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Maladaptive daydreaming: definition, differentiation & causes. Psychotherapy and coping strategies for individuals, as well as resources for psychologists and therapists.

Related

• Maladaptive daydreaming - causes, symptoms and help

• Diagnostics: The Maladaptive Daydreaming Scale (MDS), other tests and further research (6)

• Causes of maladaptive daydreaming (4)

• Online self-test: Maladaptive daydreaming

Teaser (Lead)

Daydreaming is a regular and creative activity. But what happens when fantasies become so intense, prolonged and realistic that they overshadow reality? In this article, we define maladaptive daydreaming, differentiate it from everyday daydreaming and explain why it is not laziness or simple "daydreaming".

Definition and differentiation of daydreaming from personality disorders and other disorders in psychotherapy, clinical and psychodynamic characteristics of maladaptive daydreaming

First, read the detailed main article, "Maladaptive Daydreaming: Understanding, Treating, and Overcoming It," a comprehensive guide.

Or

The overview "Maladaptive Daydreaming - Causes, Symptoms and Help" provides a definition, research, causes, symptoms, diagnosis, effects and treatment options. This themed article explains how maladaptive daydreaming differs from normal daydreaming and clears up common misconceptions.

Daydreaming is a regular and creative activity. But what happens when fantasies become so intense, prolonged and realistic that they overshadow reality? In this article, we define maladaptive daydreaming, distinguish it from everyday daydreaming and explain why it is not laziness or simple "daydreaming".

2 What are maladaptive daydreams?

The term maladaptive daydreaming (MD) was coined in 2002 by Israeli psychologist Eli Somer. He uses it to describe "extensive fantasy activity that replaces human interaction and/or impairs academic, occupational or social functioning". Somer's qualitative study was based on six patients who immersed themselves for hours in inner dream worlds to alleviate stress or emotional pain. The patients knew that their fantasies were not real, but suffered from the loss of control and the effects on their lives. It can therefore be said that MD sufferers have developed their own strategy to escape reality.

The first research studies date back to the early 2000s. Larger online surveys followed from 2011. To measure the phenomenon, Somer and his colleagues developed the Maladaptive Daydreaming Scale (MDS-16), which assesses quality, controllability, emotional benefit, and impairment. MD is not yet an official diagnosis in the DSM-5, but rather a research construct. Many who suffer from MD have difficulties in everyday life and often feel misunderstood by psychiatrists because it is not an official disorder.

3 Differences to usual daydreams

Every daydream is short, spontaneous, and often connected to reality. They can help to solve problems, lift the mood or develop creative ideas. Maladaptive daydreaming is distinct: the vividness and complexity of MD fantasies are incredibly vivid, rich in detail, and resemble an ongoing series with fixed characters. The duration and intensity of the episodes last from minutes to hours; those affected lose track of time and struggle to end the daydreams.

While everyday daydreaming can be easily interrupted, MD sufferers feel the need to continue the imaginary story; interruptions lead to irritation. MD often serves as a strategy for coping with stress, sadness or boredom, whereas normal daydreaming is more random. MD is characterised by movement (walking back and forth, rocking), facial expressions and quiet speech during daydreaming. These differences make it clear why MD is more than "normal daydreaming" and deserves its own attention.

4 Clinical criteria and challenges in diagnosis

Phenomena such as obsessions, psychotic ideas or dissociation must be ruled out. In contrast to delusional disorders, MD sufferers retain a connection to reality. While concentration difficulties can also occur in ADHD or obsessive-compulsive disorder, in MD, it is mainly the captivating fantasies that dominate everyday life. Research groups have proposed diagnostic criteria (including intensity of fantasies, loss of control, and distress), but a clinical consensus has yet to be reached.

The MDS-16 helps assess the extent of daydreaming, but does not replace a medical diagnosis. It is important to note that MD can often be associated with other mental disorders, such as anxiety disorders or depression. A comprehensive diagnosis is therefore crucial for identifying the underlying causes and developing a suitable therapy. Differentiation from other disorders is not always easy, but it is essential for effective treatment.

