Description: How maladaptive daydreaming is linked to substance and behavioural addictions - and why both are based on similar mechanisms of emotion regulation.

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Teaser (Lead)

Whether substance addiction, pathological gambling or eating disorders: Addictive disorders and maladaptive daydreaming share a common core - the escape from unbearable emotions. This article deciphers the striking similarities in the underlying mechanisms and explains why daydreaming can become a behavioural addiction.

Addictive disorders and maladaptive daydreaming: common ways of escaping emotions

First, read the detailed main article [Understanding, treating and overcoming maladaptive daydreaming]

or

The overview "Maladaptive daydreaming - causes, symptoms and help". This themed article explores the profound links between addictions and maladaptive daydreaming.

1. Similarities: Common mechanisms of emotion regulation

Addictive behaviour and maladaptive daydreaming (MD) show significant overlaps in their function as coping strategies for emotional dysregulation. The comorbidity rate ranges from 25% to 40%.

Common features:

• Avoidance behaviour: Escape from unpleasant emotions or reality demands

• Reward deferral: Short-term relief by delaying problem-solving

• Tolerance development: Increasing duration/intensity to achieve the same effects

• Withdrawal symptoms: Restlessness, irritability when attempting to reduce consumption

Neurobiological parallels:

• Dopaminergic reward systems are activated in a similar way to substance-related addictions

• Prefrontal control networks are less active during daydreaming phases

• Amygdala activation during emotional triggering is comparable to addictive behaviour

2. Specific correlations with non-substance-related addictions

Behavioural addictions:

• Pathological gambling: comparable impulse control disorders

• Internet and gambling addiction: Similar tendencies to escape reality

• Shopping addiction: comparable mood regulation patterns

Eating disorders:

• Bulimia: a cycle of loss of control and compensation

• Binge eating: episodes triggered by negative emotions with loss of control

• Obesity: Eating behaviour as a comfort with an addictive character

Impulse control disorders:

• Pathological stealing: Impulsive behaviour to regulate affect

• Trichotillomania: A Repetitive behaviour pattern in case of emotional tension

• Skin picking: Automated coping strategies for stress

3. The addictive cycle of maladaptive daydreaming

Triggering situation:

Emotional strain, stress or excessive demands

Mental preparation:

Anticipatory (anticipatory) arousal ("I'm about to escape")

Daydream episode:

Intense immersion with emotional relief

Aftermath:

Short-term relief, followed by feelings of guilt

Tolerance development:

Increasing duration/frequency for the same effect

4. Comparison of dysfunctional emotion regulation patterns

5. Integrative treatment approaches for comorbid disorders

Special diagnostic features:

• Differentiation between primary addiction and compensatory MD

• Function of daydreaming behaviour in the context of addiction

• Recognition of interactions between different addictions

Therapy modules:

• Motivational interviewing for willingness to change

• Relapse prevention with early warning systems

• Emotion regulation training as a core component

• Mindfulness-based approaches to impulse control

• Reality orientation and building alternative rewards

Specific challenges:

• Treatment prioritisation for multiple addictions

• Integrative approaches instead of isolated disorder treatment

• Consideration of neurobiological similarities

• Longer-term care due to high relapse rates

6. case study: Sophia's double escape

Initial situation:

• Sophia (34) with binge eating disorder and MD

• Daydreams about perfect relationships for 4-5 hours a day

• Binge eating after emotionally disappointing real-life experiences

• Cycle of emotional disappointment → daydreams → binge eating → feelings of guilt

Therapeutic approach:

1. Simultaneous treatment of both disorders

2. Emotion regulation training

3. Identification of triggers and early warning signs

4. Development of alternative coping strategies

5. Reality-based relationship design

Result after 9 months:

• Binge eating reduced from 5 × to 1 × per week

• Daydreaming time is limited to 1-2 hours daily

• Improved emotion regulation skills

• Less impulsivity in crises

FAQ

Can maladaptive daydreaming develop an addictive character?

Yes, due to the development of tolerance, loss of control and withdrawal symptoms, MD shows typical addictive characteristics.

Should MD be treated like an addiction?

In part, with a focus on the underlying emotion regulation, not on "withdrawal".

Are there medications for addictive daydreaming?

Non-specific, but SSRIs or addiction medications may help with comorbidity.

How does MD differ from other behavioural addictions?

It has a purely cognitive nature with no behavioural component.

Where can I find help for addictive daydreaming?

You can find addiction counselling centres or therapists with expertise in behavioural addictions online, via your GP or your health insurance provider.

In the case of addictive maladaptive daydreaming, integrative treatment that combines both addiction-specific and emotion regulation approaches is recommended.