Study suggests maladaptive daydreaming should be classified as a unique mental disorder, distinct from ADHD

While maladaptive daydreaming (MD) is not currently recognized as a psychiatric disorder, a new study suggests that the condition deserves more clinical attention. The researchers found that only about 20% of an ADHD sample met criteria for MD, suggesting that maladaptive daydreaming involves a unique form of inattention that makes it distinct from ADHD. The findings were published in the Journal of Clinical Psychology.

Maladaptive daydreaming is the act of immersing oneself in detailed, imaginative fantasies that consume one’s attention at the expense of everyday functioning. This type of daydreaming shares some overlap with symptoms of attention deficit hyperactivity disorder (ADHD), a condition involving difficulty maintaining attention.

However, the authors of the current study proposed a distinction between MD and ADHD. The researchers suggest that the daydreaming associated with ADHD is better described as mind wandering — the spontaneous shifting of attention to task-unrelated thoughts. Maladaptive daydreaming, on the other hand, is defined by daydreaming that is intentional, complex, and vivid. These distinctions are important because the two forms of daydreaming may have different underlying mechanisms and call for different treatment.

“In a previous study, we recruited about 40 people with MD and did a full clinical interview with each of them to identify if they meet criteria for any DSM-5 disorders, and if so, which. The most striking finding in that study was that they had overwhelming levels of clinical-level psychopathology: all participants met criteria for DSM-5 disorders, with most of them meeting criteria for more than one, often even three or four,” said study author Nirit Soffer-Dudek, a senior lecturer and head of The Consciousness and Psychopathology Laboratory at Ben-Gurion University of the Negev.

“In addition, we found that 77% of the sample met criteria for ADHD, most of them to the inattention only type (without hyperactivity). Spontaneously in the interview they explained that their difficulty concentrating on tasks was a result of their addiction to fantastical daydreaming. Thus, we began to view meeting criteria for ADHD as a secondary result of MD.”

“Moreover, we came to view this supposed ‘comorbidity’ not as a true comorbidity but rather as inaccurate labeling. Specifically, it seemed that if MD were a formal diagnostic syndrome, the label of ADHD would be superfluous for these people (because the symptoms seemed to be better explained by MD in their cases). We assumed that having MD leads to meeting criteria for ADHD, but not necessarily vice versa.”

For their new study, Soffer-Dudek and her colleagues aimed to investigate whether MD is a distinct mental phenomenon from ADHD by examining rates of MD among people with ADHD. While studies have found high rates of ADHD among people with MD, if the two constructs are independent, people with ADHD will not have similarly high rates of MD.

A group of 98 people with ADHD completed online questionnaires that assessed ADHD symptoms, several measures of psychological distress, and maladaptive daydreaming. Of these participants, 59 had elevated MD scores and were contacted to undergo a clinical interview to assess MD. After 44 of these participants responded and were interviewed, 17 met criteria for MD. Accounting for selective dropout, this means that roughly 20-23% of the full sample of ADHD participants also met criteria for MD.

Notably, this rate of MD in an ADHD sample is far smaller than the previously reported incidence of ADHD in an MD sample, which was around 77%. This suggests that the two constructs are distinct, with MD involving unique characteristics that are not explained by ADHD.

The study authors suggest that maladaptive daydreaming is better described as a dissociative disorder or behavioral addiction, rather than an issue of attention. They suggest that MD is an “independent mental phenomenon, which often creates a deficit in attention as a side effect, causing MDers in some cases to also meet criteria for ADHD, but not necessarily vice versa.”

Participants who met criteria for both ADHD and MD had higher depression and loneliness, and worse self-esteem. These heightened symptoms of distress were not explained by ADHD symptom severity, suggesting a unique contribution of MD.

The researchers note the importance of distinguishing between the two conditions. “There are many reasons why people may find it hard to focus,” Soffer-Dudek told PsyPost. “The ADHD diagnosis is a bit broad in that it looks mainly at the end result, and not on the inner dynamic of thought leading to that result. We suggest that different thought dynamics should be treated differently.”

“If your ADHD stems from general mind-wandering with ever-changing distractions (which is characteristic of typical ADHD), you may need different treatment than if you find yourself compulsively drawn to engage in elaborate, narrative, vivid and highly emotional fantasies (characteristic of MD). If it is the latter, we suggest seeking psychological help, and introducing to the clinician the concept of MD, which has been researched extensively in the past years, but is still quite unknown.”

Along similar lines, many people with MD have called for better recognition of the construct of maladaptive daydreaming, expressing that the existing psychological definitions do not adequately capture the depth of their experiences. While further study is needed to confirm whether MD should be considered a psychiatric disorder, it could be that some people with an ADHD diagnosis would be better served by a diagnosis of MD.

“If someone has fanciful immersive daydreams but does not experience them as a problem, then that would not count as MD, and is not a problem,” Soffer-Dudek noted. “Our aim is not to pathologize normal daydreaming. MD describes a situation where the person feels that their addiction to daydreaming is impairing their lives (e.g., loneliness, difficulties concentrating due to daydreaming, or difficulty creating or maintaining relationships because it is easier and more rewarding in the short run to daydream them).”

“Many MD communities exist online (e.g., Facebook, Reddit) offering peer support,” Soffer-Dudek added. “Also, we have a website dedicated to the research of MD, where people who see themselves as suffering from MD can register to get news updates on the topic and be offered to participate in research.”

The researchers are currently seeking participants for a new study. “We are looking for people who have been diagnosed as suffering from ADHD (they don’t have to be maladaptive daydreamers),” Soffer-Dudek said. Information about the new study can be found here: https://bgupsych.eu.qualtrics.com/jfe/form/SV_2lQVt6a2JKLFzD0

The study, “Could immersive daydreaming underlie a deficit in attention? The prevalence and characteristics of maladaptive daydreaming in individuals with attention‐deficit/hyperactivity disorder”, was authored by Nitzan Theodor‐Katz, Eli Somer, Rinatya M. Hesseg, and Nirit Soffer‐Dudek.