To determine the comorbidity profile of individuals meeting criteria for a proposed new disorder, daydreaming disorder (more commonly known as maladaptive daydreaming [MD]), the Structured Clinical Interview for Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) and the Structured Clinical Interview for DSM-IV Dissociative Disorders were administered to 39 participants who met criteria for MD on a structured interview. We determined high rates of comorbidity: 74.4% met criteria for more than three additional disorders, and 41.1% met criteria for more than four. The most frequent comorbid disorder was attention deficit hyperactivity disorder (76.9%); 71.8% met criteria for an anxiety disorder, 66.7% for a depressive disorder, and 53.9% for an obsessive-compulsive or related disorder. Notably, 28.2% have attempted suicide. Individuals meeting criteria for MD have complex psychiatric problems spanning a range of DSM-5 disorders. This finding provides evidence that MD is different than normal daydreaming and that these individuals experience considerable distress and impairment.

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Background: Maladaptive Daydreaming (MD) characterizes individuals who engage in vivid, fanciful daydreaming for hours on end, neglecting real-life relationships and responsibilities, resulting in clinical distress and functional impairment. Sufferers have embraced the term MD in cyber-communities devoted to this problem because it seemed to uniquely fit their experience and since existing diagnostic labels and their therapies seemed inadequate. However, scientific research in the field has been scarce, relying on cross-sectional or case study designs. Existing knowledge on MD suggests the involvement of dissociative and obsessive-compulsive symptoms, as well as positive reinforcement comparable to processes in addiction disorders. The present study aimed to rigorously explore factors that accompany MD employing a longitudinal daily-diary design, hypothesizing that temporal increases in MD will associate concurrently with, and will temporally precede, other symptoms and emotional changes. In addition, we aimed to explore which symptoms may act as precursors to increases in MD, in order to identify possible mechanisms bringing about daydreaming in these individuals.Methods: In a sample of 77 self-diagnosed individuals with MD we assessed relevant daily symptoms for 14 days, including MD, depression, general anxiety, social anxiety, obsessive-compulsive symptoms, and dissociation, as well as positive and negative emotion.Results: Increases in MD were strongly related to concurrent increases in all other symptoms and negative emotion, and to decreased positive emotion. Obsessive-compulsive symptoms, dissociation, and negative emotion also temporally followed MD. Obsessive-compulsive symptoms were the only consistent temporal antecedent of MD.Conclusions: MD and obsessive-compulsive symptoms coincided in what seems to be a vicious cycle; understanding possible shared mechanisms between these symptoms may inform our understanding of the etiology of MD. For example, Serotonin levels may possibly be involved in the development or maintenance of this condition. The findings may also provide clues as to potentially beneficial interventions for treating MD. For example, perhaps utilizing response prevention techniques may be useful for curbing or intercepting unwanted daydreaming. Future studies on MD should address its compulsory nature.

Daydreaming, a common mental activity, can be excessive and accompanied by distress and impaired functioning in daily life. Although currently not formally identified by diagnostic manuals, daydreaming disorder (maladaptive daydreaming [MD]) is a clinically well-defined phenomenon. However, research is lacking regarding the diagnostic reliability of MD. Our aims were (a) to develop diagnostic criteria and a structured interview for MD, (b) to examine the reliability of this measure for distinguishing individuals with and without MD, and (c) to establish an optimal cutoff score for identifying clinical-level MD using an existing self-report measure. Thirty-one individuals who met screening criteria for MD and 31 matched controls completed the self-report measure and participated in 2 structured clinical interviews. Each participant was interviewed independently by 2 clinicians blind to the participant’s group membership. Cohen’s kappa values for the agreement rate between each interviewer and the screening criterion, and between the 2 interviewers, ranged from good to excellent (κ = .63–.84). A cutoff score of 50 on the self-report measure yielded nearly perfect sensitivity and specificity and good-to-excellent agreement between the self-report measure and the interview (κ = .68–.81). Our interviews were conducted over the Internet, rather than in person; results might have been influenced by self-selection; and interviewing wider samples is warranted. We found that MD can be diagnosed reliably using a structured interview developed for that purpose. The new diagnostic interview showed excellent agreement with a self-report measure for the disorder. Additionally, we identified a useful cutoff score for future self-report research.

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