Maladaptive daydreaming (MD) is a relatively newly recognized psychological phenomenon characterized by extensive fantasy activity that replaces human interaction and interferes with daily functioning. Since Eli Somer first described this condition in 2002, growing research has illuminated its relationship with various mental health conditions, particularly depression. This relationship appears multifaceted and bidirectional, with important implications for both understanding and treatment. This article explores the complex interplay between maladaptive daydreaming and depression, examining their shared features, potential causal relationships, and clinical implications.
Defining Maladaptive Daydreaming
Core Characteristics
Maladaptive daydreaming refers to extensive fantasy activity that:
- Consumes excessive amounts of time (often 4-8 hours daily)
- Replaces normal human interaction
- Interferes with academic, interpersonal, and/or vocational functioning
- Creates significant distress for the individual
Unlike normal daydreaming, which constitutes a small fraction of waking thoughts for most people, MD can consume an overwhelming portion of daily life. Research by Somer, Lehrfeld, Bigelsen, and Jopp (2016) found that individuals with MD reported spending an average of 57% of their waking hours engaged in fantasy activities, compared to approximately 16% for non-MD individuals.
Phenomenology of Maladaptive Daydreaming
MD typically involves:
Immersive fantasy worlds: Elaborate, detailed scenarios with complex narratives and recurring characters, often continuing for years
Kinesthetic elements: As described by Pietkiewicz et al. (2018), approximately 80% of individuals with MD engage in repetitive movements such as pacing, rocking, or fidgeting with objects while daydreaming, which seems to enhance immersion
Intense emotional engagement: Individuals often experience strong emotional reactions to their daydreams, including laughing, crying, or expressing anger in response to imagined scenarios
Difficulty controlling: Despite recognizing the problematic nature of their daydreaming, individuals struggle to limit or reduce this activity
Reality distinction: Unlike psychosis, individuals with MD maintain awareness that their daydreams are fictional
Triggered activity: Music, specific movements, or certain emotional states often trigger or intensify daydreaming episodes
As one participant in Bigelsen et al.’s (2016) study described: “I daydream to distract myself from the pain of everyday living, to allow some relief from emotional processing.”
Depression in the Context of Maladaptive Daydreaming
Prevalence and Comorbidity
Multiple studies have documented significant relationships between maladaptive daydreaming and depression:
Rauscenberger and Lynn (1995) found that two-thirds of their fantasy-prone sample met criteria for either past or present DSM-III-R Axis I diagnoses, with depression being particularly common
Somer et al. (2016) demonstrated that individuals scoring above the cutoff for maladaptive daydreaming on the Maladaptive Daydreaming Scale (MDS) endorsed significantly higher rates of depression symptoms than controls
Bigelsen et al. (2016) found that maladaptive daydreamers reported significantly higher levels of psychological distress, including depression, compared to non-MD individuals
Theoretical Models of the Relationship
Several theoretical frameworks help explain the connection between MD and depression:
1. The Escape Model
Maladaptive daydreaming may function as an escape mechanism from negative emotions and difficult realities. As described by Somer (2002), MD can provide:
- Disengagement from stress and pain
- Enhancement of mood through pleasurable fantasies
- Creation of idealized self-representations
- Imagined experiences of power, control, and competence
This framework suggests that depression may precede MD, with daydreaming developing as a coping strategy. One subject in Somer’s original study explained: “These fantasies, basically, disconnect me from situations that are too painful for me. It’s as if it is easier for me to live in fantasy than in reality.”
2. The Functional Impairment Model
Conversely, the excessive time spent daydreaming leads to functional deficits that trigger or exacerbate depression:
- Academic and occupational underachievement
- Social isolation and relationship difficulties
- Sleep disturbance
- Reduced self-efficacy and self-esteem
In this model, MD precedes depression, as the life consequences of excessive daydreaming create circumstances conducive to depressive symptoms. As noted by Pietkiewicz et al. (2018): “Despite stated (and fantasized) painful yearning for optimal performance in these spheres, MD was associated with very poor interpersonal involvement, and anxious avoidance of intimacy in all participants.”
