Could immersive daydreaming underlie a deficit in attention? The prevalence and characteristics of maladaptive daydreaming in individuals with attention-deficit/hyperactivity disorder.

OBJECTIVE: Maladaptive daydreaming (MD) entails excessive immersion and engagement in complex fantasy worlds, causing distress and impairing functioning. Maladaptive Daydreamers often report that existing diagnostic labels are unhelpful for them. Previous studies reported high rates of comorbid attention deficit hyperactivity disorder (ADHD) among persons with MD, raising the question of their separateness. This study explored whether MD differs essentially from ADHD by examining an ADHD sample, hypothesizing a much lower incidence of MD. METHOD: Adults diagnosed with ADHD (N = 83) were assessed for ADHD symptoms, MD, depression, loneliness, and self-esteem. Participants who exceeded the study's cutoff score for suspected MD were invited to participate in a structured diagnostic interview for MD. RESULTS: In accordance with the hypothesis, only 20.5% of the ADHD sample met the proposed diagnostic criteria for MD. Compared with ADHD-only participants, this subgroup presented increased depression, loneliness, and lowered self-esteem. CONCLUSION: MD has unique clinical characteristics that are distinct from ADHD. We suggest that in some cases presenting with ADHD symptoms, an MD conceptualization may better explain the clinical picture. Future research should aim at a better differentiation of daydreaming, ADHD, and related constructs such as mind-wandering.

Childhood Trauma and Maladaptive Daydreaming: Fantasy Functions and Themes In A Multi-Country Sample.

We analyzed responses of 539 adults who met an evidence-based criterion for probable maladaptive daydreaming (MD). Their reported childhood traumata were associated with the utilization of MD to distract from painful memories. A history of childhood physical and emotional neglect as well as emotional abuse was associated with daydreaming aimed to regulate emotional pain. Childhood exposure to physical and emotional abuse was associated with an increased likelihood of daydreaming about an idealized version of their original families. Themes of emotional suffering were associated with exposure to childhood emotional abuse. A range of morbid imageries and trauma-related reenacting behaviors featured in the fantasies of our respondents. Childhood emotional abuse was related to daydreaming about death, physical violence as a victim, being a captor, being rescued, and being a rescuer. Childhood sexual abuse was correlated with themes of sexual violence as a victim, being a captive, and being rescued. Childhood emotional neglect was linked with daydreaming about taking revenge, and a childhood history of physical abuse was associated with current fantasies about being captive. MD fantasy among adults exposed to childhood trauma may not only serve as mere coping mechanisms but potentially manifest a pathological preoccupation with unresolved childhood adversities.

Reality shifting: psychological features of an emergent online daydreaming culture.

Reality shifting (RS) is a trendy mental activity that emerged abruptly following the flare-up of the COVID-19 pandemic in 2020 and seems to be practiced mainly by members of the post-millennial generation. RS, described as the experience of being able to transcend one's physical confines and visit alternate, mostly fictional, universes, is discussed by many on Internet platforms. One RS forum boasts over 40,000 members and RS clips on some social media platforms have been viewed over 1.7 billion times. The experience of shifting is reportedly facilitated by specific induction methods involving relaxation, concentration of attention, and autosuggestion. Some practitioners report a strong sense of presence in their desired realities, reified by some who believe in the concrete reality of the alternate world they shift to. One of the most popular alternate universes involves environments adopted from the Harry Potter book and film series. We describe the phenomenology of RS as reported online and then compare it to related phenomena such as hypnosis, tulpamancy, dissociation, immersive and maladaptive daydreaming, and lucid dreaming. We propose a theoretical model of interactive factors giving rise to RS, and conclude that it is an important, uninvestigated emerging phenomenon and propose future research directions.

Self-Reported Medication and Recreational Drug Effectiveness in Maladaptive Daydreaming.

