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Maladaptive daydreaming as a new form of behavioral addiction

  • Ignatianum University of Cracow
  • Research Centre for Trauma & Dissociation


Background and aims: Maladaptive daydreaming (MD) has many features of behavioural addiction but research exploring this syndrome is limited. This case study provides a qualitative exploration of MD. Method: A structured clinical interview and mental state examination of a patient with MD was video-recorded and transcribed verbatim. Transcripts were subjected to the interpretative phenomenological analysis. Results: MD developed as a strategy to cope with distress but led to uncontrollable absorption in fantasy, social withdrawal, and neglecting aspects of everyday life. It was coupled with excessive Internet use and viewing porn. Discussion and conclusions: Patients should be questioned about MD during clinical assessment. Further studies are necessary to determine whether MD constitutes a separate syndrome or is a part of other behavioural addictions.
Maladaptive daydreaming as a new form of behavioral addiction
Research Centre for Trauma & Dissociation, Katowice Faculty of Psychology, SWPS University of
Social Sciences and Humanities, Katowice, Poland
Faculty of Psychology, Jagiellonian University, Krak´ow, Poland
(Received: February 16, 2018; revised manuscript received: May 27, 2018; second revised manuscript received: July 17, 2018;
accepted: August 13, 2018)
Background and aims: Maladaptive daydreaming (MD) has many features of behavioral addiction, but research
exploring this syndrome is limited. This case study provides a qualitative exploration of MD. Methods: A structured
clinical interview and mental state examination of a patient with MD were video-recorded and transcribed verbatim.
Transcripts were subjected to the interpretative phenomenological analysis. Results: MD was developed as a strategy
to cope with distress but led to uncontrollable absorption in fantasy, social withdrawal, and neglecting aspects of
everyday life. It was coupled with excessive Internet use and viewing porn. Discussion and conclusions: Patients
should be questioned about MD during clinical assessment. Further studies are necessary to determine whether MD
constitutes a separate syndrome or is a part of other behavioral addictions.
Keywords: maladaptive daydreaming, absorption, social exclusion, bullying, addictive behavior
While the fth edition of Diagnostic and Statistical Manual
of Mental Disorders (DSM-5) only lists the gambling
disorder in the behavioral addictions chapter, authors also
consider additional forms, such as Internet gaming disorder,
and recommend further research into excessive use of social
media or viewing pornography (American Psychiatric
Association [APA], 2013). Internet gaming may involve
role-playing games (RPGs) or live action RPG in which
participants are identied with their characters and co-create
imagined scenarios (Tychsen, Brolund, & Kavakli, 2006;
Vorobyeva, 2016). Some people use paid services allowing
participants to create avatars and virtual environments in
which they interact with others, for example, World of
Warcraft or Second Life (Messinger, Stroulia, & Lyons,
2008). Studies show that users often develop idealized
versions of themselves, with personality traits or preferences
similar to their own, and engage in normal actions, such as
socializing or shopping or express forbidden, conicting
desires (Gottschalk, 2010;Linares, Subrahmanyam, Cheng,
& Guan, 2011). RPGs, which are in signicant imaginative
involvement, compared with other types (e.g., shooters or
strategic games), have been associated with the highest
risk of generating behavioral addiction (Lee et al., 2007;
Lemmens & Hendriks, 2016).
There is a growing body of evidence identifying dys-
functional forms of imaginative involvement, dened as
maladaptive daydreaming (MD), which may be expressed
through extensive book-reading, watching lms, or gaming.
MD refers to extensive, often compulsive, absorption in
fantasy for several hours a day, which replaces human
interaction and impairs functioning in various domains:
academic, interpersonal, or vocational (Somer, 2002,
2018). This syndrome was found in patients with a wide
range of DSM-5 disorders, including attention-decit hy-
peractivity disorder, anxiety disorder, depressive disorder,
and obsessivecompulsive or related disorders (Somer,
Soffer-Dudek, & Ross, 2017). Somer (2002) initially asso-
ciated MD with dissociative pathology and personality
disorders. More recently, however, he described this behav-
ior in relation to four categories: a dissociative disorder,
disturbance of attention, obsessivecompulsive spectrum
disorder, or behavioral addiction (Somer, 2018). Maladap-
tive daydreamers may share certain similarities with prob-
lematic Internet gamers who play games to avoid real-life
difculties (escapism), and use fantasy to experience things
that are not workable in real life or live out alternative
identities through the game (Ballabio et al., 2017). Escap-
ism, according to Demetrovics et al. (2011), should be
distinguished from coping (i.e., improvement of mood or
channeling of aggression), which has no clear relationship
with problematic gaming. MD could be considered a be-
havioral addiction, because it is so rewarding that people
experience intense yearning for it or feel compelled to
extend and repeat this action (Somer, Somer, & Jopp,
* Corresponding author: Igor J. Pietkiewicz; Research Centre for
Trauma & Dissociation, Katowice Faculty of Psychology, SWPS
University of Social Sciences and Humanities, Technik´ow 9,
Katowice 40 326, Poland; Phone: +48 602 648 713; E-mail:
This is an open-access article distributed under the terms of the Creative Commons Attribution-NonCommercial 4.0 International License,
which permits unrestricted use, distribution, and reproduction in any medium for non-commercial purposes, provided the original author and
source are credited, a link to the CC License is provided, and changes if any are indicated.
