Consciousness and Cognition 42 (2016) 254–266

Contents lists available at ScienceDirect

Consciousness and Cognition

journal homepage: www.elsevier.com/locate/concog

Maladaptive daydreaming: Evidence for an under-researched

mental health disorder
Jayne Bigelsen a,⇑, Jonathan M. Lehrfeld b, Daniela S. Jopp c, Eli Somer d
a
New York, USA
b
Fordham University, New York, NY, USA
c
University of Lausanne, and National Centre of Competence in Research LIVES ‘‘Overcoming Vulnerability: Live Course Perspectives”, Switzerland
d
School of Social Work, University of Haifa, Israel

a r t i c l e i n f o a b s t r a c t

Article history: This study explores the recently described phenomenon of Maladaptive Daydreaming
Received 26 June 2015 (MD) and attempts to enhance the understanding of its features. It documents the
Revised 19 March 2016 experiences of 340 self-identified maladaptive daydreamers who spend excessive amounts
Accepted 24 March 2016
of time engaged in mental fantasy worlds, in comparison to 107 controls. Our sample
included a total of 447 individuals, aged 13–78, from 45 countries who responded to online
announcements. Participants answered quantitative and qualitative questions about their
Keywords:
daydreaming habits and completed seven questionnaires assessing mental health symp-
Maladaptive daydreaming
Compulsive fantasy
toms. Findings demonstrated that MD differs significantly from normative daydreaming
Absorption in terms of quantity, content, experience, controllability, distress, and interference with life
Visual cognition functioning. Results also demonstrated that Maladaptive Daydreamers endorsed signifi-
Stereotypic movement cantly higher rates of attention deficit, obsessive compulsive and dissociation symptoms
Kinesthetic activity than controls. In sum, findings suggested that MD represents an under-acknowledged
Fantasy prone person clinical phenomenon that causes distress, hinders life functioning and requires more
scientific and clinical attention.
Ó 2016 Elsevier Inc. All rights reserved.

1. Introduction

‘‘I have 35 distinct characters in my daydreams. They have been with me since childhood. I cannot remember a time when
my mind was alone, with just myself. They have always been there. All of my daydreams revolve around these 35
characters. They live in a fictional town in a non-fictional city and state.”
[(Participant 164)]

‘‘My daydreams are based on a TV show I saw when I was 10. Imagine a television show that kept getting renewed year
after year for 30 years. Think of all the experiences you would have watched the characters go through. That is what my
mind has been doing for over 30 years. I do not feel like there is any way to possibly describe how in-depth it all is. There
have been times I have been caught up in the daydream for entire days. Many nights, I force myself to stay awake and get
no sleep so that I can have my ‘daydreaming’ time.”
[(Participant 221)]

⇑ Corresponding author.
E-mail address: [email protected] (J. Bigelsen).

http://dx.doi.org/10.1016/j.concog.2016.03.017
1053-8100/Ó 2016 Elsevier Inc. All rights reserved.
 J. Bigelsen et al. / Consciousness and Cognition 42 (2016) 254–266 255

‘‘It stops me from interacting in real world and real people. My relationship with family goes from fine to bad as I did not
speak to them often because I would just locked myself in my room. . . .My school performance worsens. I can’t
concentrate on studies. I skipped school a lot just to be in my world.”
[(Participant 519)]

1.1. The proliferation of discussion of maladaptive daydreaming on the internet

There are hundreds of pages on the Internet devoted to the topic of ‘‘maladaptive daydreaming” (herein MD). These
websites have been established by individuals from around the world who have concerns about spending enormous
amounts of time engaged in highly structured daydreams, often with well-developed characters and plots. Most of the day-
dreamers on these site state that they felt like they were the only ones who engaged in this behavior until they discovered
these websites. These individuals have diagnosed themselves as ‘‘maladaptive daydreamers” (herein MDers), and frequently
describe engaging in repetitive movement in conjunction with their daydreams, such as pacing or rocking. Although they
state that they never confuse fantasy from reality, many of the daydreamers seek advice on how to stop, claiming they feel
as if they have an addiction.
As a consequence, many of the MDers on the Internet forums indicate that they have sought out help from mental health
professionals, but most had never heard of the symptoms and seemed to minimize them. Others have been given a differing
array of diagnoses including Attention Deficit/Hyperactivity (ADHD) and Obsessive–Compulsive Disorder (OCD). This is not
surprising, as MD is not a classified mental disorder or term familiar to mental health professionals. Although ‘‘ordinary”
daydreaming, when accompanied by other symptoms, including lack of focus and organization, has been implicated in dis-
orders such as ADHD (National Institute of Mental Health, 2012), at this point in time no disorder listed in the Diagnostic and
Statistical Manual of Mental Disorders (DSM-5; American Psychiatric Association, 2013) or in any other classification system
describes highly structured and absorbing daydream worlds as a primary symptom.

