Maladaptive Daydreaming (MD)
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Maladaptive Daydreaming 2026: MDS-16, ICMDR fusion, comorbidities with depression and trauma – an overview of the current state of MD diagnosis and treatment.
Maladaptive daydreaming, MDS-16 and ICMDR: How Eli Somer and Nirit Soffer-Dudek are shaping the diagnosis of maladaptive daydreaming in 2026 – the state of research
Maladaptive daydreaming, or MD for short, is undergoing scientific consolidation in 2026. The consortium is merging with the ISMD, Nirit Soffer-Dudek’s lab is conducting the first experimental study on causality, and the Maladaptive Daydreaming Scale is establishing itself as the standard instrument. Those who understand the phenomenon clinically can base their diagnosis and treatment on evidence, including coexisting conditions such as depressive episodes.
What is maladaptive daydreaming, and what does the Maladaptive Daydreaming Scale measure?
Maladaptive daydreaming is a condition in which extensive, narrative daydreams impair everyday functioning. Eli Somer first described the construct in a clinical paper from Israel in 2002. Clinical psychology has continuously addressed MD since its initial description; a decade later, it had grown into a distinct field of research that now operates within an international network. Most of those affected describe themselves as ‘maladaptive daydreamers’. They describe hours-long, plot-driven inner worlds with firmly established characters and story arcs.
The standard instrument is called the MDS-16, a 16-item version of the Maladaptive Daydreaming Scale. It measures four dimensions: Yearning, Impairment, Awareness and Music-induced Daydreaming. The responses are totalled to yield an overall score; a cutoff of around 50 points is considered indicative of clinically relevant intensity. Clinically, MD is not yet an independent concept in the DSM-5-TR or ICD-11. Its inclusion as ‘maladaptive daydreaming disorder’ has been under discussion for years, but its formal status remains open.
Who established this field of research? Eli Somer and the early work
Eli Somer of the University of Haifa first clinically described MD in 2002. A decade later, his collaboration with Jayne Bigelsen expanded the field of knowledge. The co-author led a groundbreaking study of 90 individuals with pronounced symptoms (Bigelsen et al. 2016, Consciousness and Cognition). The study systematically distinguished narrative, immersive daydreams from ordinary mind-wandering activity and established the profile that the assessment tool would later formally capture.
Since around 2017, the infrastructure has continued to expand. Nirit Soffer-Dudek from Ben-Gurion University is simultaneously developing a so-called structured clinical interview to supplement the self-report. This means there are now two methodologically complementary standard instruments: self-report and interview procedures. The findings of this working group continue to shape the field internationally.
How does the MDS-16 assessment procedure work?
The MDS-16 assessment follows a defined procedure: the participant answers sixteen questions regarding the frequency, duration, immersion, distress and compensatory function of their daydreams. Responses are given using a Likert scale. Sample questions: How often do I experience daydreams that last for hours? To what extent do they interfere with my daily functioning? What emotional functions do they serve?
The assessment takes about ten minutes. The instrument has been validated in several replication studies; replications are available from Israel, Italy and North America. It is a screening tool, not a diagnosis: it provides indications and points to the need for further investigation. Those who use it in clinical practice should be aware of its limitations. An elevated score is a reason for further investigation, not a definitive result.
The instrument is also suitable for international use. Data show that self-reported frequency and impairment occur across cultures, from studies at the University of Haifa and Italian university samples to North American Reddit communities where those affected have been sharing experiences for years.
What role does the new Structured Clinical Interview play?
The SCI-MD, Soffer-Dudek’s diagnostic interview, compensates for the weaknesses of self-reporting. The procedure systematically checks whether the self-assessment corresponds with clinical observation, and distinguishes the described daydreams from fantasies, dissociative experiences and psychotic symptoms. At the same time, the interview captures the intensity of impairment in everyday life, an aspect that self-reporting often underestimates.
The combination of self-report test and interview has been regarded as the gold standard in the field since around 2018. Both instruments complement one another; neither alone captures enough. A score without an interview remains merely an indication. An interview without self-assessment remains an observation of an individual case. Only the combination provides a clinically robust profile.
Anyone working with patients who report MD themselves should be familiar with both instruments. The self-report tool serves as a rapid initial screening, and the interview serves as a means of further exploration. The self-report alone is not sufficient. This is the most important practical finding from the consortium’s literature.
What is the underlying cause of maladaptive daydreaming?
No single cause of maladaptive daydreaming can be identified; the phenomenon is multifactorial. A recurring observation in the research of the last twenty years is that childhood trauma is overrepresented. Several studies show correlations between MD scores and ACE (Adverse Childhood Experiences) scores, as well as between MD and emotional neglect or physical abuse.
Mechanistically, MD can plausibly be interpreted as a coping strategy. Those who have experienced unbearable emotional states in childhood construct an internal narrative world, a daydream, into which they can retreat. This is an adaptive response. It only becomes maladaptive when, as an adult, it remains the sole available coping mechanism and erodes everyday functioning.
In addition, personality traits play a role: a vivid imagination, a capacity for absorption, and sensitivity to inner images. These traits are not pathological in themselves; they only become a risk when combined with unresolved trauma. The medical history should therefore cover both the biographical trauma and the individual’s tendency towards imagination.
Which comorbid disorders have been documented?