Maladaptive daydreaming is a proposed disorder characterized by excessive daydreaming that causes subjective distress and/or interferes with function. The daydreaming involves complex inner worlds, characters, and plots that are understood by the person as fantasy, and the daydreaming may occupy many hours per day. The disorder has good reliability and validity in studies using a structured interview and a self-report measure developed for it. To date, no information on the responses of maladaptive daydreamers to either recreational or prescription drugs has been available. The authors obtained survey data from 202 participants who completed the Maladaptive Daydreaming Scale-16. The results indicated that this population has tried many different recreational drugs and has been prescribed many different psychotropic medications. Most of the participants reported little to no effect of drugs or medications on daydreaming, although tentative recommendations can be made in favor of prescribing antidepressants and against the use of marijuana for individuals with maladaptive daydreaming.

Trauma, attachment style, and somatization: a study of women with dyspareunia and women survivors of sexual abuse.

BACKGROUND: Evidence points toward shared characteristics between female survivors of sexual abuse and women with dyspareunia. This study explored, for the first time, similarities and differences between women who were exposed to sexual abuse to those with dyspareunia, in order to examine whether insecure attachment styles and high somatization level are associated with trauma among women with dyspareunia. METHODS: Attachment styles were explored using the Experience in Close Relationships Scale to reflect participants' levels of anxiety and avoidance. Somatization was assessed using the Brief Symptom Inventory focusing on the frequency of painful and non-painful bodily complaints. Trauma was categorized into three levels: sexual trauma, nonsexual trauma, and no trauma. RESULTS: Sexually abused (SA) women (n = 21) compared to women with dyspareunia (dys) (n = 44) exhibited insecure attachment styles, as expressed by high levels of avoidance (SA 4.10 ± 0.99 vs. dys 3.08 ± 1.04, t(61) = 2.66, p = .01) and anxiety (SA 4.29 ± 1.22 vs. dys 3.49 ± 1.04, t(61) = 3.61, p = .001), and higher somatization (21.00 ± 8.25 vs. 13.07 ± 7.57, t(59) = 3.63, p = .001). Attachment and somatization level did not differ significantly between women with dyspareunia without trauma to those with nonsexual trauma. CONCLUSIONS: Our findings emphasized the unique role of sexual trauma as a contributing factor to the augmentation of perceived bodily symptoms and to insecure attachment style. This illuminates the importance of disclosing previous sexual abuse history among women with dyspareunia.

Incidence and Clinical Features of Panic Related Posttraumatic Stress.

The current study assessed the incidence and associated features of posttraumatic stress after the experience of panic. One hundred seventy-eight participants meeting diagnostic criteria for panic attacks (PAs) were assessed using standardized measures of posttraumatic symptoms and posttraumatic stress disorder (PTSD) in specific reference to their experience of panic. Sixty-three (35.4%) participants scored above the cutoff for PTSD in reference to the worst PA they had experienced. Adjusted means for the four PTSD symptom clusters indicate that panic-related posttraumatic symptoms are, on average, experienced "moderately" to "quite a bit." Panic-related posttraumatic symptoms and PTSD were best predicted by specific features of the panic experience itself, including subjective levels of distress, fear of losing control, chest pain, agoraphobia, and number of PAs experienced. These findings are discussed in terms of the diagnostic, prognostic, and treatment implications for a subset of individuals presenting with panic who may also have panic-related PTSD.

Reliability of the Dissociative Trance Disorder Interview Schedule: A preliminary report.

One hundred inpatients in a hospital-based Trauma Program in the USA were interviewed with the Dissociative Trance Disorder Interview Schedule (DTDIS). There were no significant differences for the DTDIS total score or any of the subscale scores on test-retest: all t-values comparing the two administrations of the DTDIS were below 0.7, and all p-values were above 0.5. Cronbach's alpha for the US sample was 0.966 and for the Israeli sample it was 0.971. The findings indicate that the DTDIS has good reliability and may be suitable for use in cross-cultural research; however, the results require replication by independent researchers in a variety of cultures and languages, and in both clinical and nonclinical samples.

The Comorbidity of Daydreaming Disorder (Maladaptive Daydreaming).

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 Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (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 have 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.

Maladaptive daydreaming: Evidence for an under-researched mental health disorder.