© 2018 The Author(s)
CASE REPORT Journal of Behavioral Addictions
DOI: 10.1556/2006.7.2018.95
2016b). Some report an irresistible urge to immerse them-
selves in a fantasy world immediately on waking or want to
continue fantasizing when interrupted (Bigelsen, Lehrfeld,
Jopp, & Somer, 2016). Bigelsen and Schupak (2011),
however, note that daydreamers are also distressed about
losing control over fantasizing and unsuccessful attempts to
limit it.
There are only a few studies on MD, and its symptoms
are often unacknowledged or dismissed during clinical
assessment (Somer, Somer, & Jopp, 2016a). Because this
may lead to unsuccessful treatment, further research is
required (Somer, 2018;Somer et al., 2016b). There is also
an ongoing dispute among researchers whether or not to
classify certain problematic behaviors as newbehavioral
addictions. To avoid overpathologizing the daily life activi-
ties, Billieux, Schimmenti, Khazaal, Maurage, and Heeren
(2015) suggest that preliminary qualitative studies should
precede quantitative research and explore underlying
psychological processes and how certain behaviors are
experienced, instead of merely comparing behavior
against diagnostic criteria. This paper is in line with this
approach. It presents a case study of a patient having
MD with features of behavioral addiction, whose narrative
was explored adhering to rigorous diagnostic and methodo-
logical procedures of the interpretative phenomenological
analysis (IPA).
This study took place in Poland in 2018 as part of the project
exploring alterations in consciousness. IPA was used for
data analysis. IPA generates rich and detailed descriptions of
how individuals experience phenomena under investigation
and synthesizes concepts derived from phenomenology,
hermeneutics, and idiography. Detailed exploration of how
participants make meaning of their world is combined with
researchersattempts to make sense of the participants
meaning (Pietkiewicz & Smith, 2014).
Peter (his real name has been changed to ensure condenti-
ality), aged 25 years, is a single Caucasian male who has
moved out of the family home and lives with a atmate. He
is about to complete an IT degree. He uses alcohol rarely and
in small doses and has never used drugs or other psychoac-
tive substances. He meets the DSM-5 criteria of the 301.82
avoidant personality disorder (he avoids interpersonal con-
tacts fearing disapproval, criticism, and rejection; he has
never had an intimate relationship or sexual initiation
because of shame and fear; he is preoccupied about being
socially ashamed or mocked and feels inadequate, inhibited,
and socially inept; he has poor self-esteem and feels inferior;
and he is reluctant to engage in activities potentially associ-
ated with being embarrassed). He also reported multiple
symptoms indicating non-substance behavioral addiction
associated with daydreaming and excessive Internet use for
watching videos, pornography, playing games, and reading
news. He has become increasingly involved in these activi-
ties to achieve desired excitement, experienced irritation
when unable to continue that behavior, stayed preoccupied
with it, and made repeated and unsuccessful attempts to
control his mental and physical actions. He used that
behavior to regulate affect but was ashamed and tried to
conceal it, experiencing distress as a result. However, he
reported neither posttraumatic stress disorder symptoms and
somatoform or psychoform dissociation, nor symptoms
indicating the existence of dissociative personality parts.
The study was approved by the local university research
committee. Our participant had been screened for dissocia-
tive experiences by a local psychiatrist who referred him to
the Research Centre for Trauma & Dissociation for an in-
depth diagnostic examination, where he was subjected to the
Trauma and Dissociation Symptoms Interview TADS-I
(Boon & Matthess, 2017) to explore his medical history,
substance use, and various aspects of everyday functioning
(including sleep, eating, self-image, mood regulation, inter-
personal relationships, and alterations in consciousness).
TADS-I is a comprehensive tool for a differential diagnosis
of dissociative disorders, thoroughly examining alterations
in consciousness (including depersonalization, derealiza-
tion, absorption, and daydreaming) and symptoms indicat-
ing structural dissociation of the personality. The interview
was held in two sessions and lasted approximately 4 hr in
total. A psychiatrist also performed a standard mental health
assessment and informed the participant about his results
and recommended treatment. All interviews were video
Data analysis
A detailed, verbatim transcript of the video recording was
separately analyzed by all authors in Nvivo11 (computer-
assisted qualitative data analysis software), using the con-
secutive analytical steps recommended for IPA (Pietkiewicz
& Smith, 2014). First, the transcript was carefully read
several times and researchers made their interpretative
comments about the content and language use. They regis-
tered repetitive phrases, similes, and similarities in how the
participant described various experiences at different points
of the interview. The hermeneutic circlewas applied in
the analysis, meaning researchers tried to understand each
individual part by reference to the whole and vice versa.
Then, they categorized the notes into emergent themes by
allocating descriptive labels (nodes) and discussed their
coding and interpretations of data with each other. They
analyzed the connections between themes and grouped
themes according to conceptual similarities into super-
ordinate ones and subthemes. This article presents an
elaboration of salient themes relating to the experience of
excessive daydreaming and the participants associations
and interpretations.
The study procedures were carried out in accordance with
the Declaration of Helsinki. The institutional review board
of the SWPS University of Social Sciences & Humanities
Journal of Behavioral Addictions
Pietkiewicz et al.
approved the study. The participant was informed about the
study and provided informed consent.
