Maladaptive daydreaming: A shortened assessment measure and its mental health correlates in a large United States sample.

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.

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.

The path to dissociative experiences: A direct comparison of different etiological models.

Severe dissociation is trauma-related, but a range of dissociative experiences are also prevalent in clinical populations that are not necessarily trauma-based (e.g., depression, anxiety disorders, and obsessive-compulsive disorders). These remain poorly understood as the dominant etiological model for dissociation relies on trauma. Importantly, dissociation in such samples predicts poor prognosis and high drop-out rates. We set out to better understand the aetiology of dissociative experiences in a mixed clinical (anxiety and depression) and community sample by exploring between- and within-subjects effects of two domains: psychological distress or negative affectivity (operationalized as anxiety and depression symptoms), and poor sleep quality, including disturbed dreaming. The idea that negative affectivity triggers dissociation (Distress Model) is inspired by the trauma model. The idea that poor sleep and unusual dreaming underlie dissociation (Sleep Model) has been suggested as a competing theory. We examined both models by exploring which domains oscillate alongside dissociative experiences. N = 98 adults, half of them diagnosed with depression and anxiety and half community controls, underwent a structured clinical interview and completed questionnaires monthly for 6 months. Support was found for both models in that each domain had a unique explanatory contribution. Distress evinced consistent effects that could not be explained by sleep or dreaming, both between individuals and across time. Oscillations in dissociation across months, when taking psychological distress into account, were better explained by unusual dreaming than traditional sleep quality measures. These findings cannot be generalized to highly-traumatized samples. A complex, integrated etiological model for dissociative experiences is warranted.

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.

Who wrote that? Automaticity and reduced sense of agency in individuals prone to dissociative absorption.

Dissociative absorption (DA) is a tendency to become completely immersed in a stimulus while neglecting to attend to one's surroundings. Theoretically, DA implies automatic functioning in areas that are outside the focus of attention. This study examined whether high absorbers indeed act more automatically, i.e., with decreased meta-consciousness for, and therefore poor memory of, their own actions, along with reduced sense of agency (SoA). High and low absorbers (N = 63) performed three DA-promoting tasks: choice-reaction time (CRT), Tetris, and free writing. Participants were tested on memory of task details and self-reported their state SoA. As hypothesized, trait DA was correlated with impaired autobiographical memory for self-generated writing. However, DA was not related to episodic memory disruptions in externally-generated content tasks (Tetris, CRT). In most tasks, DA was associated with decreased SoA. Absorbers' specific difficulty in identifying self-generated content suggests that their memory failures stem from reduced accessibility to self-actions and intentions.

Dissociative absorption, mind-wandering, and attention-deficit symptoms: Associations with obsessive-compulsive symptoms.

OBJECTIVE: Dissociative absorption is a tendency to become absorbed in imagination or in an external stimulus (movie, book) to the point of obliviousness to one's surroundings and reduced self-awareness. It has been hypothesized to play a role in the maintenance of obsessive-compulsive (OC) symptoms. However, because absorption is a trait of reduced attentional control, a possible confound may be attention-deficit/hyperactivity (ADHD) symptoms, which have been reported to be comorbid with obsessive-compulsive disorder (OCD). This study aimed to validate dissociative absorption as unique from ADHD symptoms as well as from mind-wandering and to show that it has incremental predictive value over these constructs in predicting OC symptoms. DESIGN: Cross-sectional. METHOD: Three-hundred and three undergraduate students completed online questionnaires, which were analysed using exploratory and confirmatory factor analyses. RESULTS: As hypothesized, dissociative absorption emerged as a unique construct, separate from ADHD, and mind-wandering (whereas the latter two were not completely separate from each other). Additionally, absorption was uniquely associated with OC symptoms, with a moderate-to-strong effect size, demonstrating incremental predictive value over the other constructs. CONCLUSIONS: Attentional deficits and mind-wandering cannot account for the association between absorption and OC symptoms. Future research should explore whether reports of comorbidity between ADHD and OC symptoms may be inflated due to misdiagnosis of absorption tendencies as ADHD. PRACTITIONER POINTS: Dissociative absorption is a personality tendency that may interact with obsessive-compulsive symptoms, and thus, it may deserve clinical attention when treating obsessive-compulsive disorder (OCD) Dissociative absorption might bring about an unnecessary diagnosis of attention-deficit hyperactivity disorder (ADHD) in individuals with obsessive-compulsive symptoms, and thus, it should be screened for. This study was based on a non-clinical sample; future studies should replicate the findings among samples with an OCD diagnosis. This study is based on self-report questionnaires; future studies should use clinician interviews.