3. The Negative Feedback Loop Model
Gold, Gold, Milner, and Robertson (1986) proposed a cyclical relationship wherein:
- Depression triggers increased daydreaming as an escape mechanism
- Excessive daydreaming leads to functional impairment
- Functional impairment worsens depression
- Worsened depression increases reliance on daydreaming as a coping strategy
This model suggests a self-perpetuating cycle that maintains both conditions. The researchers noted: “Psychologically healthy individuals use their daydreams in a way that enhances their good feelings about themselves whereas distressed people interpret their daydreams as another sign of weakness or inadequacy.”
4. The Shared Vulnerability Model
Both MD and depression may emerge from common underlying vulnerabilities:
Childhood adversity: Though not universal, studies by Somer (2002) and others suggest a higher prevalence of childhood difficulties among individuals with MD
Neurobiological factors: Preliminary research suggests potential shared neurobiological mechanisms, particularly involving the default mode network (DMN) of the brain, which is active during mind-wandering and has been implicated in depression
Cognitive styles: Tendencies toward rumination, absorption, and dissociation may predispose individuals to both conditions
Content and Themes in Maladaptive Daydreaming Related to Depression
Qualitative analyses of MD content reveal several themes potentially related to depression:
1. Idealized Self-Representation
Many individuals with MD create fantasies featuring idealized versions of themselves with characteristics they feel they lack in real life. As one participant in Somer’s (2002) study described: “I am usually a conservative, shy man. But when I daydream I am the man I want to be.”
These fantasies often serve compensatory functions, providing experiences of:
- Social confidence and popularity
- Physical attractiveness
- Achievement and recognition
- Power and control
The contrast between these idealized self-representations and perceived real-world inadequacies may contribute to negative self-comparison and depression.
2. Companion and Intimacy Fantasies
MD often involves creating fantasies of close relationships, particularly for socially isolated individuals. As one participant in Pietkiewicz et al.’s (2018) study explained: “I am basically a very lonely person who is uncomfortable around people. In my daydreaming I used to bring real people into my life, that is, people I would have liked to talk to but felt too awkward to strike up a conversation with.”
These fantasies may initially provide comfort but ultimately reinforce social withdrawal, creating a pattern where:
- Real relationships seem more difficult and risky by comparison
- Social skills remain undeveloped due to lack of practice
- Actual loneliness persists or worsens
- Depression is maintained or exacerbated
3. Violence and Power Themes
Research has documented themes of violence, power, and control in the MD content of many individuals. Pietkiewicz et al. (2018) found that five of six participants in their study reported violent daydreams, often involving:
- Defeating enemies or aggressors
- Being powerful or invulnerable
- Rescuing or protecting others
- Controlling interpersonal situations
These themes may reflect efforts to counteract feelings of helplessness and lack of agency that frequently accompany depression.
Neurobiological Considerations
Recent research suggests potential neurobiological links between MD and depression:
Default Mode Network Activation: Both MD and depression involve high levels of activity in the DMN, which is associated with self-referential thinking and mind-wandering. Hyperactivity in this network has been associated with rumination in depression.
Reward Processing: Preliminary evidence suggests MD may involve altered dopaminergic reward processing similar to that seen in other behavioral addictions. This may intersect with the anhedonia (reduced capacity for pleasure) commonly observed in depression.
Attentional Networks: Difficulties in controlling attention and shifting between internal and external focus may be common to both conditions, potentially involving dysfunction in frontoparietal control networks.
While research in this area remains preliminary, these shared neurobiological mechanisms may help explain the frequent co-occurrence of MD and depression.
Differential Contributions to Clinical Presentation
When MD Predominates
When MD is the primary issue with secondary depressive features, the clinical presentation often includes:
- Intense preoccupation with and emotional attachment to daydreams
- Distress specifically related to time spent daydreaming
- Secretiveness and shame about daydreaming activity
- Depression more focused on consequences of daydreaming
- Potentially better response to treatments targeting compulsive behaviors
When Depression Predominates
When depression is primary with MD as a coping mechanism, presentation may include:
- More pervasive negative affect not limited to daydreaming contexts
- Traditional depression symptoms (sleep disturbance, appetite changes, etc.)
- Daydreaming primarily as escape from negative emotions
- Less distress about daydreaming itself
- Potentially better response to traditional depression treatments
Assessment Considerations
Identifying MD in depressed individuals presents unique challenges:
Low disclosure rates: Many individuals with MD do not spontaneously report their daydreaming habits due to shame or lack of awareness that it constitutes a potential problem. As Barth (1997) noted, “daydreams have remained unexplored in psychotherapy because therapists do not ask about them.”