Theme 1: Facing social rejection was unbearable
In primary school rst grade, Peter saw himself as a sociable
and communicative and focused on school achievements.
He had limited awareness of his competitive tendencies.
I think I didnt realise that I pushed too hard and they
[classmates] didnt like it. I wasnt arrogant, selsh or
unfriendly, I simply bragged about how fortunate I was. I
craved the spotlight.
He could not understand why, months later, his classmates
began to tease him, intimidate him in front of others, or
inict pain.
They mocked me all the time, and avoided me. I sat alone
at the back in class and had no one to talk to. Everyone
knew I was a gure of fun.
This led him to feel weak, inferior, and socially excluded.
He felt especially ashamed and humiliated when teased or
mocked in the presence of girls he found attractive.
Theme 2: Seeking distraction and release of tension
Perceiving himself as an outcast and feeling worthless, Peter
sought ways to distract himself from negative thoughts. He
played video games or browsed the Internet for many hours
and masturbated excessively. This way of discharging
emotional tension started at a young age and he calls it
my detox after school.Over the years, the time spent
fantasizing increased, usually triggered by pictures, lms, or
news on the Internet, which he found difcult to stop.
I spend about 14 hours a day surng on my computer,
watching pictures of cars, YouTube, and wanking. Po-
litical news, for example, may trigger delusional fanta-
sies in which I am a multimillionaire who would never let
that situation happen. If nothing stops my fantasizing
like going swimming or to the library then I crave
music, which gets me even more hopped up. I walk
around the at, imagining how it would be in that world.
When I have had too much, I need to watch some porn
and masturbate.
Peter thinks he initially tried to avoid painful reality by
developing alternative scenarios of events and experiencing
them as if they were real. In this way, he could regulate his
emotions and cope with loneliness.
When I felt this pain as a child, I started imagining how
things could be different. I created stories which never
happened. To suppress that pain I would hug my pillow
or quilt, thinking I was being comforted by someone
Theme 3: Intense imaginative involvement
In his experience, spending most of the time playing
video games, browsing the Internet, and masturbating com-
pulsively also involves excessive daydreaming, which gives
him excitement and pleasure. Peter seeks solitude and
favorable conditions to immerse himself in his fantasy
world. He realizes that daydreaming increasingly consumed
more time and energy. Over the years, he recorded this
activity in his diary, growing concerned, and angry with
himself when he realized that he had limited control over his
compulsive behavior.
Time goes by and I am not really able to control it. I sit at
my PC and daydream day by day. I start in the morning
and realise it is already night. It started by the second
grade but did not bother me then so much. Now I fear that
I have wasted my life and opportunities.
Although daydreaming is pleasurable, he says he has devel-
oped a delusional personalityand lost control over fanta-
sizing, becoming afraid of losing touch with reality or that
the alterwill take over.
Triggers for excessive daydreaming. Peter blames the
peers who bullied him at school for his current difculties
and coping strategies. He thinks he was overly stressed and
lacked emotional support, which discouraged him from
interaction with others and expressing his needs.
My main problem is that I was too traumatised to express
my feelings and needs. No life, women, hobbies through-
out these years ::: only fear and shame about saying
what I wanted. This is what they did to me at school.
Occasionally, Peter tries to concentrate on the here and
nowas his form of rehab. However, listening to music or
watching media triggers or supports fantasies. It is easy for
him to get hookedon one thought, which leads to him
developing elaborate and exciting stories.
Thinking about something, I automatically create a scenar-
io. For instance, I become this multimillionaire, giving an
interview. People admire my wisdom, respect me and make
way for me. I move around my at, listening to music and
getting really high. I live these delusions for a few hours,
daydreaming about that life: driving cars, car racing, sex.
Experimenting with alters. The protagonists in his fanta-
sy world are always men with special attributes associated
with admiration or awe. They use their abilities to help
others, which make Peter feel strong, proud, and special,
because he imagines being them.
I created this delusional personality of a multimillionaire by
building digital systems that allow mankind to conquer
death and cure all mental or physical problems. Sometimes
I am the king of Poland, a guardian of values, ideals, social
order, or a hero who can do things that other people are
unable to do. I rescue them. I am an FBI agent with a
photographic memory, an Iron Man who kills Muslim
terrorists, or I destroy villains like a Robocop. I am the best.
Journal of Behavioral Addictions
Maladaptive daydreaming
He also produces elaborate fantasies in which he hugs
women or aggressively penetrates them, which he attributes
to his lack of intimate contacts. Peter maintains that being a
virgin is another reason for his shame. In his imagination, he
then inspires people who feel weak, hopeless, or possess
other qualities he himself despises. In his daydreams, he
ascribes vulnerability to those he would save. He also has a
sense of moral triumph for not expressing openly hostile
feelings toward those who caused him pain.
As a multimillionaire I visit my old school and share my
story with the pupils. I tell them how I managed to
conquer my own weakness and that this was the best
lesson I received from life ::: not giving in to my hatred.
Fantasies are private experiences. Peter is ashamed of
the fragile self-esteem and sensitivity to criticism or rejec-
tion that he rst experienced at school. He sees expressing
emotions and reacting to being teased as weakness, so feigns
indifference. He says,
I dont want people to see my emotions, whether I am
angry, happy, or sad. I want them to see nothing but my
unimpressed attitude, my poker face.