1.2. Maladaptive daydreaming: Definition attempts

Somer (2002) first introduced the concept of MD, which he defined as ‘‘extensive fantasy activity that replaces human inter-
action and/or interferes with academic, interpersonal, or vocational functioning” (p. 199). Somer described six patients with
severe difficulty in social and vocational functioning, who had seemed to escape reality into a life of fantasy after experiencing
abusive childhoods. Their daydreams were often accompanied by movement such as pacing, which Somer termed kinesthetic
activity. Somer theorized that MD may have developed as a coping strategy in response to aversive early life experiences.
In 2009, Schupak and Rosenthal presented a case study of a woman troubled by excessive daydreaming. Similar to
Somer’s (2002) patients, the subject reported that her childhood daydreaming had been accompanied by kinesthetic activity,
involving pacing while twirling a string. The daydreaming was eventually reduced and controlled with the treatment of pre-
scription medication, Fluvoxamine, commonly used to treat obsessive–compulsive disorders. Unlike Somer’s (2002) MDers,
this woman did not report an abusive childhood and seemed to function successfully in the real world, suggesting that there
may be more than one pathway to MD and varying degrees of psychopathology. The same patient eventually underwent a
functional magnetic resonance imaging (fMRI) procedure conducted by researcher Malia Mason. In a 2015 interview describ-
ing the fMRI study, Mason stated ‘‘The test showed great activity in the ventral striatum, the part of the brain that lights up
when an alcoholic is shown images of a martini. Frankly it was super strong” (Bigelsen & Kelley, 2015).
After analyzing surveys by 90 MDers, Bigelsen and Schupak (2011) presented a population of individuals who engaged on
average over half (56%) of their waking hours in immersive daydreams, with 80% using kinesthetic activity. Findings
indicated that these daydream worlds provided participants with an unending source of comfort and emotional fulfillment,
but at the same time caused distress through three factors: (1) difficulty controlling the need or desire to fantasize, (2)
concern that the amount of time spent fantasizing interfered with actual relationships and life goals, and (3) intense embar-
rassment regarding the fantasy resulting in exhaustive efforts to keep this behavior hidden. Over 70% reported that they did
not experience childhood trauma, thereby providing further evidence that trauma, although potentially a contributing risk
factor, is not necessarily causal to MD.

1.3. Quantities of daydreaming

To date daydreaming has mostly been seen as a universal experience comprising much of normal mental activity (Klinger,
2009; Singer, 1966). Killingsworth and Gilbert (2010) found that almost half of all human thoughts qualify as daydreaming
activity. The reported high levels of daydreaming among the general population may leave clinicians reluctant to consider
excessive daydreaming a mental health issue.
A potential source of confusion can arise when researchers use differing definitions to compare daydream quantity. Many
definitions of daydream and mind wandering encompass all off-task thought (Singer, 1975; Smallwood, Obonsawin, & Heim,
2003), which is far broader than the activity of interest to the MDers. For this reason Bigelsen and Schupak (2011) chose the
term ‘fantasy’ to describe the behavior of their study population. They defined fantasy by using Klinger’s (1971) definition of
‘‘a fictional tale created by a subject for his own pleasure and for no other purpose constitutes an instance of fantasy” (p. 6).
256 J. Bigelsen et al. / Consciousness and Cognition 42 (2016) 254–266

Fantasy, defined as above, is considered to occur much less frequently than daydreaming. Klinger (1990) wrote, ‘‘Most of
us have some fanciful daydreams, but for the majority of us the extremely fanciful ones occupy only a tiny fraction of our
thoughts” (p. 83). Yet it is precisely the fanciful daydreaming that the MDers describe as engaging in excessively
(Bigelsen & Schupak, 2011; Schupak & Rosenthal, 2009; Somer, 2002).
For the above reasons, fantasy is the more technically accurate term for the mental activity under examination in this
article. However, due to the more common usage of the term ‘maladaptive daydreaming’ and the thousands of individuals
who identify as such, and because daydreaming does include the subcategory of fantasy, we will continue to use the term
MD to describe the symptoms of concern.

