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Maladaptive daydreaming MD has many features of behavioral addiction, but research exploring this syndrome is limited. This case study provides a qualitative exploration of MD. A structured clinical interview and mental state examination of a patient with MD were video-recorded and transcribed verbatim. Transcripts were subjected to the interpretative phenomenological analysis.

MD was developed as a strategy to cope with distress but led to uncontrollable absorption in fantasy, social withdrawal, and neglecting aspects of everyday life. It was coupled with excessive Internet use and viewing porn. Patients should be questioned about MD during clinical assessment.

Further studies are necessary to determine whether MD constitutes a separate syndrome or is a part of other behavioral addictions. While the fifth edition of Diagnostic and Statistical Manual of Mental Disorders DSM-5 only lists the gambling disorder in the behavioral addictions chapter, authors also consider additional forms, such as Internet gaming disorder, and recommend further research into excessive use of social media or viewing pornography American Psychiatric Association [APA], RPGs, which are in significant imaginative involvement, compared with other types e.

There is a growing body of evidence identifying dysfunctional forms of imaginative involvement, defined as maladaptive daydreaming MD , which may be expressed through extensive book-reading, watching films, or gaming. MD refers to extensive, often compulsive, absorption in fantasy for several hours a day, which replaces human interaction and impairs functioning in various domains: academic, interpersonal, or vocational Somer, , Somer initially associated MD with dissociative pathology and personality disorders.

More recently, however, he described this behavior in relation to four categories: a dissociative disorder, disturbance of attention, obsessive—compulsive spectrum disorder, or behavioral addiction Somer, Bigelsen and Schupak , however, note that daydreamers are also distressed about losing control over fantasizing and unsuccessful attempts to limit it.

To avoid overpathologizing the daily life activities, Billieux, Schimmenti, Khazaal, Maurage, and Heeren suggest that preliminary qualitative studies should precede quantitative research and explore underlying psychological processes and how certain behaviors are experienced, instead of merely comparing behavior against diagnostic criteria.

This paper is in line with this approach. It presents a case study of a patient having MD with features of behavioral addiction, whose narrative was explored adhering to rigorous diagnostic and methodological procedures of the interpretative phenomenological analysis IPA. This study took place in Poland in as part of the project exploring alterations in consciousness. IPA was used for data analysis. IPA generates rich and detailed descriptions of how individuals experience phenomena under investigation and synthesizes concepts derived from phenomenology, hermeneutics, and idiography.

Peter his real name has been changed to ensure confidentiality , aged 25 years, is a single Caucasian male who has moved out of the family home and lives with a flatmate. He is about to complete an IT degree. He uses alcohol rarely and in small doses and has never used drugs or other psychoactive substances. He meets the DSM-5 criteria of the He also reported multiple symptoms indicating non-substance behavioral addiction associated with daydreaming and excessive Internet use for watching videos, pornography, playing games, and reading news.

He has become increasingly involved in these activities to achieve desired excitement, experienced irritation when unable to continue that behavior, stayed preoccupied with it, and made repeated and unsuccessful attempts to control his mental and physical actions.

He used that behavior to regulate affect but was ashamed and tried to conceal it, experiencing distress as a result. However, he reported neither posttraumatic stress disorder symptoms and somatoform or psychoform dissociation, nor symptoms indicating the existence of dissociative personality parts. The study was approved by the local university research committee. TADS-I is a comprehensive tool for a differential diagnosis of dissociative disorders, thoroughly examining alterations in consciousness including depersonalization, derealization, absorption, and daydreaming and symptoms indicating structural dissociation of the personality.

The interview was held in two sessions and lasted approximately 4 hr in total. A psychiatrist also performed a standard mental health assessment and informed the participant about his results and recommended treatment. All interviews were video recorded. First, the transcript was carefully read several times and researchers made their interpretative comments about the content and language use. They registered repetitive phrases, similes, and similarities in how the participant described various experiences at different points of the interview.

Then, they categorized the notes into emergent themes by allocating descriptive labels nodes and discussed their coding and interpretations of data with each other. They analyzed the connections between themes and grouped themes according to conceptual similarities into superordinate ones and subthemes.

The study procedures were carried out in accordance with the Declaration of Helsinki. The participant was informed about the study and provided informed consent. In primary school first grade, Peter saw himself as a sociable and communicative and focused on school achievements. He had limited awareness of his competitive tendencies. I craved the spotlight. He could not understand why, months later, his classmates began to tease him, intimidate him in front of others, or inflict pain.