5. normal vs. maladaptive daydreaming

Every daydream is short, spontaneous, and often connected to reality. They can help to solve problems, lift the mood or develop creative ideas. In contrast, maladaptive daydreaming is a different phenomenon. Here are some key differences:

Differentiating maladaptive daydreaming from normal daydreaming is a crucial step in diagnosis. While everyday daydreaming can be a relaxing and harmless activity, the consequences of maladaptive daydreaming can have a significant impact on the lives of those affected. Many MD sufferers experience a form of coping that proves harmful over time as it isolates them from reality. I support you with empathy and clarity in recognising these patterns and finding healthier ways of coping.

6. Differentiation from daydreaming disorders - who needs psychotherapy

Daydreaming disorders are recorded in the two most crucial diagnostic classification systems under different terms and with different conceptualisations.

ICD-11 (International Classification of Diseases, 11th revision)

In ICD-11, the disorder is listed under the following official auxiliary term:

Maladaptive Daydreaming (MaDD) - 6B25 Maladaptive daydreaming (German: Maladaptives Tagträumen)

Details:

Status: Since the implementation of ICD-11 in 2022, "maladaptive daydreaming" has been a recognised diagnosis for the first time (coded under "other specified obsessive-compulsive or related disorders").

Core criteria: The focus is on excessive, immersive daydreaming that is: Excessive and time-consuming.

Causes clinically significant distress or impairment in social, occupational or other important areas of functioning.

Cannot be better explained solely as a symptom of another disorder (e.g. schizophrenia, neurological disorder).

Additional specification: The ICD-11 allows the specification "With addictive behaviours" if intense craving and difficulty controlling daydreaming are prominent.

DSM-5 (Diagnostic and Statistical Manual of Mental Disorders, 5th Edition)

There is no separate diagnosis for daydreaming disorder in the current DSM-5. They are therefore represented with a different auxiliary term:

Other Specified Dissociative Disorder (OSDD) - 300.16 (German: Sonstige näher bezeichnet dissoziative Störung)

Details:

Status: "Maladaptive daydreaming" is not listed as a separate disorder in the DSM-5. Clinicians, therefore, use the category OSDD to recognise the disorder nevertheless.

Auxiliary term: The specific addition that is used is:

"Identity disturbance due to prolonged and intense coercive persuasion" - However, this term is very vague and often does not fit perfectly in terms of content.

In practice, the more general addition "... with maladaptive daydreaming" or simply the descriptive term "maladaptive daydreaming" is often used in the diagnostic report, followed by the OSDD code number.

Conceptualisation: In the DSM-5, the phenomenon is often seen in the spectrum of dissociative disorders, as the intense absorption and immersion in a fantasised world can be seen as a form of dissociation from the real environment. There are also discussions about categorising it as a compulsive spectrum disorder.

Summarised comparison

Important note: Both manuals emphasise that daydreaming disorder must be distinguished from daydreaming in the context of other disorders such as ADHD (inattention), autism spectrum disorder, psychoses or substance use.

The inclusion of 6B25 Maladaptive Daydreaming in the ICD-11 represents a significant step towards recognising this condition and enables more precise diagnosis and research than the "stopgap" solution in the DSM-5.

It is therefore essential to exclude disorders such as obsessions, psychotic ideas or dissociation. In contrast to delusional disorders, people with maladaptive daydreams maintain a connection to reality. Although concentration difficulties can also occur in ADHD or OCD, in maladaptive daydreams, they are mainly caused by the captivating fantasies that dominate everyday life. Research groups have proposed diagnostic criteria, such as the intensity of the fantasies, loss of control and distress, but there is still no clinical consensus. Differentiation from other mental disorders is an essential therapeutic issue. In my psychotherapy, I offer you a safe space to explore these aspects and to understand your individual symptoms better.

7 Influencing factors and open questions

Connection between mental disorders and daydreaming

Maladaptive daydreaming is sometimes misunderstood as an excuse for laziness. In fact, studies show that MD is associated with psychological stress: ADHD, anxiety disorders, depressive disorders or obsessive-compulsive disorders. Many sufferers report stress or traumatic experiences; others use MD as a creative outlet. There is controversy as to whether MD should be recognised as an independent disorder or whether it is part of a comorbidity. One thing is sure: Anyone who escapes into fantasies for hours on end and neglects everyday life needs understanding and professional support, not reproach.

It is essential to recognise that maladaptive daydreaming rarely occurs in isolation. There is often a close connection with other psychological disorders that can influence daydreaming or be intensified by it. In my psychotherapy, I offer you a space in which we can get to the bottom of these connections together and develop individual strategies for coping. You are at the centre: with your story, your goals, your change. I will help you to understand the connections between your daydreams and other mental health problems.