Talking about his fantasy world evokes tension and extreme
shame; thus, he has never spoken about daydreaming to any
healthcare provider before and neither has anyone asked
about absorption in earlier interviews.
Theme 4: Regret for lost opportunities
Although intense daydreaming helps Peter escape from
painful reality and regulate his emotions, he is aware of
the losses it involves. He believes that avoiding social
interaction has deprived him of opportunities for experi-
ences typical of his age. He especially regrets not having
established an intimate relationship and a sense of maturity.
I love my addiction and know I can escape unpleasant
situations with porn and daydreaming. But when I do that,
I miss something more valuable the chance to attract the
love of a woman. I had no social life at school, missed
parties and other chances to get to know girls. Later on, my
peers would wake up in bed with women, have relation-
ships, work and reach maturity. I never grew up. I could
have learnt the taste of love, kisses, walks, hugging, sex.
Literature acknowledges that many people engage in day-
dreaming as a strategy to cope with distress (Winnicott,
1971). This may become maladaptive when used
excessively, causing social withdrawal (Somer, 2002). MD
has been considered in terms of four psychopathological
categories: as a symptom of dissociation, disturbance
of attention, obsessivecompulsive, or behavioral addi-
ction (Somer, 2018). This case study illustrates the last
Several distinct components of behavioral addiction
are commonly identied as: (a) salience the activity
becomes more important than anything else and dominates
thinking, (b) mood modication experiencing the activity
leads to an arousing buzzor a high,(c) tolerance
ability to do increasing amounts of the particular activity,
(d) withdrawal unpleasant states when activity is dis-
continued or suddenly reduced, (e) conict (inter- or
intrapersonal), and (f) relapse addictive patterns are
easily and quickly restored even after a long time of
abstinence or control (Grifths, 2005). Although the
DSM-5 only describes symptoms of gambling disorder,
the Appendix lists additional forms of behavioral addiction
that should be explored (e.g., excessive use of social media
or watching porn), and proposes criteria for Internet gam-
ing disorders (APA, 2013). Various authors note that this
form of entertainment can lead to preoccupation (obsessive
thinking about online games), overuse, neglecting areas of
everyday life, social isolation, inter- and intrapersonal
conicts, and escape from painful reality (Demetrovics
et al., 2012;King, Herd, & Delfabbro, 2017,2018;Király
et al., 2017;Kuss, 2013;Kuss & Grifths, 2012). Such
people risk substituting real life with virtual reality
(Smahel, Blinka, & Ledabyl, 2008).
While our subject has all these characteristics in relation
to Internet use and viewing porn, he also reports MD
as his main area of concern and difculty. His MD alone
involves seeking opportunities to indulge himself in
fantasies and elaborate his scenarios (preoccupation),
feeling very excited (mood modication), excessive and
increasing use (tolerance), feeling irritated when some-
thing or someone disturbs his daydreaming (withdrawal),
and inner frustration associated with avoiding confronta-
tion with problems (conict). Fantasy, which is normally a
natural coping strategy to regulate affect, apparently
becomes dysfunctional in MD and leads to escapism,
causing impairment of functioning in school, work, and
social life.
Our subject initially used daydreaming to distract his
attention from problems at school or aid emotional regula-
tion. Only later he discovered that daydreaming can be
triggered using the Internet or viewing porn. Although he
identied MD as his main problem for which he sought
help, there were few days when fantasy dominated his
functioning but did not involve using the Internet. This
shows that further quantitative studies are necessary to
distinguish whether MD is merely a component of other
disorders or compulsive behaviors (e.g., personality disorder
or porn/Internet addiction) or is an isolated symptom that
justies creating its own separate diagnostic category.
Interestingly, our entire subjects compulsive behaviors
(excessive Internet use, watching porn, and MD) required
being absorbed. This justies further studies into alterations
in consciousness in people with behavioral addictions. It
could be rewarding to analyze the function of imaginative
involvement and its impact on daily life in people exces-
sively using RPG (Tychsen et al., 2006;Vorobyeva, 2016)
or virtual reality (Messinger et al., 2008).
Literature shows that adverse childhood experiences can
lead to the structural dissociation of the personality
(Nijenhuis, 2015;van der Hart, Nijenhuis, & Steele, 2006).
Journal of Behavioral Addictions
Pietkiewicz et al.
Our subject felt neglected at home and bullied at school,
which resulted in alterations in consciousness (immersion
in his inner world) and compulsive behavior. He also
developed symptoms of avoidant personality and revealed
narcissistic conicts associated with shame and fragile self-
esteem. However, he reported no symptoms of pathological
dissociation. This supports the observation that some cases
of MD do not involve dissociative pathology at all.
Although MD may involve a disordered form of absorption,
many researchers disregard these alterations in conscious-
ness as dissociative in nature. This, however, relates to the
ongoing theoretical dispute, what is dissociation per se, and
will not be explained here.
Finally, it is interesting that our subject had never
revealed his MD symptoms to any healthcare professional.
This can be attributed to intense shame associated with the
contents of his fantasies, limited control over imaginative
involvement, and perceived consequences. This, however,
justies the need to openly ask questions about potential
signs of MD during clinical interviews.
Funding sources: This publication has been created as part
of the project funded by the National Science Centre,
Poland, number: 2016/22/E/HS6/00306.