A neural correlate for common trait dissociation: Decreased EEG connectivity is related to dissociative absorption.

OBJECTIVE: Dissociation refers to a disintegration between psychological elements; common manifestations are embodied in "absorption and imaginative involvement," a propensity for being immersed in a stimulus while oblivious to the environment, and acting without awareness. Trait dissociation was hypothesized to relate to lower EEG signal connectivity, but studies on healthy populations are scarce. The present study set out to examine whether dissociative absorption in a nonclinical sample would be associated with decreased intrahemispheric coherence. METHOD: In 84 healthy Israeli soldiers (49% females; Mage = 22.24, SD = 2.64), resting-state electroencephalography (rsEEG) was recorded for a period of 3 min with eyes closed and 3 min with eyes open. RESULTS: Decreased coherence was related to high dissociative absorption in the long (frontal-occipital) range, and in one of the pairs of the short range (central-parietal). The effects emerged mostly in the left hemisphere, in both eyes-open and eyes-closed conditions, and for a range of spectral bands, although long-range effects were more pronounced in slow-wave bands (theta and delta). CONCLUSIONS: Dissociative absorption is manifested in segregated cortical activity, supporting the notion that it may represent less integrated mental functioning. The findings contribute to our understanding of the neural correlates of consciousness and personality.

Absorbed in sleep: Dissociative absorption as a predictor of sleepiness following sleep deprivation in two high-functioning samples.

In recent years, a labile sleep-wake cycle has been implicated as a cause for dissociative experiences, and studies show that dissociation is elevated following sleep deprivation. Dissociative individuals may find it harder to regulate sleepiness in the face of sleep disruption. Although there is significant variability in reactions to sleep deprivation, research on trait predictors is scarce. The present study examined the ability of trait dissociation to prospectively predict sleepiness following sleep loss and recovery sleep. Two high-functioning samples, namely, Remotely Piloted Aircraft officers (N=29) and Air Force jet pilots (N=57) completed state and trait questionnaires assessing sleep and dissociation before and after full or partial sleep loss. Dissociative absorption was a consistent predictor of an increase in sleepiness following sleep loss and following recovery sleep, controlling for baseline sleepiness levels. We discuss the findings in light of a difficulty to regulate and monitor consciousness states.

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.

Dissociative absorption: An empirically unique, clinically relevant, dissociative factor.

Research of dissociative absorption has raised two questions: (a) Is absorption a unique dissociative factor within a three-factor structure, or a part of one general dissociative factor? Even when three factors are found, the specificity of the absorption factor is questionable. (b) Is absorption implicated in psychopathology? Although commonly viewed as "non-clinical" dissociation, absorption was recently hypothesized to be specifically associated with obsessive-compulsive symptoms. To address these questions, we conducted exploratory and confirmatory factor analyses on 679 undergraduates. Analyses supported the three-factor model, and a "purified" absorption scale was extracted from the original inclusive absorption factor. The purified scale predicted several psychopathology scales. As hypothesized, absorption was a stronger predictor of obsessive-compulsive symptoms than of general psychopathology. In addition, absorption was the only dissociative scale that longitudinally predicted obsessive-compulsive symptoms. We conclude that absorption is a unique and clinically relevant dissociative tendency that is particularly meaningful to obsessive-compulsive symptoms.

Reactivity and sleep in infants: a longitudinal objective assessment.

Sleep patterns and temperament in the first year of life are closely related. However, research utilizing objective, rather than subjective measurements of sleep and temperament is scarce and results are inconsistent. In addition, a relative lack of longitudinal data prevents inference of causality between the two constructs. In this study, infant sleep was objectively assessed among 95 infants at 3, 6, and 12 months-of-age with an actigraph in the home setting. Reactivity to sound, light, and touch, a specific aspect of temperament, was behaviorally assessed at 3 and 6 months, both during sleep (at home) and during waking (at the laboratory). Expected maturational trends were recorded in sleep, with a temporal increase in sleep efficiency and percent of motionless sleep. Quadratic (i.e., inverse U shape) relations were found, especially among girls, when predicting change in sleep by reactivity thresholds, suggesting that both hyposensitive and hypersensitive infants are at risk for poor sleep quality. These are the first research findings suggesting that low reactivity in infancy might be associated with compromised sleep quality. The observed nonlinear effects may account for null or inconsistent results in previous studies that explored only linear associations between temperament and sleep. Future studies should address both extremes of the temperament continuum when exploring relations with sleep patterns.