The psychodynamic role of stress and trauma

Stress and traumatic experiences play a significant role in the development and maintenance of maladaptive daydreaming. MDs often use intense daydreaming as a coping mechanism to escape reality and protect themselves from overwhelming emotions. Especially in situations in which people experience stress or have suffered trauma in the past, daydreaming can become a frequently used escape strategy. It offers a temporary dream world in which they can find a sense of control and safety. I will support you with empathy and clarity to recognise these patterns and find healthier ways of coping.

Psychotherapy can help to work on the underlying causes of maladaptive daydreaming and develop healthier coping strategies. The processing of post-traumatic experiences can also play an important role here. Through trauma-sensitive approaches, we can work together to reduce the adverse effects of stress and trauma on your daydreaming behaviour and help you regain more control over your life.

Mental disorders and their effects

Maladaptive daydreaming rarely occurs in isolation, but is often associated with other mental disorders. These so-called comorbidities can intensify daydreaming behaviour and significantly impair the quality of life of those affected. The most common co-morbidities include anxiety disorders, depressive disorders, ADHD, obsessive-compulsive disorders and personality disorders. The presence of these comorbidities can complicate the diagnosis and treatment of maladaptive daydreaming, as the symptoms often overlap and reinforce one another. A detailed diagnosis is critical here.

In my psychotherapy, I take these complex interactions into account and develop an individualised treatment plan that addresses both the maladaptive daydreaming and the accompanying disorders. By taking a holistic approach, we can work together to alleviate symptoms, improve quality of life and help you lead a more fulfilling life. Coping strategies can then be learned and consolidated to prevent slipping back into old patterns of behaviour. I offer you a space in which you can open up without pressure.

8 Conclusion: Clarity about daydreams for the design of appropriate treatment options

The importance of raising awareness of the symptoms of maladaptive daydreaming

It is crucial to educate the public about maladaptive daydreaming. Many people confuse it with normal daydreaming or think it is just a fad. Comprehensive education can help reduce the stigma and give sufferers the courage to seek help. Psychiatrists, psychologists and other mental health professionals must be informed about the phenomenon to make an informed diagnosis and offer appropriate treatment. I support you with empathy and clarity in recognising the connections and understanding yourself better.

Targeted information campaigns, articles and lectures can raise awareness of maladaptive daydreaming in society. This can help those affected to feel understood and less isolated. It is essential to emphasise that maladaptive daydreaming is not a sign of laziness or a lack of willpower, but rather a severe disorder that may require professional support. In my psychotherapy, I offer you a space where you can open up without pressure - you are at the centre, with your story, your goals, and your change.

Future research opportunities

Research into maladaptive daydreaming is still in its infancy, so there are numerous opportunities for future studies. It is essential to investigate the causes and risk factors for the development of maladaptive daydreaming in more detail. Genetic, neurological and psychosocial factors could play a role here. The development of standardised diagnostic criteria and measuring instruments is also of great importance to record the phenomenon more reliably. I support you with empathy and clarity in recognising these patterns and finding healthier ways of coping with them.

Furthermore, studies are needed to assess the efficacy of various therapeutic approaches. To date, there have been only a few controlled studies that have investigated the effectiveness of behavioural therapy, psychodynamic psychotherapy, or other forms of treatment for maladaptive daydreaming. Future research should also consider the long-term effects of maladaptive daydreaming on the quality of life, social interaction and occupational performance of those affected. It is essential to develop a comprehensive understanding of the disorder to inform the development of effective intervention strategies.

9 Resources for those concerned

Individuals experiencing maladaptive daydreaming must have access to suitable resources and support. These include self-help groups, online forums and counselling centres where they can talk to other sufferers and seek professional help. Psychotherapeutic programmes that are specifically tailored to the needs of MD sufferers are also critical. I support you with empathy and clarity as you overcome personal or professional challenges. I offer you a space in which you can open up without pressure.

Additionally, relatives and friends of individuals with maladaptive daydreams must be informed about the phenomenon and learn how they can effectively support their loved ones. An open and understanding environment can help to reduce the stigma and give those affected the courage to seek help. Individuals with maladaptive daydreaming and their loved ones must understand that they are not alone and that there are effective ways to manage this condition, allowing them to lead a fulfilling life. Together, we can work on improving your coping strategies.