Maladaptive Daydreaming May Be Better Diagnosis Than ADHD for Some

A new study suggests that maladaptive daydreaming might be a better diagnosis than ADHD for some individuals.

Researchers from Ben-Gurion University of the Negev, in collaboration with the University of Haifa, assessed 83 adults with an ADHD diagnosis. They found that around one-fifth met the proposed criteria for maladaptive daydreaming (MD), which does not yet have formal recognition as a psychiatric syndrome.

The researchers assessed the adults for inattention symptoms, MD, depression, loneliness, and self-esteem. Those meeting the proposed criteria for MD showed higher rates of depression, loneliness, and self-esteem than those who didn’t meet the criteria. 

In a press release shared by the university, senior lecturer in the Department of Psychology and co-author of the study Nirit Soffer-Dudek, PhD, said, “Our findings suggest that there is a subgroup of those diagnosed with ADHD who would benefit more from a diagnosis of MD.”

What Is Maladaptive Daydreaming?

The condition of maladaptive daydreaming was first outlined by Professor Eli Somer in 2002, who described it as “extensive fantasy activity that replaces human interaction and/or interferes with academic, interpersonal or vocational functioning”, and identified key functions, themes, and dynamics of MD.

Maladaptive daydreaming is a form of addiction characterized by an urge to daydream and absorb oneself into an imaginary world, neglecting social, academic, and occupational obligations. While it might feel rewarding in the short term, it can have a negative impact on well-being in the long run - this can prompt a vicious cycle of retreating further into maladaptive daydreaming as a way to cope.

According to therapist, coach, and neuroscientist Bobbi Banks, maladaptive daydreaming “is used as a coping mechanism and is considered to be a form of dissociation, normally in response to previous trauma or chronic loneliness. People who experience [maladaptive daydreaming] report vividly daydreaming for hours or even days, often in an attempt to escape painful experiences, memories or triggers.”

She contrasts it to occasional daydreaming and ‘spacing-out,' “something most of us have experienced and is completely normal," with maladaptive daydreaming having a larger impact on the ability to function in day-to-day life. 

“Over time, it can start to replace human interaction, lead to insomnia, and hinder a person’s professional and academic life,” Banks explains. “In some cases, it can lead to anxiety, social anxiety, depression, and further dissociation.”

Mind Wandering and Maladaptive Daydreaming

Difficulties in sustaining attention is one of the consequences of MD, and the DSM also lists this as a symptom of a number of other conditions, most notably ADHD.

Inattentiveness in people with ADHD is often considered to relate to mind wandering (MW), described in the study as “passive mental activity of associative thoughts that are stimulus-independent and unrelated to the task at hand”, but doesn’t allow for differentiation between what would be considered maladaptive daydreaming and “task unrelated thoughts”, for example. As a result, some people who think they might be maladaptive daydreamers don’t find existing diagnostic labels—like ADHD—to be helpful.

The study outlines three key differences between mind-wandering in ADHD, and maladaptive daydreaming.

The first is that with maladaptive daydreaming, the state of daydreaming is often deliberately activated rather than the mind wandering spontaneously. The second is that maladaptive daydreamers tend to be aware that they’re daydreaming, and the third is that whereas mind wandering often has a lack of guidance or direction, maladaptive daydreaming tends to involve a more detailed, complex plot.

Symptoms of Maladaptive Daydreaming

While symptoms of MD may differ from person to person, some of the main symptoms are as follows.

• Vivid, intricate daydreams
• Daydreaming for up to several hours at a time
• Difficulty sleeping
• Difficulty completing day-to-day tasks and fulfilling obligations
• Facial expressions and repetitive movements, often without noticing
• Daydreams triggered by real-life events or stimuli

Professor Somer created a 16-question test for professionals to use when assessing whether a diagnosis of MD may be appropriate for someone, while it can also be used for self-reporting if someone suspects that they have symptoms.

In the test, subjects are asked questions including whether music activates their daydreaming, whether they get distressed if they don’t have as much time to daydream as usual, and whether or not it’s difficult for them to keep their daydreaming under control. 

Another tool developed by Professor Somer is the Structured Clinical Interview for Maladaptive Daydreaming, and this is designed to help doctors assess whether someone is experiencing maladaptive daydreaming. 

It’s been suggested that maladaptive daydreaming can develop as a response to trauma, with people retreating into their own world as a coping mechanism, while one study found that it could relate to gaming addiction in some cases. However, there’s still relatively little research on the condition. 

While more research on maladaptive daydreaming—particularly in terms of its relationship with ADHD—would be beneficial, the body of research on MD is continuing to increase. Something the authors of the study go on to say is that “the inattention mechanism in MD may be essentially different from that experienced by people with ‘pure’ or typical ADHD”, and that if MD was included in the DSM, a diagnosis of ADHD may not have been necessary in every instance, though they also make it clear that further studies are needed to provide more evidence.