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Maladaptive daydreaming as a new form of behavioral addiction
IGOR J. PIETKIEWICZ
1
*, SZYMON NĘCKI
2
, ANNA BAŃBURA
2
and RADOSŁAW TOMALSKI
1
1
Research Centre for Trauma & Dissociation, Katowice Faculty of Psychology, SWPS University of
Social Sciences and Humanities, Katowice, Poland
2
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
INTRODUCTION
While the fifth 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 identified 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, conflicting
desires (Gottschalk, 2010;Linares, Subrahmanyam, Cheng,
& Guan, 2011). RPGs, which are in significant 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, defined as
maladaptive daydreaming (MD), which may be expressed
through extensive book-reading, watching films, 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-deficit hy-
peractivity disorder, anxiety disorder, depressive disorder,
and obsessive–compulsive 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, obsessive–compulsive 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
difficulties (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:
ipietkiewicz@swps.edu.pl
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
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© 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 “new”behavioral
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).
METHODS
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
researchers’attempts to make sense of the participants’
meaning (Pietkiewicz & Smith, 2014).
Participants
Peter (his real name has been changed to ensure confidenti-
ality), aged 25 years, is a single Caucasian male who has
moved out of the family home and lives with a flatmate. 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.
Procedure
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
recorded.
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 circle”was 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 participant’s associations
and interpretations.
Ethics
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.
RESULTS
Theme 1: Facing social rejection was unbearable
In primary school first 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 didn’t realise that I pushed too hard and they
[classmates] didn’t like it. I wasn’t arrogant, selfish 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
inflict 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 figure 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, films, or
news on the Internet, which he found difficult to stop.
I spend about 14 hours a day surfing 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 flat, 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
else.
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 personality”and lost control over fanta-
sizing, becoming afraid of losing touch with reality or that
the “alter”will take over.
Triggers for excessive daydreaming. Peter blames the
peers who bullied him at school for his current difficulties
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
now”as his form of rehab. However, listening to music or
watching media triggers or supports fantasies. It is easy for
him to get “hooked”on 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 flat, 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 first experienced at school. He sees expressing
emotions and reacting to being teased as weakness, so feigns
indifference. He says,
I don’t 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.
DISCUSSION
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, obsessive–compulsive, or behavioral addi-
ction (Somer, 2018). This case study illustrates the last
category.
Several distinct components of behavioral addiction
are commonly identified as: (a) salience –the activity
becomes more important than anything else and dominates
thinking, (b) mood modification –experiencing the activity
leads to an arousing “buzz”or 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) conflict (inter- or
intrapersonal), and (f) relapse –addictive patterns are
easily and quickly restored even after a long time of
abstinence or control (Griffiths, 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
conflicts, and escape from painful reality (Demetrovics
et al., 2012;King, Herd, & Delfabbro, 2017,2018;Király
et al., 2017;Kuss, 2013;Kuss & Griffiths, 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 difficulty. His MD alone
involves seeking opportunities to indulge himself in
fantasies and elaborate his scenarios (preoccupation),
feeling very excited (mood modification), 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 (conflict). 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
identified 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
justifies creating its own separate diagnostic category.
Interestingly, our entire subject’s compulsive behaviors
(excessive Internet use, watching porn, and MD) required
being absorbed. This justifies 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 conflicts 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,
justifies 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.
Authors’contribution: All authors made substantial contri-
bution to acquisition, analysis, or interpretation of data.
Conflict of interest: The authors declare no conflict of
interest.
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