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Health and Disease

Maladaptive Daydreaming: Trapped in a Fictional Reality

Maladaptive daydreaming, or MD, is characterized by lucid daydreaming lasting several hours at a time. MD sufferers are often so immersed in these daydreams, that they neglect prior responsibilities or commitments, resulting in impaired social skills and/or chronic stress.

By Lily Kangas

Published 7:37 PM EST, Sat February 27, 2021

Introduction

It is completely normal for people to daydream from time to time. In fact, up to 96% of adults daydream daily. However, when these daydreams interfere with daily tasks and responsibilities, it may be a sign of maladaptive daydreaming. Maladaptive daydreaming (MD) is a form of dissociative absorption and is typically seen as a coping mechanism for PTSD, serious psychiatric conditions, and loneliness. Unfortunately for MD patients, the condition is not widely recognized within the medical community, making its diagnosis excessively difficult. Still, an Israeli Professor, Eliezer Somer, created a scale based on the condition’s most commonly experienced symptoms, which may be used to make an MD diagnosis. Following this diagnosis, cognitive behavioral therapy or select SSRIs may be used as treatment. 

Causes

Maladaptive daydreaming is one facet of dissociative absorption, an absorption in and reliance on external stimuli such as television or books, to a point of limited self-awareness. Experts believe that (in most cases) MD, like dissociative absorption, is not a psychiatric condition itself, but a coping mechanism for prior trauma, abuse, serious mental illness, or even loneliness. MD sufferers seek an escape from their own harsh reality. For instance, when triggered, maladaptive daydreamers will dissociate and slip into a story-like world, playing through fiction scenarios in their minds until the underlying stress brought on by the trigger goes away. This conjecture is supported by a study conducted by Professor Eliezer Somer, which identified six maladaptive daydreamers, each one a sexual assault survivor. 

Symptoms and Diagnosis

The most common symptoms of MD include:

  • Lucid, storylike daydreams with a definitive plot, characters, and setting
  • Daydreams are triggered by or based on real-life events or circumstances
  • Daydreams interfere with daily activities and responsibilities 
  • Insomnia or difficulty falling/staying asleep 
  • Pacing or the performance of other repetitive movements/facial expressions while daydreaming
  • Talking, mumbling, or whispering during daydreams
  • Strong urge to continue daydreaming 
  • social/academic withdrawal
  • Daydreaming for extensive periods of time (1+ hours )  

Despite MD not being mentioned in any diagnostic manuals and a lack of medical recognition, MD can be diagnosed using the following list of symptoms in conjunction with Professor Somer’s, maladaptive daydreaming scale (MDS). The MDS is a 14 part scale based on the 5 main characteristics of maladaptive daydreaming. The scale rates and individual in each of the following areas:

  1. Quality/detail of daydreams
  2. The individual’s ability to control both the content and duration of their daydreams
  3. Amount of distress daydream causes the individual
  4. The individual’s perceived benefits of daydreaming
  5. Interference of daydreams with daily life 

Treatment Options and Addiction

Though there is no official treatment for MD, experts believe that cognitive-behavioral therapy, or CBT, may help alleviate the intensity and frequency of daydreams. CBT is one of many psychotherapeutic treatment options for individuals suffering from OCD, anxiety, depression, and other common mental illnesses. In the case of maladaptive daydreaming, cognitive behavioral therapy is used to change the daydreamer’s train of thought. Through mindfulness and grounding techniques, CBT shifts one’s focus from past traumas or worries about the future to the present moment, and because MD is a form of dissociation, grounding the sufferer in the present lessens the urge to slip into a false reality. 

In addition to CBT, a 2009 study found that Luvox (fluvoxamine), may be beneficial in controlling maladaptive daydreams. Luvox is a selective serotonin reuptake inhibitor frequently used for obsessive-compulsive disorder, depression, and other psychiatric conditions in which serotonin production may be lacking. Medical professionals are not yet sure how Luvox works to curve daydreams, but it likely has to do with the fact that the medication treats underlying mental disorders, which as mentioned earlier, have been known to trigger MD. 

Unfortunately, many maladaptive daydreamers never seek treatment due to the condition’s addictive nature. Because MD eliminates any emotion or psychological pain for a given period of time, many MD patients find that they would rather spend time in their fantasy worlds than in reality. Over time, these individuals will not only increase the frequency, but also the duration of their daydreams, which impedes daily responsibilities and often leads to a significant social withdrawal, which in turn poses a great risk to a sufferer’s school or work life. Still, to many MD sufferers, the pleasure provided by these daydreams outweighs any drawbacks, and this mentality stops these individuals from seeking proper treatment.  

Lily Kangas, Youth Medical Journal 2021

References 

Cirino, Erica. “Maladaptive Daydreaming.” Healthline, 13 Dec. 2018, http://www.healthline.com/health/mental-health/maladaptive-daydreaming#treatments.

“Maladaptive Daydreaming as a New Form of Behavioral Addiction.” PubMed Central (PMC), 1 Sept. 2018, http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6426361.

“People with ‘Maladaptive Daydreaming’ Spend an Average of Four Hours a Day Lost in Their Imagination.” Research Digest, 3 Nov. 2020, digest.bps.org.uk/2018/06/25/people-with-maladaptive-daydreaming-spend-an-average-of-four-hours-a-day-lost-in-their-imagination.

Schupak, Cynthia. “Excessive Daydreaming: A Case History and Discussion of Mind Wandering and High Fantasy Proneness.” PubMed, pubmed.ncbi.nlm.nih.gov/19062309. Accessed 15 Jan. 2021.

By Lily Kangas

Lily Kangas is a student at the Head-Royce School in Oakland, California. She is interested in all STEM fields, specifically medicine, neuroscience, and psychology.

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