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.

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.

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.

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.

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).

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.

Perceived Stress During the COVID-19 Pandemic Mediates the Association Between Self-quarantine Factors and Psychological Characteristics and Elevated Maladaptive Daydreaming.

Since the emergence of the COVID-19 pandemic, almost all countries have employed varying degrees of lockdown measures to limit the spread of the infection. Previous studies showed that individuals with maladaptive daydreaming (MD) are affected negatively by the lockdown. In this study, we explored a set of lockdown measures (e.g., self-quarantine) and personal factors (e.g., education, history of depression, and personality traits) that might potentially exacerbate MD experienced during the lockdown period. We also examined whether perceived stress acted as a mediator in the relationship between these factors and MD. During the first lockdown from April to June, we analyzed data provided by 1083 individuals from the USA, the UK, Italy, and Turkey. A path analysis revealed that perceived stress mediated the effects on MD of self-quarantine, previous episodes of depression, low education level, and introversion and emotional instability. Our study suggests a conceptual framework for the factors that intensify maladaptive daydreaming under the threats of the pandemic and forced home confinement, offering implications for interventions with vulnerable populations.

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.

Maladaptive Daydreaming in an Adult Italian Population During the COVID-19 Lockdown.

During the COVID-19 outbreak, individuals with or without mental disorders may resort to dysfunctional psychological strategies that could trigger or heighten their emotional distress. The current study aims to explore the links between maladaptive daydreaming (MD, i.e., a compulsive fantasy activity associated with distress and psychological impairment), psychological symptoms of depression, anxiety, and negative stress, and COVID-19-related variables, such as changes in face-to-face and online relationships, during the COVID-19 lockdown in Italy. A total of 6,277 Italian adults completed an online survey, including socio-demographic variables, COVID-19 related information, the 16-item Maladaptive Daydreaming Scale (MDS-16), and Depression, Anxiety, and Stress Scales-21 Items (DASS-21). Based on an empirically derived cut-off score, 1,082 participants (17.2%) were identified as probable maladaptive daydreamers (MDers). A binary logistic regression revealed that compared to controls, probable MDers reported that during the COVID-19 lockdown they experienced higher levels of anxiety and depression, decreased online social relationships, and, surprisingly, stable or increased face-to-face social relationships. Given the peculiar characteristics of the pandemic context, these findings suggest that the exposure to the risk of contagion had probably exacerbated the tendency of probable MDers to lock themselves inside their mental fantasy worlds, which in turn may have contributed to further estrangement from online social relationships and support, thus worsening their emotional distress.

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.

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.

Heightened Levels of Maladaptive Daydreaming Are Associated With COVID-19 Lockdown, Pre-existing Psychiatric Diagnoses, and Intensified Psychological Dysfunctions: A Multi-country Study.

The COVID-19 pandemic has been spreading globally since December 2019, bringing with it anxieties, mortal risk, and agonizing psychological suffering. This study aimed to explore the relationship between maladaptive daydreaming (MD)-an addictive mental behavior to vivid fantasy associated with distress and functional impairment-and forced COVID-19 pandemic-related self-isolation and quarantine. Previous literature indicated that individuals employ MD for the regulation of distress and boredom, wish fulfillment, and entertainment experiences. The literature on the impact of the COVID-19 pandemic on mental health identifies a flareup in psychological difficulties in the general population. In this study we explored the associations between the pandemic threat and mental health indices among individuals with MD. We surveyed 1,565 adults from over 70 countries who responded to calls for participants posted in online MD communities and other general social media sites. Probable MD was determined based on an empirically derived cut-off score on a pertinent measure. After controlling for sociodemographic variables, a series of MANCOVAs, followed by post-hoc ANCOVAs, revealed that individuals with probable MD who were observing lockdown restrictions reported having spent more time in fantasy, experienced more intense and vivid daydreaming, and had a stronger urge to daydream than other participants. Similar statistical procedures indicated that, individuals with probable MD who reported pre-existing anxiety and depression disorders described a greater urge to daydream due to the pandemic and greater difficulty to control this addictive behavior. Compared to individuals with likely normal daydreaming, individuals with suspected MD reported more pandemic-attributed deterioration on a wide array of psychological distress indices. Our data show that the current worldwide pandemic threat is connected with an elevated intensity of this addictive form of mental activity, and that MD is associated with the exacerbation of psychological distress and dysfunction rather than with beneficial regulation of the experienced stressor.

Different cultures, similar daydream addiction? An examination of the cross-cultural measurement equivalence of the Maladaptive Daydreaming Scale.

BACKGROUND AND AIMS: Maladaptive Daydreaming (MD) is a proposed mental disorder, in which absorption in rich, narrative fantasy becomes addictive and compulsive, resulting in emotional, social, vocational, or academic dysfunction. Most studies on MD were carried out on aggregated international samples, using translated versions of the Maladaptive Daydreaming Scale (MDS-16). However, it is unknown whether the properties of MD are affected by culture. Thus, we investigated the cross-cultural measurement invariance of the MDS-16. METHODS: We recruited both individuals self-identified as suffering from MD and non-clinical community participants from four countries: the USA, Italy, Turkey, and the UK (N = 1,081). RESULTS: Configural invariance was shown, suggesting that the hypothesized four-factor structure of the MDS-16 (including Yearning, Impairment, Kinesthesia, and Music) holds across cultures. Metric invariance was shown for Impairment, Kinesthesia, and Music, but not for Yearning, suggesting that the psychological meaning of the latter factor may be understood differently across cultures. Scalar invariance was not found, as MD levels were higher in the USA and UK, probably due to the over-representation of English-speaking members of MD communities, who volunteered for the study. DISCUSSION AND CONCLUSIONS: We conclude that the urge to be absorbed in daydreaming and the fantasies' comforting and addictive properties may have different meanings across countries, but the interference of MD to one's daily life and its obstruction of long-term goals may be the central defining factor of MD.

