In their 2017 paper, Eli Somer and colleagues looked at a group of maladaptive daydreamers to see whether they’d been diagnosed with any other mental-health conditions. Their results were striking: 77% of the group had ADHD, 72% had some form of anxiety disorder, 67% had depression, and 54% had OCD or a related disorder. These numbers raise the inevitable question of why. Why do so many maladaptive daydreamers have additional diagnoses? Does being an immersive or maladaptive daydreamer increase your risk of mental-health problems? Does having one of these conditions increase the likelihood that your daydreaming will be maladaptive? Or does the low awareness of MaDD among mental-health professionals mean that maladaptive daydreamers tend to be misdiagnosed with something else?
I suspect all of the above happen to some extent, and there is no single explanation for the high rates of additional diagnoses among maladaptive daydreamers. To try to untangle this, let’s look at each condition separately:
A recent study in the Journal of Clinical Psychology looked at whether MaDD is simply an under-reported symptom of ADHD. Given that over three-quarters of maladaptive daydreamers meet the criteria for an ADHD diagnosis, this is a reasonable question. People with ADHD and people with MaDD both have difficulty paying attention to real-world tasks. But in ADHD, the problem with attention typically results from excessive mind-wandering. Mind-wandering involves flitting from topic to topic without consciously trying to direct your thoughts; it’s quite different from our style of daydreaming, which is more purposeful and involves focussing on a single theme or plot. It’s possible that a failure by mental-health professionals to understand this distinction has led to some daydreamers being misdiagnosed with ADHD, but I suspect that in many cases, people do genuinely have both. Both ADHD and MaDD may have their origins in trauma, so it’s possible that if an immersive daydreamer experiences trauma, they could develop both ADHD and MaDD.
Anxiety disorders involve excessive fear or worry, and affect up to 30% of the general population. But why do over 70% of maladaptive daydreamers struggle with anxiety? Anxiety often arises when we feel out of control, so it makes sense that if you’re feeling anxious, you might retreat to somewhere where you have total control – your daydreams. Also, we all have a need to connect with other people, to feel seen and accepted. If you have social anxiety, you’ll find real-life social situations difficult, so you’re more likely to try to satisfy your need for connection through your daydreams. Alternatively, if you’ve been a life-long daydreamer, you might never have learned the social skills you need to navigate real-world relationships, and that might make you more likely to develop social anxiety.
I’ve written previously about the association between MaDD and depression. As with ADHD, I think it’s likely that MaDD and depression could have a common cause. If something in your life is causing you pain, or if your life isn’t meeting your emotional needs, that can cause depression, but it can also cause you to escape the pain through excessive daydreaming. On the other hand, it’s also possible that MaDD could cause depression. Many maladaptive daydreamers feel deeply ashamed of their habit, and excessive daydreaming can give us unrealistic expectations about what we need to be happy or prevent us from working towards our goals. Any of these factors can initiate or maintain depression.
Obsessive-compulsive disorder (OCD) involves recurring unwanted thoughts, ideas or sensations (obsessions) that drive someone to do something repetitively (compulsions). On the face of it, this sounds very different from MaDD. In OCD, someone has a distressing thought or sensation, and the main purpose of the compulsive behaviour is to relieve that distress. But in MaDD, the main purpose of daydreaming is to be somewhere that’s more appealing than real life. It doesn’t make your life any better; it just helps you forget about it for a while. But what OCD and MaDD have in common is that they’re both about control. In OCD, the compulsive behaviour is a way of controlling the discomfort that arises from thoughts or situations that the person doesn’t have control over. Similarly, MaDD is often about escaping a world we can’t control in favour of one we can.
In conclusion, although MaDD is frequently associated with other conditions, that doesn’t mean that MaDD necessarily causes those other conditions, or that it is caused by them. In some cases, the same underlying factor might lead to the development of both MaDD and another problem. When that’s the case, treating the two conditions separately may be confusing and ineffective. Often, it’s better to address the underlying factor that caused them both. Once that’s been done, it might be easier to tackle any remaining symptoms. With MaDD, once the problem you’re escaping from has been resolved, therapy to address the daydreaming is more likely to be successful; in some cases, the daydreaming may even subside on its own.