This study explores the recently described phenomenon of Maladaptive Daydreaming (MD) and attempts to enhance the understanding of its features. It documents the experiences of 340 self-identified maladaptive daydreamers who spend excessive amounts of time engaged in mental fantasy worlds, in comparison to 107 controls. Our sample included a total of 447 individuals, aged 13-78, from 45 countries who responded to online announcements. Participants answered quantitative and qualitative questions about their daydreaming habits and completed seven questionnaires assessing mental health symptoms. Findings demonstrated that MD differs significantly from normative daydreaming in terms of quantity, content, experience, controllability, distress, and interference with life functioning. Results also demonstrated that Maladaptive Daydreamers endorsed significantly higher rates of attention deficit, obsessive compulsive and dissociation symptoms than controls. In sum, findings suggested that MD represents an under-acknowledged clinical phenomenon that causes distress, hinders life functioning and requires more scientific and clinical attention.

Development and validation of the Maladaptive Daydreaming Scale (MDS).

This study describes the development of the Maladaptive Daydreaming Scale (MDS), a 14-item self-report instrument designed to gauge abnormal fantasizing. Our sample consisted of 447 English-speaking individuals from 45 different countries. A 3-correlated-factors model best presented the underlying dimensions Yearning, Kinesthesia and Impairment, capturing related rewarding experiences as well as psychological impairment of maladaptive daydreaming. MDS scores were associated with obsessive-compulsive behavior and thoughts, dissociative absorption, attention deficit, and high sense of presence during daydreaming, but less with psychotic symptoms. The MDS and its subscale demonstrated good validity, sound internal consistency and temporal stability and discriminated well between self-identified individuals with and without maladaptive daydreaming. Considering the instrument's high sensitivity and specificity levels, it seems an excellent measure for future investigation of MD that will, hopefully, shed light on the etiology and psycho-biological mechanisms involved in this mental condition, as well as on the development of effective MD treatment methods.

Childhood Antecedents and Maintaining Factors in Maladaptive Daydreaming.

This study explored the fantasy activity of 16 individuals who were seeking online peer-support and advice for maladaptive daydreaming (MD). MD is an under-researched mental activity described as persistent vivid fantasy activity that replaces human interaction and/or interferes with important areas of functioning. We employed a grounded theory methodology that yielded seven common themes presented as a sequential descriptive narrative about the nature, precursors, and consequences of MD. The presented "storyline" included the following themes: (1) daydreaming as an innate talent for vivid fantasy; (2) daydreaming and social isolation-a two-way street; (3) the role of trauma in the development of MD; (4) the rewards of daydreaming; (5) the insatiable yearning for daydreaming; (6) shame and concealment; (7) unsuccessful treatment attempts. A main conclusion of our study is that there is an urgent need for early identification of MD and its correct diagnoses in adulthood.

Parallel lives: A phenomenological study of the lived experience of maladaptive daydreaming.

This qualitative study describes the lived experience of maladaptive 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 profound sense of presence. A total of 21 in-depth interviews with persons who self-identified as struggling with MD were analyzed 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 several 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.

The importance of mental pain and physical dissociation in youth suicidality.

This study examines the importance of two suicide risk factors, mental pain and physical dissociation, among young people. Participants were 42 suicidal inpatients, 36 nonsuicidal inpatients, and 45 nonclinical participants. Overall, suicide attempters reported a stronger intensity of and lower tolerance for mental pain and more physical dissociation compared to the other two groups. Suicide attempters with a low tolerance for mental pain showed a higher level of dissociation from pain and insensitivity to bodily cues compared to nonsuicidal inpatients with similar levels of tolerance for mental pain. Physical dissociation contributed significantly to the likelihood of suicidality beyond the contribution of mental pain. Our results accentuate the importance of the combination of mental pain and physical dissociation in suicidality. Further research on the applicability of our findings to self-injurious behavior is warranted.

When Imagination Feels Like Reality: A Case Study of False Memories and Maladaptive Daydreaming in Visual Impairment.