Posttraumatic symptoms and poor sleep are independent pathways to agency disruptions and dissociation: A longitudinal study with objective sleep assessment.

Dissociation and diminished sense of agency are experiential distortions of disintegration in the perception of self and action. Although one is often implied in the other, they are seldom studied together. Assessing their relationship and shared influences may allow for a more comprehensive and nuanced understanding of dissociative experiences. We aimed to examine their temporal (concurrent or directional) co-occurrence, and to elucidate their etiology, focusing on posttraumatic symptoms (PTS), poor sleep, and their hypothesized joint effect. N = 113 adults oversampled for the existence of trauma exposure history reported PTS and then, for a week, wore an actigraphic sleep monitor, reported subjective sleep quality each morning, and reported state dissociation (depersonalization, derealization, and absorption) and sense of agency four times each day. Data were analyzed using multilevel linear modeling. Higher state dissociation correlated with diminished state sense of agency, but only contemporaneously, not directionally. Both hypothesized etiological factors, namely, PTS (especially complex) and poor sleep (objective and subjective) predicted state dissociation and diminished state sense of agency, but psychological distress seemed to overshadow these main effects. However, robust interactive effects suggested that poor sleep predicted dissociation and disruptions in the sense of agency only among individuals with low PTS. These findings suggest that PTS and poor sleep quality are separate paths to dissociation and impaired sense of agency. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

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.

The synergy of depression and flourishing/languishing on suicidal thoughts and behaviors: Findings from a national sample of emerging adult students in higher education in the United States.

BACKGROUND: Suicide is a leading cause of death among students in higher education, driven in large part by mental illness, but also mental wellness. Relatively few studies have examined the extent to which depression and flourishing/languishing interact in relation to suicidal thoughts and behaviors. METHODS: We analyzed data from the Healthy Minds Study (2020-2021; emerging adult students aged 18-29; N = 101,435), and calculated interaction contrast ratios to estimate the interaction between depression and flourishing/languishing on suicidal thoughts and behaviors, using an additive scale, adjusting for age, gender, race/ethnicity, and food insecurity. RESULTS: When compared with students who were flourishing without depression, the students who were languishing without depression, and the students who were depressed but still flourishing had significantly greater odds of suicidal thoughts and behaviors. However, students who were depressed and languishing had the greatest odds, exceeding the sum of the individual effects. CONCLUSION: The interaction of depression and flourishing/languishing produced a synergy that increased odds of suicidal thoughts and behaviors. Flourishing interventions may prove to be an effective strategy for universal suicide prevention.

Obsessive-compulsive symptoms and dissociative experiences: Suggested underlying mechanisms and implications for science and practice.

A strong and specific link between obsessive-compulsive disorder or symptoms (OCD/S) and a tendency for dissociative experiences (e.g., depersonalization-derealization, absorption and imaginative involvement) cannot be explained by trauma and is poorly understood. The present theoretical formulation proposes five different models conceptualizing the relationship. According to Model 1, dissociative experiences result from OCD/S through inward-focused attention and repetition. According to Model 2, dissociative absorption causally brings about both OCD/S and associated cognitive risk factors, such as thought-action fusion, partly through impoverished sense of agency. The remaining models highlight common underlying causal mechanisms: temporo-parietal abnormalities impairing embodiment and sensory integration (Model 3); sleep alterations causing sleepiness and dreamlike thought or mixed sleep-wake states (Model 4); and a hyperactive, intrusive imagery system with a tendency for pictorial thinking (Model 5). The latter model relates to Maladaptive Daydreaming, a suggested dissociative syndrome with strong ties to the obsessive-compulsive spectrum. These five models point to potential directions for future research, as these theoretical accounts may aid the two fields in interacting with each other, to the benefit of both. Finally, several dissociation-informed paths for further developing clinical intervention in OCD are identified.

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).

Longitudinal associations between maladaptive daydreaming and psychological distress during the COVID-19 health crisis.

Background and aims: Maladaptive Daydreaming (MD) is a suggested syndrome where individuals become addicted to fantasizing vividly for hours on end at the expense of engaging in real-world relationships and functioning. MD can be seen as a behavioral addiction. However, a paucity of longitudinal research means that there is no empirical evidence confirming the stability of this alleged addiction. Moreover, the direction of its association with psychopathology is unclear. Methods: We examine, for the first time, long-term stability and longitudinal associations between MD, psychological distress (stress, anxiety, and depression symptoms) and COVID-19 related exposure. Results: Participants (N = 814) completed an online survey twice, with a lag of 13 months. A two-wave structural equation model demonstrated high MD stability and positive cross-lagged pathways from MD to psychological distress. COVID-19 related exposure was not a longitudinal predictor. Discussion and conclusions: MD is a stable condition and a risk factor for an increase in psychological distress.