Authorscontribution: All authors made substantial contri-
bution to acquisition, analysis, or interpretation of data.
Conict of interest: The authors declare no conict of
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Journal of Behavioral Addictions
Pietkiewicz et al.
... Many authors link grandiose fantasies directly with pathological narcissism (Back et al., 2013) but there is insufficient evidence how grandiose and vulnerable narcissists differ in daydreaming activity. Literature on daydreaming shows that it can protect vulnerable self-image, give consolation, enable attentional deployment and escape from painful reality, or modify adverse situations in fantasy (Abu-Rayya, Somer, & Knane, 2020;Pietkiewicz, Nęcki, Bańbura, & Tomalski, 2018;Somer, Abu-Raya, & Nsairy Simaan, 2019). Although daydreaming can be a normal strategy to regulate emotions, some people may start using it in a rigid or addictive manner. ...
... According to Pietkiewicz et al. (2018), MD features a form of behavioural addiction, because it becomes more important than anything else, leads to an arousing 'buzz' or 'high', involves increasing amounts, leads to unpleasant states when discontinued or disturbed and causes intra-and inter-personal conflicts, and addictive patterns can be easily restored even after a long time of abstinence or control. MD may be accompanied by listening to music or movements, which sometimes trigger and enhance absorption in fantasy. ...
... Freimuth et al. (2008) say that practitioners often overlook behavioural addictions accompanying other psychiatric disorders, and this complicates the accuracy of assessment and badly affects treatment. While MD is often associated with shame (Bigelsen & Schupak, 2011;Pietkiewicz et al., 2018;Somer, Soffer-Dudek, Ross, & Halpern, 2017) patients may feel reluctant to disclose this tendency, report it spontaneously, or minimise the significance of their daydreaming. Therefore, more active screening for MD during assessment for psychotherapy is necessary. ...
Maladaptive daydreaming (MD) refers to excessive absorption in fantasy worlds, sometimes for many hours a day, which interferes with academic, occupational and social functioning. It shares features of a behavioural addiction which may negatively impact psychotherapy of patients with personality disorders. Links were found between MD and vulnerable narcissism (VN) but no studies have compared MD and specific types of narcissism in clinical groups, especially narcissistic personality disorder (NPD). This study explored MD, narcissistic rivalry, admiration, and VN in 491 participants classified into three groups: NPD, mixed-clinical and non-clinical. It also examined whether rivalry, admiration and VN predicts MD. The level of MD was significantly higher in the NPD group compared with mixed-clinical and non-clinical groups. Over ⅔ of NPD patients had scores indicating MD compared to ⅓ from the mixed-clinical and less than ¼ from non-clinical groups. VN was the strongest predictor of MD. Results justify the need for screening NPD patients, especially those with vulnerable traits, for MD and actively addressing this problem during treatment.
... The vicious cycle that MD has created becomes its distinctive characteristic and sets it apart from other mental activities and disorders. Its roots and repercussions have drawn the interest of professionals and have been the focus of their works (Meari-Amer, 2018; Pietkiewicz et al., 2018;Ross et al., 2020;. Recent exploration of its causal factors suggests that MD is often developed as a cause of abuse, trauma, pain, stress, anxiety, or even a feeling of helplessness (Nsairy-Samaan, 2017;Meari-Amer, 2018;Ross et al., 2020;Nye, 2020;Rakshit, 2020;Shafir, 2021;Rousch, 2022). ...
... Daydreaming has become an escape and coping mechanism for individuals from the pain and isolation of their lives (Nsairy-Samaan, 2017;Dodgson, 2018;Pietkiewicz et al., 2018;Rakshit, 2020;Sahan, 2021). In their daydreams, they can build a world that suffices their emotional needs such as self-worth, validation, and connection (Shafir, 2021). ...
ABSTRACT Title: Shackled by Dreams: A Case Study of Maladaptive Daydreaming Authors: Myrtle Mae G. Ortazon Nimfa Gail J. Villenas Adviser: Dr. Ma. Elna R. Cosejo This paper investigates the case of maladaptive daydreaming in an individual. This multiple case study identifies the demographic profile of the participants in terms of their age, gender, civil status, occupational status, and educational attainment, the factors that contribute to the development of maladaptive daydreaming, its components, and its perceived effects. Data were gathered from six (6) participants who have a high probability of maladaptive daydreaming using a semi-structured interview, the Maladaptive Daydreaming Scale, the Immersive Daydreaming Content Checklist, the Daydreaming Contents and Functions Checklist, and a diary. A case analysis and thematic analysis were adapted to assess the gathered information. Findings revealed that there are three factors that contribute to the development of maladaptive daydreaming: psycho-emotional, socio-cultural, and biological. The study concluded that regardless of the perceived positive effects of daydreaming on the participants, the negative effects on various aspects of their lives were significantly greater. Further study regarding the relation of childhood experiences on maladaptive daydreaming is recommended. Keywords: components, effect, factors, maladaptive daydreaming, multiple case study
... Self-reflection might exacerbate mental pain, since an act of introspection could potentially lead to rumination or dwelling on negative thoughts and feelings [64,65]. Similarly, self-reflection theoretically might contribute to increased mind wandering, as the introspective process frequently involves the mind drifting to past experiences, hypothetical scenarios, and potential future events, a process called "daydreaming" [66]. ...
