are aimed at bringing attention back to the present moment, acting against pathology.
  • Last, but not least, is psychological therapy. Reconstructing the patient’s experience makes it possible to identify the cause that generated the disorder, directing therapy toward a pathway of processing the experiences themselves, working on social skills and relational areas made deficient by MD, going on to resolve the symptom

References

  1. https://en.wikipedia.org/wiki/Maladaptive_daydreaming ↩︎
  2. E Somer, “Maladaptive daydreaming: A qulitative inquiry“, 2002 ↩︎
  3. https://en.wikipedia.org/wiki/DSM-5 ↩︎
  4. E Somer, “Maladaptive daydreaming: A qulitative inquiry“, 2002 ↩︎
  5. https://en.wikipedia.org/wiki/DSM-5 ↩︎
  6. E Somer, “Development and Validation of the Maladaptive Daydreaming Scale (MDS)“, 2016 ↩︎
  7. Valeria Franco, president of Maladaptive Daydreaming Italia, in an interwiev ↩︎
  8. J Bigelsen, “Compulsive fantasy: Proposed evidence of an under-reported syndrome through a systematic study of 90 self-identified non-normative fantasizers“, 2011 ↩︎
  9. E Somer, “Childhood Antecedents and Maintaining Factors in Maladaptive Daydreaming“, 2016 ↩︎
  10. J Bigelsen, “Compulsive fantasy: Proposed evidence of an under-reported syndrome through a systematic study of 90 self-identified non-normative fantasizers“, 2011 ↩︎
  11. E Somer, “Childhood Antecedents and Maintaining Factors in Maladaptive Daydreaming“, 2016 ↩︎
  12. I Pietkiewicz, “Maladaptive daydreaming as a new form of behavioral addiction“, 2018 ↩︎
  13. E Somer, “Heightened Levels of Maladaptive Daydreaming Are Associated With COVID-19 Lockdown, Pre-existing Psychiatric Diagnoses, and Intensified Psychological Dysfunctions: A Multi-country Study“, 2020 ↩︎
  14. E Somer, “Maladaptive Daydreaming and Obsessive-Compulsive Symptoms: A confirmatory and exploratory investigation of shared mechanisms“, 2021 ↩︎
  15. N Soffer Dudek, “Trapped in a Daydream: Daily Elevations in Maladaptive Daydreaming Are Associated With Daily Psychopathological Symptoms“, 2018 ↩︎
  16. E Somer, “The Comorbidity of Daydreaming Disorder (Maladaptive Daydreaming)“, 2017 ↩︎
  17. N Theodor-Katz, “Could immersive daydreaming underlie a deficit in attention? The prevalence and characteristics of maladaptive daydreaming in individuals with attention-deficit/hyperactivity disorder“, 2022 ↩︎
  18. R Raskin, “Narcissism, self-esteem, and defensive self-enhancement“, 1991 ↩︎
  19. O Herscu, “Mindfulness meditation and self-monitoring reduced maladaptive daydreaming symptoms: A randomized controlled trial of a brief self-guided web-based program“, 2023 ↩︎

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