Screening approaches: Directly asking about fantasy activity, time spent daydreaming, and associated behaviors (e.g., pacing, music use to trigger daydreaming) can help identify MD.
Formal assessment: The Maladaptive Daydreaming Scale (MDS; Somer et al., 2016) is the most validated measure for assessing MD, with a cutoff score of 25 (out of 100) showing 95% sensitivity and 89% specificity for identifying MD.
Differential diagnosis: Distinguishing MD from psychosis, dissociative disorders, and obsessive-compulsive disorder requires careful assessment of reality testing, presence of dissociative symptoms, and nature of intrusive thoughts.
Treatment Approaches
Integrated Treatment Models
Given the bidirectional relationship between MD and depression, integrated treatment approaches are likely most effective:
Schema Therapy: Particularly useful for individuals whose MD may be rooted in early maladaptive schemas and adverse childhood experiences:
- Identifying and modifying early maladaptive schemas that may drive both depression and fantasy escape
- Working with “modes” or self-states that emerge in daydreaming content
- Reparenting techniques to address unmet emotional needs that may be satisfied through fantasy
- Imagery rescripting to transform distressing memories that may trigger daydreaming as a coping mechanism
- Developing healthy adult coping strategies to replace maladaptive daydreaming
Eye Movement Desensitization and Reprocessing (EMDR): May be beneficial for individuals whose MD developed in response to trauma:
- Processing traumatic memories that may underlie both depression and the need for fantasy escape
- Using bilateral stimulation techniques to process emotional material that emerges in daydreams
- Developing resources and adaptive coping mechanisms to replace daydreaming
- Targeting negative beliefs about self that may be compensated for through idealized fantasy scenarios
- Installing positive cognitions that support healthier engagement with reality
Cognitive-Behavioral Therapy (CBT): Addressing both the cognitive patterns underlying depression and the behavioral components of MD through:
- Scheduling limited “daydreaming time”
- Gradually reducing time spent daydreaming
- Identifying and challenging depressive thought patterns
- Behavioral activation to increase real-world engagement
Pharmacological Approaches: Limited case reports suggest potential benefit from:
- Selective serotonin reuptake inhibitors (SSRIs), particularly fluvoxamine
- Medications targeting both depressive symptoms and compulsive aspects of MD
- Stimulant medications for individuals with comorbid attention deficits
Social Rehabilitation
Addressing social isolation is critical for long-term recovery:
- Gradual exposure to social situations
- Social skills training
- Building authentic relationships to replace fantasy companions
- Involvement in structured group activities
Case Study Insights
A case reported by Schupak and Rosenthal (2009) described a woman whose excessive daydreaming was successfully reduced with fluvoxamine treatment, suggesting shared mechanisms with obsessive-compulsive spectrum disorders. This patient had no history of childhood trauma and functioned well in other areas of life, highlighting the varied presentations of MD.
Future Research Directions
Several important research areas remain to be explored:
Longitudinal studies: Tracking the development and interaction of MD and depression over time to better understand causal relationships
Neuroimaging research: Investigating neural correlates of MD and its overlap with depression-related brain activity patterns
Treatment trials: Systematically evaluating the efficacy of various therapeutic approaches for comorbid MD and depression
Biological markers: Exploring potential biomarkers (e.g., inflammatory markers, neurochemical profiles) common to both conditions
Prevention strategies: Developing early interventions for imaginative children at risk for developing MD
Conclusion
The relationship between maladaptive daydreaming and depression represents a complex interplay of psychological, social, and potentially neurobiological factors. MD may develop as a coping mechanism for depression, while also creating conditions that maintain or worsen depressive symptoms through its impact on functioning. Both conditions may also share underlying vulnerabilities.
Understanding this relationship has important implications for assessment and treatment. Clinicians should routinely inquire about daydreaming habits when evaluating depression, particularly in individuals who show significant social withdrawal or report difficulty concentrating. Integrated treatment approaches addressing both the depressive symptoms and the compulsive daydreaming behaviors are likely to be most effective.
As research in this field continues to develop, a more nuanced understanding of the connections between maladaptive daydreaming and depression will emerge, potentially leading to more effective interventions for this underrecognized clinical phenomenon.