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Understanding the cognitive processes that contribute to mental pain in individuals with psychotic disorders is important for refining therapeutic strategies and improving patient outcomes. This study investigated the potential relationship between mental pain, mind wandering, and self-reflection and insight in individuals diagnosed with psychotic disorders. We included individuals diagnosed with a ‘schizophrenia spectrum disorder’ according to DSM-5 criteria. Patients in the study were between 18 and 65 years old, clinically stable, and able to provide informed consent. A total of 34 participants, comprising 25 males and 9 females with an average age of 41.5 years (SD 11.5) were evaluated. The Psychache Scale (PAS), the Mind Wandering Deliberate and Spontaneous Scale (MWDS), and the Self-Reflection and Insight Scale (SRIS) were administered. Statistical analyses involved Spearman’s rho correlations, controlled for potential confounders with partial correlations, and mediation and moderation analyses to understand the indirect effects of MWDS and SRIS on PAS and their potential interplay. Key findings revealed direct correlations between PAS and MWDS and inverse correlations between PAS and SRIS. The mediation effects on the relationship between the predictors and PAS ranged from 9.22% to 49.8%. The largest statistically significant mediation effect was observed with the SRIS-I subscale, suggesting that the self-reflection and insight component may play a role in the impact of mind wandering on mental pain. No evidence was found to suggest that any of the variables could function as relationship moderators for PAS. The results underscore the likely benefits of interventions aimed at reducing mind wandering and enhancing self-reflection in psychotic patients (e.g., metacognitive therapy, mindfulness). Further research will be essential to elucidate the underlying mechanisms.
... Although Winnicott (1971) distinguished between adaptive and maladaptive fantasizing, Somer originally identified MD as a suggested syndrome (Somer, 2002). Comorbid clinical constructs may include obsessive-compulsive spectrum disorders (Salomon-Small et al., 2021), addictive disorders (Pietkiewicz et al., 2018), and attention deficit hyperactivity disorder (ADHD), yet, they are distinct . Autism spectrum disorder is also comorbid with MD (West et al., 2023). ...
Maladaptive daydreaming (MD) is the excessive employment of immersive daydreaming characterized by highly absorbing fantasy experiences that become a preferred focus of consciousness at the expense of living in the real world. Active dissociative processes like depersonalization and derealization, including those also characteristic of dissociative identity disorder (DID): amnesia, identity confusion, and identity alteration, may be present and, like in DID, seem to be psychodynamically driven. Comorbidity with attention deficit disorder, obsessive-compulsive disorder, post-traumatic stress disorder, and others is typical. Often associated with profound shame experience, it is, like DID, a condition that tends to be concealed and requires a clinician to be knowledgeable about its nature before a diagnosis can occur and effective treatment be initiated. We introduce the concept, explore its clinical associations and manifestations, and provide several case vignettes to illustrate the breadth and depth of this potentially debilitating variation on daydreaming.
... Skills such as cognitive reappraisal, appropriate goal setting, and accepting and applying corrective feedback foster competence (Olszewski-Kubilius et al., 2015). Rather than isolating and drifting into intense immersive daydreams, sustaining taskoriented focus during challenging situations will promote emotion regulation and foster wellbeing (Perrone-McGovern et al., 2015;Pietkiewicz et al., 2018;Stawarczyk et al., 2012). Education directed toward optimizing emotional intelligence may further support individuals who possess high OEs, especially emotional OE (Beduna & Perrone-McGovern, 2016), as well as individuals with a high predilection for MD (Chirico et al., 2022;Greene et al., 2020). ...
... In sexology, the role of sexual fantasizing is described, especially high-risk sexual fantasies as a clinical phenomenon [10]. Topical research in current psychology is devoted to maladaptive daydreaming, which refers to a mental condition characterized by excessive involvement in fantasy (uncontrollable absorption in fantasy) significantly interfering with an individual's daily functioning and health [11,12]. It was shown that maladaptive daydreaming was positively related to higher levels of psychopathology symptoms (i.e., anxiety, depression or obsessive-compulsive symptoms, somatization, and interpersonal sensitivity), and obsessive-compulsive symptoms may play a critical role in this mental condition [11]. ...
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Introduction: This study aims to (1) examine the factorial structure, validity, and internal consistency reliability of a 6-item Polish version of the Emotion Regulation Questionnaire-Fantasizing (ERQ–F) for measuring an extent to which people habitually use daydreaming or fantasizing as a strategy to regulate their emotions; (2) examine the role of fantasizing for a mental health status in a Polish community sample. Material and methods: Our sample consisted of 918 Polish adults (660 females and 258 males) aged 18–77 (M = 26.23, SD = 11.73). The ERQ–F factor structure was assessed with exploratory and confirmatory factor analyses. Cronbach's alpha coefficients were calculated for assessing internal consistency reliability. The ERQ–F score correlations with negative and positive emotional reactivity as well as with anxiety and depressive symptoms were calculated. Results: Our results indicated a strong factorial validity, conforming to the intended original 1-factor model. We also proposed a theoretically sound and empirically valid 2-factor model, which was the best factor solution in our data set. This model consists of two 3-item subscales, reflecting the use of fantasizing to feel less negative emotions (negative-fantasizing) and the use of fantasizing to feel more positive emotions (positive-fantasizing). Internal consistency reliability was good for two ERQ–Fsubscales and the total score. It was shown that positive-fantasizing is positively related to negative reactivity as well as to other mental health symptoms, whereas negative-fantasizing was not related to negative or positive emotional reactivity, or to these symptoms. Conclusions: Overall, the Polish version of the 2-factor ERQ–F has good preliminary psychometric properties, reinforcing the clinical relevance of distinguishing fantasizing for feeling less negative emotions and fantasizing for feeling more positive emotions. It seems that using fantasizing to feel more positive emotions may lead to adverse effects (opposite of expected), i.e., to more easily activated and more prolonged negative emotions as well as to higher levels of mental health symptoms.