A 2025 meta-analysis (Soffer-Dudek et al., Clinical Psychology Review) shows that MD is distributed across diagnostic categories. Positive correlations exist with depression, anxiety disorders, dissociation, obsessive-compulsive disorder, ADHD, general psychopathology, psychotic symptoms, autism and traumatic experiences. Since its publication, this review has been the primary source of data on the prevalence of comorbid disorders in MD.
The comorbid disorders are real and warrant their own treatment; at the same time, they obscure the actual mechanism. If the depressive episode is treated without the underlying phenomenon being recognised, maladaptive daydreaming remains a risk factor. Any MD-focused medical history should also assess the typical comorbidities, and conversely, in cases of long-standing depressive symptoms with an unclear course, it is worth considering MD.
The high comorbidity rate is also an argument against treating MD as a curiosity. If a symptom statistically covaries with so many other disorders, it is clinically relevant, regardless of what the formal diagnostic status in the DSM and ICD ultimately turns out to be.
Is maladaptive daydreaming a dissociative disorder?
The categorical question remains unresolved. Eli Somer originally classified MD as conceptually close to dissociative absorption, the ability to immerse oneself in imagination to the point that the connection to reality temporarily wanes. Several studies show positive correlations between MD scores and symptoms of dissociation.
However, the correlations are not strong enough for MD to be completely subsumed under dissociation. Soffer-Dudek’s more recent work argues that MD and dissociative absorption are empirically distinct factors. The dissociative component is a concomitant feature, not the defining characteristic, and this has implications for the next DSM/ICD revision: where does MD belong if it is not a dissociative disorder in the strict sense?
This raises a systemic question: if MD does not clearly fit into an existing category, is it worth establishing a separate one, or should it, for the time being, remain a subcategory within dissociative phenomena? The international consortium discussion leans towards the first option; there are methodological arguments in favour of this, but as yet no definitive evidence.
How will the field be organised institutionally in 2026?
The ICMDR (International Consortium for Maladaptive Daydreaming Research) and the ISMD (International Society for Maladaptive Daydreaming) will merge in 2026. Two structures working in parallel will become one. This is a classic sign of a field becoming professionalised. A shared website, shared conference logistics, and a unified position in discussions with DSM/ICD authorities.
It brings together working groups from the Middle East, Italy, the USA, Canada, Australia and Western Europe. Conferences held in Italy in 2026 presented eight new studies, and the body of evidence continues to grow. The internationally recognised MD construct is thus being better substantiated year on year; it is not an internet subculture, but a scientifically documented patient group.
In practical terms, this means that the consortium’s position will guide anyone publishing on MD in 2026. Those treating patients can rely on the consortium as a central source of knowledge and refer colleagues to a coherent body of literature, rather than having to explain a disparate collection of scattered individual studies.
What does Nirit Soffer-Dudek’s experimental study show?
Previous work has been almost exclusively correlational. In 2026, Nirit Soffer-Dudek’s Consciousness and Psychopathology Laboratory will conduct an experimental study to test whether MD directly contributes to difficulties with memory and self-concept. It is the first experimental study of its kind, a methodological leap that will shape the field.
Conceptually, MD is manipulated as an independent variable. Individuals with clinically relevant scale scores are compared with control groups; memory and self-concept indicators are measured. If the design holds up, the study will provide the first robust evidence of a causal effect of MD on other cognitive functions.
The operationalisation is methodologically elegant. The cross-cultural validation of the MDS-16 rules out cultural influences; the interview confirms the findings. If the design holds up, the study represents a turning point.
What does an MD diagnosis look like in everyday clinical practice?
Clinical diagnosis proceeds in three steps. First: self-report as a screening tool (ten minutes). Second: SCI-MD is an interview-based, in-depth assessment. Third: defining what MD is not. Only the combination of these three steps leads to a robust result.
MD is not an invention of the TikTok self-diagnosis trend: the data refutes this. But daydreaming is not automatically pathological. There are many adaptive forms: creative visualisation, mind-wandering, and daydreams as a moment of relaxation. What distinguishes MD from these is frequency, duration and impairment. People with MD do not have a ‘dreamer personality’; they are people whose inner world supplants the outer world.
MD can be treated through biographical therapy, cognitive strategies to reduce triggers, self-monitoring and, in some cases, pharmacotherapy. It is important to note that the DSM/ICD diagnostic system is not a prerequisite for treatment: even without a formal diagnosis, the symptoms can be treated, and the psychological distress should be taken seriously.
Key points in brief
· Maladaptive daydreaming is at a turning point in 2026: the ICMDR/ISMD merger, the first experimental study, and a wealth of international research.
· The MDS-16 is the standard screening tool; the Structured Clinical Interview (SCI-MD) complements it as the gold standard.
· MD is transdiagnostic in nature, with correlations to depression, anxiety disorders, dissociation, obsessive-compulsive disorder and ADHD.
· Childhood trauma is a major cause; a biographically oriented approach is usually part of the treatment.
· Nirit Soffer-Dudek’s experimental study tests the causal question for the first time and can elevate the field to a new level of evidence.
· Eli Somer and Bigelsen established the field; the consortium will consolidate it institutionally in 2026.
· Clinically, MD is not yet listed in the DSM or ICD diagnostic systems; the debate over a separate category remains open.
· MD can also be treated without a formal diagnosis; the key factors are assessment, medical history and treatment planning.
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