They mocked me all the time, and avoided me. I sat alone at the back in class and had no one to talk to. Everyone knew I was a figure of fun. This led him to feel weak, inferior, and socially excluded. He felt especially ashamed and humiliated when teased or mocked in the presence of girls he found attractive. Perceiving himself as an outcast and feeling worthless, Peter sought ways to distract himself from negative thoughts.

He played video games or browsed the Internet for many hours and masturbated excessively. I spend about 14 hours a day surfing on my computer, watching pictures of cars, YouTube, and wanking.

Political news, for example, may trigger delusional fantasies in which I am a multimillionaire who would never let that situation happen. If nothing stops my fantasizing — like going swimming or to the library — then I crave music, which gets me even more hopped up. I walk around the flat, imagining how it would be in that world. When I have had too much, I need to watch some porn and masturbate. Peter thinks he initially tried to avoid painful reality by developing alternative scenarios of events and experiencing them as if they were real.

In this way, he could regulate his emotions and cope with loneliness. When I felt this pain as a child, I started imagining how things could be different. I created stories which never happened. To suppress that pain I would hug my pillow or quilt, thinking I was being comforted by someone else.

In his experience, spending most of the time playing video games, browsing the Internet, and masturbating compulsively also involves excessive daydreaming, which gives him excitement and pleasure. Peter seeks solitude and favorable conditions to immerse himself in his fantasy world. He realizes that daydreaming increasingly consumed more time and energy. Over the years, he recorded this activity in his diary, growing concerned, and angry with himself when he realized that he had limited control over his compulsive behavior.

Time goes by and I am not really able to control it. I sit at my PC and daydream day by day. I start in the morning and realise it is already night.

It started by the second grade but did not bother me then so much. Now I fear that I have wasted my life and opportunities. Peter blames the peers who bullied him at school for his current difficulties and coping strategies. He thinks he was overly stressed and lacked emotional support, which discouraged him from interaction with others and expressing his needs.

My main problem is that I was too traumatised to express my feelings and needs. No life, women, hobbies throughout these years … only fear and shame about saying what I wanted. This is what they did to me at school. However, listening to music or watching media triggers or supports fantasies. Thinking about something, I automatically create a scenario. For instance, I become this multimillionaire, giving an interview. People admire my wisdom, respect me and make way for me.

I move around my flat, listening to music and getting really high. I live these delusions for a few hours, daydreaming about that life: driving cars, car racing, sex. The protagonists in his fantasy world are always men with special attributes associated with admiration or awe. They use their abilities to help others, which make Peter feel strong, proud, and special, because he imagines being them.

I created this delusional personality of a multimillionaire by building digital systems that allow mankind to conquer death and cure all mental or physical problems. Sometimes I am the king of Poland, a guardian of values, ideals, social order, or a hero who can do things that other people are unable to do. I rescue them. I am the best. He also produces elaborate fantasies in which he hugs women or aggressively penetrates them, which he attributes to his lack of intimate contacts.

Peter maintains that being a virgin is another reason for his shame. In his imagination, he then inspires people who feel weak, hopeless, or possess other qualities he himself despises. In his daydreams, he ascribes vulnerability to those he would save.

He also has a sense of moral triumph for not expressing openly hostile feelings toward those who caused him pain. As a multimillionaire I visit my old school and share my story with the pupils. I tell them how I managed to conquer my own weakness and that this was the best lesson I received from life… not giving in to my hatred. Peter is ashamed of the fragile self-esteem and sensitivity to criticism or rejection that he first experienced at school.

He sees expressing emotions and reacting to being teased as weakness, so feigns indifference. He says,. I want them to see nothing but my unimpressed attitude, my poker face. Talking about his fantasy world evokes tension and extreme shame; thus, he has never spoken about daydreaming to any healthcare provider before and neither has anyone asked about absorption in earlier interviews.


An Introduction to Maladaptive Daydreaming

By Pen. Losing yourself in excessive daydreaming? Maladaptive Daydreaming is an actual condition undergoing study. Pen shares her own personal experiences and offers helpful suggestions on how to channel and manage the daydreaming habit. Do you experience a loss of time because you spend that time daydreaming? Do you drive from one place to another and cannot recall how you arrived at your destination?


Maladaptive daydreaming as a new form of behavioral addiction

Maladaptive daydreaming MD has many features of behavioral addiction, but research exploring this syndrome is limited. This case study provides a qualitative exploration of MD. A structured clinical interview and mental state examination of a patient with MD were video-recorded and transcribed verbatim. Transcripts were subjected to the interpretative phenomenological analysis.

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