... In sexology, the role of sexual fantasizing is described, especially high-risk sexual fantasies as a clinical phenomenon [10]. Topical research in current psychology is devoted to maladaptive daydreaming, which refers to a mental condition characterized by excessive involvement in fantasy (uncontrollable absorption in fantasy) significantly interfering with an individual's daily functioning and health [11,12]. It was shown that maladaptive daydreaming was positively related to higher levels of psychopathology symptoms (i.e., anxiety, depression or obsessive-compulsive symptoms, somatization, and interpersonal sensitivity), and obsessive-compulsive symptoms may play a critical role in this mental condition [11]. ...
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Background and aims: Maladaptive Daydreaming (MD) is a suggested syndrome where individuals addictively engage in fanciful, narrative and emotional daydreaming for hours on end, often relying on stereotypical movements and music to facilitate the absorbed state. Many individuals suffering from MD to the point of clinically significant distress and functional impairment have advocated for its medicalization as a disorder. Maladaptive daydreamers exhibit high rates of psychopathology, but most studies were biased by self-selection. We developed a brief measure for efficient assessment of suspected MD and then administered it in a large non-selected US sample to gauge the significance of MD for public mental health. Methods: Two previous datasets were utilized to develop the 5-item measure, labeled the Maladaptive Daydreaming Short Form (MD-SF5). Then, a large survey was conducted using the Qualtrics panel, administering the MD-SF5 alongside several validated measures of mental health to a general sample of panelists (N = 2512, 84.6% females, age M = 39.74, SD = 18.53, Race/Ethnicity: 66.3% White, 14.7% Black, 9.3% Hispanic, and 9.7% Other). Results: The MD-SF5 showed good to excellent agreement with the existing measure. Generally, the new sample had high psychopathology rates. Suspected MD was associated with psychological distress, loneliness, psychotic experiences, heavy drinking, and suicidality. Notably, even after controlling for psychological distress, suspected maladaptive daydreamers were more than twice as likely to have recently attempted suicide (Odds Ratio = 2.44, 95% CI [1.44, 4.16], Wald = 10.86, p = .001). Discussion and conclusions: MD harbors public health significance and can be screened for with a short self-report tool. Thus, MD should be addressed by mental health practitioners.
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Objectives: This study aimed to shed light on the lived experience of stereotypical body movement and gesturing during maladaptive daydreaming (MD). Method: Forty-one individuals with probable MD participated in asynchronous in-depth email interviews. Results: Four themes describing the movement experience in MD emerged: Need, Variety, Awareness and Agency, and Functions. Conclusion: The analyses revealed two main findings about the bi-directional effect of movement on MD. First, kinesthesia may enhance the daydreamers’ experience by deepening their fantasy immersion through improved focus featuring self-hypnotic characteristics. In addition, respondents reported that their body movements enhanced the daydreaming experience by embodying the protagonists' actions. MD-related motions were associated with occasional loss of agency, suggesting unintentional neuromuscular activation.
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This paper describes the course of psychotherapeutic treatment of a 25-year-old man presenting with maladaptive daydreaming (MD), from analysis of the underlying rationale through the treatment process to the outcomes. MD, a condition marked by highly absorptive daydreaming , consumed many hours of his day and produced distress, dysfunc-tion, and excessive Internet use. Ontological analysis resulted in classifying MD characteristics under several categories: as a dissociative disorder of absorption, as a behavioral addiction, and as an obsessive-compulsive spectrum disorder producing significant attention deficits. The therapy plan was derived from evidence-based treatment modalities for conditions elucidated in the ontological analysis and included cognitive behavioral interventions as well as mindfulness meditation. Therapy was provided for a predetermined period of six months. MD and relevant indices were measured before and after therapy, as well as at a two-month follow-up. The data show that the client was able to reduce his daydreaming time by over 50% and his time spent on the Internet by over 70%. He reported an improvement of over 70% in his work and social adjustment. Nevertheless, his maladaptive daydreaming scale score and his self-assessed pleasure derived from daydreaming showed more modest gains. I discuss this discrepancy and suggest future research directions.