Background: When a person experiences maladaptive daydreaming (MD), they spend a prolonged period daydreaming with a strong sense of presence. The symptoms of MD are often excessive, interfere with functioning, and are linked to distress and comorbid mental disorders. In this paper, apparent false memory is described in the context of a woman with MD and visual impairment due to a progressive eye condition. Her vivid daydreams seemed indistinguishable from actual memories. Case Report. A 35-year-old woman with a lifelong MD reported three incidents of fabricating detailed false memories of events that her family confirmed never occurred: obtaining a new job, miscarrying twins, and hospitalization for COVID-19. She experienced anxiety and shame when the stories were disproven. The assessment confirmed MD, PTSD, OCD, and other disorders. Her verbal memory was below average, especially for longer narratives. Her misattributions of daydreams as real-life memories may relate to reliance on vivid mental images over deteriorating vision and source monitoring deficits. Conclusion: This first reported case of confabulations in an individual with MD and visual disability suggests daydreams could potentially be mistaken for actual events in some MD cases. While sensitive, more research is needed on the prevalence of false memories among individuals with MD. The default mode network, prefrontal cortex, and their connectivity may be implicated in generating vivid daydreams and misattributing them to actual episodic events. Understanding the relationship between sensory impairments, dissociation, and susceptibility to memory distortions could inform interventions to improve reality testing for some MD patients.

Exploring the nexus between childhood adversities, trauma-related fantasy and memory in maladaptive daydreaming.

We conducted a qualitative study investigating traumatic daydreaming themes among individuals with maladaptive daydreaming (MD). Forty-one participants were interviewed regarding connections between their traumatic daydreams and real-life adversity. Specifically, we asked participants about 1) childhood trauma experiences, 2) trauma-related daydreaming, 3) perceived relationships between such daydreams and authentic experiences, and 4) difficulty distinguishing traumatic memories originating from daydreams versus actual events. Many participants reported past trauma and frequent traumatic daydream themes. However, participants also noted their daydreams often depicted corrected, more positive versions of experienced events. Finally, most participants stated they did not confuse daydreaming with actual experiences. This study provides new data on the complex interplay between trauma, memory, and daydreaming in MD.

Intense Imagery Movements May Lead to Maladaptive Daydreaming: A Case Series and Literature Review.

BACKGROUND: This case series highlights the connection between childhood intense imagery movements (IIM) and adult-reported maladaptive daydreaming (MD). Motor stereotypies occur in typically developing children and also with co-occurring neurodevelopmental differences. A subgroup with complex motor stereotypies reports accompanying intense imagery, often enhanced by the movements. This phenomenon can persist into adulthood and, in some cases, will need active management to prevent significant distress and impairment. CASES: Six adults, self-reporting maladaptive daydreaming associated with stereotypies, are presented to demonstrate the associations. LITERATURE REVIEW: The clinical significance and function of IIM and MD are unclear, but several hypotheses are discussed, including the mechanism of emotional regulation through sensory seeking, as a process for processing childhood psychological trauma, as intrusive thoughts or images as part of a subtype of Obsessive Compulsive Disorder, or as a result of diverse attentional networks seen in neurodevelopmental disorders. CONCLUSIONS: This paper highlights important connections between IIM and MD. Many adults with MD show a childhood origin of stereotypical movements. Whilst immersive daydreaming may provide creativity and emotional regulation, there is evidence of distress and impairment of function for some adults, leading to MD diagnoses. Recognizing this phenomenon is important for all neurologists and physicians working with stereotypical movements.

Mindfulness meditation and self-monitoring reduced maladaptive daydreaming symptoms: A randomized controlled trial of a brief self-guided web-based program.

