Maladaptive Daydreaming in Adulthood: Theoretical Conceptualizations, Comorbidities and the Role of Default Mode Network

Glossary of Key Terms

• Maladaptive Daydreaming (MD): Defined by Somer (2002) as an extensive fantasy activity that replaces human interaction and/or interferes with academic, interpersonal, or vocational functioning.

• Default Mode Network (DMN): A set of brain regions showing relatively higher activity during internally oriented cognition (e.g., self-referential thought, autobiographical memory, spontaneous mind-wandering) and lower activity during many externally focused tasks. It consists of discrete, bilateral, and symmetrical cortical areas in the medial and lateral parietal, medial prefrontal, and medial and lateral temporal cortices (Raichle, 2015).

• Dissociation: A disruption of or discontinuity in the normal, subjective integration of one or more aspects of psychological functioning, including memory, identity, consciousness, perception, and motor control (American Psychiatric Association, 2022).

• Psychiatric Classification (Nosology): The framework utilized to define and group mental disorders based on agreed criteria such as symptom patterns, course, and impairment to support diagnosis and clinical communication.

• Comorbidity: The co-occurrence of two or more disorders or clinically significant conditions in the same individual, occurring either simultaneously or over time.

• Functional Impairment: Limitations in daily functioning (social, academic, or occupational) attributable to symptoms, distress, or reduced capacity to carry out typical activities.

Introduction to Maladaptive Daydreaming (MD)

• Conceptual Distinction: While daydreaming is a ubiquitous human experience, for a subset of the population, it evolves into a debilitating clinical phenomenon. Early work by Somer ($2002$) and summaries by Somer et al. ($2024$) distinguish MD from normative mind-wandering and creative activities by its intensity, loss of control, and functional consequences.

• Pathological Nature: MD is described as chronic and dissociative, involving persistent engagement in imagined realities that have a detrimental impact on actual life (Soffer-Dudek et al., 2025). Individuals with MD may spend hours absorbed in highly structured, fanciful daydreams, often accompanied by stereotypical movements.

• Research Framework: This review traces MD from $2000$ to $2025$, evaluating whether it represents a stand-alone clinical syndrome or a maladaptive coping strategy overlapping with established categories.

Methodology of the Literature Review

• Search Strategy: A qualitative review was conducted across major databases including PubMed, Google Scholar, ResearchGate, and Academia.edu. The search window spanned the years $2000$ to $2025$.

• Keywords: Included ‘maladaptive daydreaming,’ ‘pathological fantasy,’ ‘default mode network,’ ‘DMN and mind-wandering,’ ‘dissociative absorption,’ and ‘MD comorbidity.’

• Criteria: Inclusion focused on adult populations ($18+$ years) and peer-reviewed psychological/neuroscientific research in English. Studies on normative child development or non-pathological creative writing were excluded.

• Synthesis: Approximately $20-30$ papers were identified as key sources from an initial screening of several hundred results.

Historical Emergence and Core Features

• Origins ($2002$): Somer first described MD in academic literature through a study involving $6$ patients in a trauma practice. Initially, it was framed as a coping response to distress and trauma.

• Momentum ($2011$): Bigelsen & Schupak reported detailed self-reports from $90$ participants. This work noted that minds wander an inordinate proportion of the time, bridging MD with the later discovery of dedicated brain networks for mind-wandering.

• Standardization ($2016-2017$):

  • MDS-16: A $16$-item self-report scale was introduced by Somer and colleagues to capture sensory-affective qualities and functional impact.

  • SCIMD: The Structured Clinical Interview for MD was developed in $2017$ to facilitate clinical assessment and larger-scale studies.

• Prevalence: Survey-based estimates suggest reported rates in some samples ranging from approximately $2.5\%$ to $4.39\%$ (Soffer-Dudek, 2022).

Conceptualizations and Classification Debates

• Competing Frameworks: MD is framed through several lenses: a distinct disorder, a maladaptive coping mechanism, a behavioral addiction/compulsive behavior, or a subtype of existing conditions.

• The Role of Dissociation: MD is strongly associated with dissociative absorption—the tendency to become deeply immersed in internal experiences, which may serve as an escape-oriented response to distress.

• Diagnostic Status: While not formally in the DSM or ICD, supporters like Soffer-Dudek et al. ($2025$) argue it meets criteria for a psychiatric syndrome, exhibiting clinical consistency and discrimination from related disorders.

Comorbidity and Clinical Complexity

• Complexity Study Findings (Somer et al., 2017):

  • $74.4\%$ of participants met criteria for more than $3$ additional disorders.

  • $41.1\%$ met criteria for more than $4$ additional disorders.

  • Specific rates: ADHD ($76.9\%$), Anxiety disorders ($71.8\%$), Depressive disorders ($66.7\%$), and OCD or related disorders ($53.9\%$).

  • Suicide attempts were reported by $28.2\%$ of the sample.

• Differential Diagnosis: MD may be misidentified as ADHD. In a case study by Mamah et al. ($2025$), a patient with apparent attention problems excelled in school, suggesting inattention was secondary to immersive daydreaming rather than a primary cognitive deficit.

• Sensory Triggers: Immersion in daydreaming is often enhanced by evocative music, a feature frequently reported by individuals with MD.

Maladaptive Daydreaming and the Default Mode Network (DMN)

• Neural Basis: Research links the DMN (including the medial prefrontal cortex and posterior cingulate cortex) to self-referential thought and future-oriented simulation. Functional connectivity within the DMN is related to individual differences in daydreaming frequency (Kucyi & Davis, 2014).

• MD Framework: MD may represent an exaggerated, prolonged, or dysregulated engagement of the DMN. Dysconnectivity involving the DMN has been identified in recent neuroimaging case reports (Mamah et al., 2025).

• Clinical Differentiation: DMN-related perspectives help distinguish MD from psychosis. Psychosis involves impaired reality testing, whereas individuals with MD usually recognize their internally generated reality is imaginary despite a compulsive need to engage with it.

Limitations and Future Research Directions

• Measurement Gaps: Most research relies on self-report measures, which are susceptible to recall bias and reporting differences.

• Longitudinal Needs: There is a lack of research showing how MD develops over time or how it begins earlier in life.

• Lack of Integration: Phenomenological descriptions, psychiatric comorbidity research, and neuroscientific work (DMN) are often siloed.

• Future Focus: Priority should be given to interdisciplinary designs combining clinical assessment, behavioral measures, and neuroimaging. Studies must involve more diverse clinical populations to determine if formal recognition as a psychiatric condition is warranted.

Questions & Discussion

• Question regarding MD's qualitative difference from mind-wandering: The review specifies that MD is qualitatively different due to the loss of control, emotional dependence, and interference with daily functioning (Somer et al., 2024).

• Question of MD as a secondary symptom: While MD overlaps with OCD and ADHD, researchers argue that comorbidity alone does not account for the distinctive phenomenology of MD, supporting the stand-alone syndrome argument (Soffer-Dudek et al., 2025).