Maladaptive daydreaming and emotional regulation difficulties: A network analysis.

This study explored the network structure of Maladaptive Daydreaming (MD), and links between MD and emotional regulation difficulties. Participants (n = 542) completed an online survey on MD and emotional regulation difficulties. Two network models were estimated. In the MD-only network, items clustered in three communities, most items were positively connected, and difficulty controlling the daydream was most central. In the expanded network, there were many cross-construct associations, and limited emotional regulation strategies and difficulty controlling the daydream were most central. These findings indicate that difficulties with control is central to MD, and that MD may be related to dysfunctional emotional regulation.

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.

Maladaptive Daydreaming Is Associated With Intensified Psychosocial Problems Experienced by Female Survivors of Childhood Sexual Abuse.

We measured maladaptive daydreaming (MD) and psychosocial indices among 194 participants, aged 18-56 years: 99 female survivors of childhood sexual abuse (CSA) and 95 control respondents with no reported history of sexual abuse. Our data show that survivors of CSA scored higher on MD compared to controls. Survivors of CSA with probable MD scored higher on psychological distress, social phobia, and social isolation compared to survivors of CSA without suspected MD, implying that MD might exacerbate the psychosocial problems linked with CSA. MD psychological screening of female survivors of CSA and the development of a treatment module for MD could improve the quality of clinical services provided to survivors.

A daily diary study on maladaptive daydreaming, mind wandering, and sleep disturbances: Examining within-person and between-persons relations.

Cross-sectional and experimental research have shown that task-unrelated thoughts (i.e., mind wandering) relate to sleep disturbances, but there is little research on whether this association generalizes to the day-level and other kinds of task-unrelated mentation. We employed a longitudinal daily diary design to examine the within-person and between-person associations between three self-report instruments measuring mind wandering, maladaptive daydreaming (a condition characterized by having elaborate fantasy daydreams so insistent that they interfere with daily functioning) and sleep disturbances. A final sample of 126 participants self-identified as experiencing maladaptive daydreaming completed up to 8 consecutive daily reports (in total 869 daily observations). The scales showed acceptable-to-excellent within-person reliability (i.e., systematic day-to-day change) and excellent between-person reliability. The proportion of between-person variance was 36% for sleep disturbances, 57% for mind wandering, and 75% for maladaptive daydreaming, respectively (the remaining being stochastic and systematic within-person variance). Contrary to our pre-registered hypothesis, maladaptive daydreaming did not significantly predict sleep disturbances the following night, B = -0.00 (SE = 0.04), p = .956. Exploratory analyses indicated that while nightly sleep disturbances predicted mind wandering the following day, B = 0.20 (SE = 0.04), p < .001, it did not significantly predict maladaptive daydreaming the following day, B = -0.04 (SE = 0.05), p = .452. Moreover, daily mind wandering did not significantly predict sleep disturbances the following night, B = 0.02 (SE = 0.05), p = .731. All variables correlated at the between-person level. We discuss the implications concerning the differences between maladaptive daydreaming and mind wandering and the possibility of targeting sleep for mind wandering interventions.

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.

Trapped in a Daydream: Daily Elevations in Maladaptive Daydreaming Are Associated With Daily Psychopathological Symptoms.

Background: Maladaptive Daydreaming (MD) characterizes individuals who engage in vivid, fanciful daydreaming for hours on end, neglecting real-life relationships and responsibilities, resulting in clinical distress and functional impairment. Sufferers have embraced the term MD in cyber-communities devoted to this problem because it seemed to uniquely fit their experience and since existing diagnostic labels and their therapies seemed inadequate. However, scientific research in the field has been scarce, relying on cross-sectional or case study designs. Existing knowledge on MD suggests the involvement of dissociative and obsessive-compulsive symptoms, as well as positive reinforcement comparable to processes in addiction disorders. The present study aimed to rigorously explore factors that accompany MD employing a longitudinal daily-diary design, hypothesizing that temporal increases in MD will associate concurrently with, and will temporally precede, other symptoms and emotional changes. In addition, we aimed to explore which symptoms may act as precursors to increases in MD, in order to identify possible mechanisms bringing about daydreaming in these individuals. Methods: In a sample of 77 self-diagnosed individuals with MD we assessed relevant daily symptoms for 14 days, including MD, depression, general anxiety, social anxiety, obsessive-compulsive symptoms, and dissociation, as well as positive and negative emotion. Results: Increases in MD were strongly related to concurrent increases in all other symptoms and negative emotion, and to decreased positive emotion. Obsessive-compulsive symptoms, dissociation, and negative emotion also temporally followed MD. Obsessive-compulsive symptoms were the only consistent temporal antecedent of MD. Conclusions: MD and obsessive-compulsive symptoms coincided in what seems to be a vicious cycle; understanding possible shared mechanisms between these symptoms may inform our understanding of the etiology of MD. For example, Serotonin levels may possibly be involved in the development or maintenance of this condition. The findings may also provide clues as to potentially beneficial interventions for treating MD. For example, perhaps utilizing response prevention techniques may be useful for curbing or intercepting unwanted daydreaming. Future studies on MD should address its compulsory nature.

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.