OBJECTIVE: Maladaptive daydreaming (MD) is a compulsive form of daydreaming that causes distress and functional impairment. We present the first treatment trial for MD. METHOD: We tested the effectiveness of an eight-session internet-based self-help training for mindfulness and self-monitoring and compared three groups across three measurement points in time. A sample of 557 people was randomly assigned. A total of 353 participants (age M[SD] = 28.3[10.5], 76% female, 77% unmarried) completed our program: full-intervention group (n = 114, psychoeducation + motivation enhancement + mindfulness + self-monitoring), partial-intervention group (n = 125, identical excluding self-monitoring), and waiting-list group (n = 125, internet-based support as usual). RESULTS: All MD measures assessing daydreaming pathology, daydreaming frequency, and life functioning showed significant improvement with a large effect size (ES) from baseline to posttreatment in both intervention groups, whereas the wait-list group showed no significant improvement, MD: F(3, 349) = 35.76, p < .0001, η² = 0.24; frequency: F(3, 349) = 32.06, p < .001, η² = 0.22; functioning: F(3, 349) = 20.43, p < .001, η² = 0.15. Mindfulness with self-monitoring training for MD was superior to mindfulness alone in the short term, but they both were equally efficient in the long term. Both interventions were superior to relying on internet-based support forums only. The clinically significant improvement rate of mindfulness with self-monitoring training was 24%, while the reliable improvement rate reached 39%. At the 6-month follow-up, achievements were maintained. CONCLUSIONS: A brief internet-based intervention program comprising mindfulness meditation and self-monitoring facilitated recovery or improvement in many individuals with MD. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Immersive and maladaptive daydreaming and divergent thinking in autism spectrum disorders.

Little is known about the internal mental experiences of individuals with ASD. While some research suggests a limited capacity for imagination, other studies show heightened interest in fantasy and unique forms of creative thinking in ASD. This study explored daydreaming experiences in adults with ASD, with a focus on immersive daydreaming and its relation to divergent thinking abilities. Individuals with and without a diagnosis of ASD were surveyed on their daydreaming habits and completed a divergent thinking task. Experiences of immersive daydreaming were identified in 42% of adults with ASD and were related to broad ASD traits in those without a diagnosis of ASD. However, ASD diagnosis was unrelated to originality of divergent thinking, which was negatively associated with immersive daydreaming. Moreover, daydreaming experiences in ASD were diverse. A more nuanced understanding of the mental experiences in ASD may assist in the development of interventions and support for this population.

The role of impulsivity in the association between childhood trauma and dissociative psychopathology: mediation versus moderation.

Previous studies on survivors of childhood trauma documented associations between psychological dysregulation, impulsivity, and both behavioral and emotional manifestations of distress. Yet, the mechanism that links these variables remains unclear. The current study aims to examine the pattern of relations between a history of child abuse, impulsivity and dissociation. More specifically, it examines whether impulsivity serves as a moderator or mediator in the association between childhood trauma and dissociation. Eighty-one inpatients from the acute wards of two psychiatric hospitals participated in this study. Data were collected by clinician-administered questionnaires. A highly significant linear hierarchical regression analysis revealed that both psychiatric comorbidity and childhood trauma made unique contributions to the variance of dissociation. Yet, the significant association between childhood trauma and dissociation decreased when impulsivity was entered into the regression model. Our findings suggest that impulsivity mediates the association between childhood trauma and dissociative psychopathology and imply that the identification and treatment of impulsivity could be a potentially valuable clinical target in individuals with dissociative disorders.

Maladaptive Daydreaming and Obsessive-Compulsive Symptoms: A confirmatory and exploratory investigation of shared mechanisms.

Maladaptive Daydreaming (MD) is a newly proposed mental disorder characterized by excessive, vivid fantasy activity impairing functioning. There is a high comorbidity of MD with Obsessive-Compulsive Spectrum Symptoms (OCSS), yet the mechanisms responsible for this relationship are still unclear. The present study set out to explore the relationship between MD and OCSS by: (1) examining dissociation, trauma, sense of control, and mind-wandering as potential mediators; (2) exploring whether MD is more strongly related to obsessions or compulsions; and (3) identifying patterns of specific obsessions and/or compulsions common in an MD sample. A group of 510 participants with self-identified MD completed a battery of online questionnaires. Dissociation and sense of control significantly mediated the MD-OCSS association. MD was moderately related to both obsessions and compulsions but was significantly more strongly related to the former. Frequently endorsed obsessions and compulsions among MD participants included checking and repetition compulsions, intrusive obsessions, and body-related obsessions and compulsions. We conclude that dissociative mechanisms, including dissociative absorption, play a major role in the relationship between MD and OCSS and may lead to consequent checking when transitioning back to reality, altered embodiment, intrusive images, and thoughts, and an impaired sense of mental control. Clinicians working with OCSS should be aware of the possible role of MD in the development or maintenance of symptoms. Future work should develop useful interventions for this type of shared psychopathology.