The Interplay Between Childhood Sexual Abuse, Self-Concept Clarity, and Dissociation: A Resilience-Based Perspective.

BACKGROUND: Despite a robust consensus regarding the potentially negative implications of childhood sexual abuse (CSA), research investigating risk and protective factors-particularly among well-functioning young adults-is scant. Dissociation is one of the major maladaptive outcomes of CSA. Nevertheless, CSA explains only about 10% of the variance of dissociation. Possibly, this modest effect size is due to protective factors moderating the relation between CSA and dissociative symptoms. One such factor may be the extent to which one has succeeded in developing a clear and coherent sense of who they are. OBJECTIVE: We aimed to explore whether self-concept clarity (SCC) moderates the relationship between CSA and dissociation (Model 1), and an alternative hypothesis, whereby CSA may moderate the relationship between SCC and dissociation (Model 2). PARTICIPANTS AND SETTING: This was tested among 65 well-functioning young women drawn from an earlier study that intentionally oversampled CSA survivors. METHODS: We included data from survivors of CSA by a known perpetrator (n = 35) and women with no sexual trauma (n = 30). RESULTS: Findings were consistent with both Model 1 and Model 2, but only when depersonalization-derealization, namely detachment, was considered. Simple effects analyses revealed that CSA was related to depersonalization-derealization only under low SCC levels (Model 1), and SCC was negatively related to depersonalization-derealization only in the CSA group (Model 2). CONCLUSIONS: Findings suggest that SCC is a protective factor, buffering the association between CSA and detachment (depersonalization-derealization) symptoms. Clinical implications are discussed.

Distress related to psychotic experiences: Enhancing the world health organization composite international diagnostic interview psychosis screen.

BACKGROUND: The abbreviated version of the World Health Organization (WHO) Composite International Diagnostic Interview (CIDI) psychosis screen tends to yield high prevalence in online samples. Psychotic Experiences (PE) may not necessarily indicate current or imminent psychopathology; however, distressing PE appear to be more clinically informative. METHODS: We analyzed data collected from an online survey administered to a Qualtrics panel (N = 2522 adults). Using multivariable logistic regression, we examined the association between PE (with and without associated distress) and several mental health outcomes, adjusting for age, gender, and race/ethnicity. RESULTS: Individuals with distressing PE had greater odds of most mental health outcomes when compared with individuals with non-distressing PE. This was true for being in mental health treatment, loneliness, probable mental illness, suicidal ideation, and suicide attempt, adjusting for age, gender, race/ethnicity, and education level. The only exception was for hazardous alcohol use, for which there was no significant association with distressing PE. CONCLUSION: As screening for PE gains traction in public health and preventive medicine, using an abbreviated version of the WHO CIDI psychosis screen may be clinically informative, especially when eliciting the distressful nature of PE.

Maladaptive Daydreaming: Epidemiological Data on a Newly Identified Syndrome.

Background: Maladaptive Daydreaming (MD) is a recently identified psychological disorder, characterized by excessively and addictively engaging in vivid, narrative, intensely emotional fantasy activity, at times with the aid of music and/or repetitive movements, causing distress and functional impairment. Over 100,000 self-diagnosed individuals are active online and thousands of them have been researched; yet there are no studies using clinical interviews on large, systematic general (non-MD) samples, to assess the estimated prevalence of this suggested disorder, and establish norms for its main psychometric tool. Methods: Four independent Israeli samples (three student samples, and one sample representing the general Jewish-Israeli population; total N = 1,023) self-reported MD. In two samples, those exceeding the cutoff score for suspected MD were invited for a structured clinical interview. Results: The skewness of most items of the 16-item Maladaptive Daydreaming Scale (MDS-16) supports the notion of MD as a binary construct rather than a normally distributed trait. In the community sample, 4.2% exceeded the cutoff for suspected MD. Rates were higher when focusing on the young adult age group or student samples (5.5-8.5%), suggesting a likely age effect. Following clinical interviews, only 60% of interviewed respondents met criteria for diagnosis, suggesting a true point-prevalence of 2.5% in the Israeli-Jewish population. Conclusions: This is the first systematic clinical evaluation of the prevalence of MD. In an Israeli sample, a point-prevalence of 2.5% was found, like several other internalizing psychiatric syndromes. This result, along with the Non-normal nature of item distribution, both support the validity of MD as a psychological disorder, which should be considered as a potential addition to future psychiatric diagnostic manuals.