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Background and aims The criterion of tolerance in DSM-5 Internet gaming disorder (IGD) refers to a need for increasing time spent gaming. However, this focus on “need for gaming time” may overlook some of the broader motivations, outcomes, or effects of gaming that underlie excessive play. This study aimed to explore regular and problematic gamers’ experiences and perceptions of tolerance in IGD. Methods An online survey of 630 adult gamers yielded 1,417 text responses to open-ended questions. A thematic analysis of 23,373 words was conducted to extract dominant themes. Results Participants reported that they increasingly desired game items, status, or story progress as they became more involved or invested in games. As players develop higher standards of play in games, an increasing number of potential reward outcomes may have diminishing mood-modifying effects. None of the participants, including those with self-reported IGD, explicitly referred to a need for increasing time spent gaming. Discussion and conclusions These results suggest that players may be motivated by preferences for specific goals or reinforcers in games rather than wanting an amount of time spent gaming. Thus, problematic gaming may involve a need for completion of increasingly intricate, time-consuming, or difficult goals to achieve satisfaction and/or reduce fears of missing out. Further research is needed to determine whether these cognitive and motivational factors related to gaming stimuli should extend or replace the concept of tolerance in IGD or be considered as separate but related processes in disordered gaming.
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In order to determine the comorbidity profile of individuals meeting criteria for a proposed new disorder, Daydreaming Disorder (more commonly known as Maladaptive Daydreaming, MD), the Structured Clinical Interview for DSM-5 and the Structured Clinical Interview for DSM-IV Dissociative Disorders were administered to 39 participants who met criteria for MD on a structured interview. We determined high rates of comorbidity: 74.4% met criteria for more than three additional disorders and 41.1% met criteria for more than four. The most frequent comorbid disorder was attention deficit hyperactivity disorder (76.9%); 71.8% met criteria for an anxiety disorder; 66.7% for a depressive disorder; and 53.9% for an obsessive-compulsive or related disorder. Notably, 28.2% have attempted suicide. Individuals meeting criteria for MD suffer from complex psychiatric problems spanning a range of DSM-5 disorders. This finding provides evidence that MD is different than normal daydreaming, and that these individuals experience considerable distress and impairment.
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Received 16 October 2015 Accepted 14 February 2016 KEYWORDS Absorption; fantasizing; mind wandering ABSTRACT This qualitative study describes the lived experience of mala- daptive daydreaming (MD), an excessive form of unwanted daydreaming that produces a rewarding experience based on a created fantasy of a parallel reality associated with a pro- found sense of presence. A total of 21 in-depth interviews with persons who self-identified as struggling with MD were ana- lyzed utilizing a phenomenological approach. Interviewees described how their natural capacity for vivid daydreaming had developed into a time-consuming habit that resulted in serious dysfunction. The phenomenology of MD was typified by complex fantasized mental scenarios that were often laced with emotionally compensatory themes involving competency, social recognition, and support. MD could be activated if sev- eral requirements were met. Because social interaction seems to be incompatible with this absorbing mental activity, solitude was necessary. In addition, kinesthetic activity and/or exposure to evocative music also appeared to be essential features. Besides delivering a firsthand description of key characteristics of MD, the study also indicates that MD is associated with dysfunctionality for which participants expressed a substantial need for help.
Tolerance in DSM-5 Internet gaming disorder (IGD) refers to a need for increasing time spent in gaming activities. However, the focus on ‘time’ has been criticized for being a superficial imitation of tolerance in substance-based addiction. Gaming tolerance may require a broader conceptualization of its motivational and cognitive features. The present study aimed to investigate tolerance-like processes in gaming and their association with IGD symptoms. An online survey that included a 20-item measure of gaming-related tolerance was administered to 630 adult gamers, including 4.0% who screened positively for IGD. Exploratory factor analysis indicated that a three-factor model for the tolerance items provided the best fit. These factors were: (1) Wealth, the need to accumulate in-game rewards of increasing rarity, novelty, or quantity; (2) Achievement, the need to pursue goal-driven activities of increasing complexity, difficulty, or uniqueness; and (3) Inadequacy, the need to rectify perceived insufficiencies in gaming capability or progress. A hierarchical regression analysis indicated that Inadequacy was modestly but significantly related to other IGD symptoms, after controlling for age, gender, and time spent gaming. These findings support the notion that problematic gaming may be motivated by the need for completion of increasingly more intricate, time-consuming, or difficult goals to achieve satisfaction and the need to rectify perceived inadequacies related to gaming.
Previous research has suggested that motives play an important role in several potentially addictive activities including online gaming. The aims of the present study were to (i) examine the mediation effect of different online gaming motives between psychiatric distress and problematic online gaming, and (ii) validate Italian versions of the Problematic Online Gaming Questionnaire, and the Motives for Online Gaming Questionnaire. Data collection took place online and targeted Italian-speaking online gamers active on popular Italian gaming forums, and/or Italian groups related to online games on social networking sites. The final sample size comprised 327 participants (mean age 23.1 years [SD = 7.0], 83.7% male). The two instruments showed good psychometric properties in the Italian sample. General psychiatric distress had both a significant direct effect on problematic online gaming and a significant indirect effect via two motives: escape and fantasy. Psychiatric symptoms are both directly and indirectly associated with problematic online gaming. Playing online games to escape and to avoid everyday problems appears to be a motivation associated with psychiatric distress and in predicting problematic gaming.
A LARP, or live-action role-playing game, is an activity enabling participants to act out their fictional characters in a make-believe world. It has followers all over the world. Research for this article was conducted in Moscow and St. Petersburg LARP communities, establishing a database with over 600 cases of “going out of character” in 2012-13. Analysis suggests that in certain cases breaks of game frame can enrich a LARP for its participants rather than spoil it. The results can be useful for enhancing sociological and anthropological understanding, including in such approaches as interaction analysis, community building research, game studies, and ludology.