1.4. The fantasy prone person/absorption

A previous line of literature that seems directly relevant to MD is the research on the fantasy prone personality. In 1981
Wilson and Barber (1981) described a category of persons who had highly vivid daydreams in which they engaged for 50% of
their waking hours. Although this description of fantasy is similar to that offered by Bigelsen and Schupak (2011), Wilson and
Barber (1981, 1982) also found that belief in parapsychological phenomena and confusion between fantasy and reality were
central features of the fantasy prone personality. Yet, Bigelsen and Schupak found that 98% of their MDers reported no
confusion between fantasy and reality, and few reported belief in parapsychological phenomena. It, therefore, seems that
those with MD have some elements of the fantasy prone personality, but not others.

1.4.1. Absorption
Glicksohn and Barrett (2003) found that the trait of absorption which consists of disconnecting from one’s current
circumstances and becoming immersed in another focus (Ross, Joshi, & Currie, 1990, 1991) can serve as the predisposing
factor for the hallucinatory experience. As hallucinations are believed to be on the continuum of normal conscious experi-
ences, which include vivid daydreaming (Slade & Bentall, 1988), MDers may show higher levels of absorption compared to
non-MDers.

1.5. Stereotypic movement disorder

In recent years, researchers may have unknowingly been investigating the early stages of MD, through their work
assessing repetitive movement in children. Stereotypic movement disorder consists of repetitive, coordinated, and rhythmic
behaviors, including hand flapping and pacing (Mahone, Bridges, Prahme, & Singer, 2004). Specifically, Freeman, Soltanifar,
and Baer (2010) found active daydreaming in 35 children who had been studied primarily for features of stereotypic
movement disorder.
Robinson, Woods, Cardona, Baglioni, and Hedderly (2014) studied ten children who described voluntary engagement in
acts of imagery with stereotyped movements. The movements were reported to occur as a secondary response to the imag-
ining activity. Interestingly, stereotyped movements typically occurred when the child was bored or relaxed, which the
authors hypothesized is likely to reflect a propensity for a need to increase cognitive stimulation at these times. Accordingly,
the authors suggested that engagement in episodes of intense imagery may serve the purpose of increasing cognitive stim-
ulation, while the associated stereotyped movements enhance concentration and may provide a sensory gain. Both studies
add further evidence of the connection between repetitive movement and fantasy activity, and they furthermore add to the
assumption that stereotypic movement disorder in childhood could represent the childhood precursor to MD. Further
investigation is needed to determine if some of those children will eventually develop MD.

1.6. The present study: Goals and hypotheses

Our primary goal was to paint a comprehensive picture of the experiences and symptomology of those with self-reported
MD using quantitative and qualitative data from the largest sample of MDers to date compared to a group of non-MDers. We
hypothesized that a population of MDers exists that shares unique daydreaming patterns that are different from non-MDers.
Specifically we expected differences in terms of daydreaming content and that MDers would experience higher levels of
quantity of daydreaming, accompanying behavioral and mental characteristics (i.e. kinesthetic activity and absorption),
and distress caused by the daydreaming.
Another goal of this paper was to locate MD in the context of potentially related clinical constructs. We hypothesized that
MDers would score significantly higher on pathologies such as OCD and ADHD, as many MDers have reported receiving those
diagnoses after seeking help for MD. More specifically, we expected that MDers would score higher on subscales related to
obsessive symptoms and inattention, but that there would not be differences on compulsion and impulsivity, because those
features have not been described in the anecdotal reports of MD. We also hypothesized that MDers would score higher on
items assessing fantasy proneness, absorption and dissociation, but did not expect large differences on items measuring psy-
chosis. Finally, we examined whether MDers differed significantly from non-MDers on trauma history as a possible etiology
for MD. Although Somer (2002) proposed that childhood trauma could be a trigger, we hypothesize in line with Bigelsen and
Schupak (2011), which found that trauma was not a necessary element of MD, and therefore that MDers and non-MDers
would not differ in reports of traumatic experiences.
 J. Bigelsen et al. / Consciousness and Cognition 42 (2016) 254–266 257

2. Method

2.1. Participants and procedures

The sample included 447 participants (347 female, 96 male, 2 transgender, 2 omitted). Age range was 13–78 (M = 30.08,
SD = 13.94). Nationalities represented 45 countries (Table 1). Most frequently represented were the United States (46%), the
United Kingdom (14%), and Australia (12%).
Participants with MD were recruited via flyers in online chat rooms for MD, psychology, and mental health. Control par-
ticipants were recruited using chain-referral (snowball) sampling, starting with researchers and MDers who approached
individuals without MD in their professional and social networks. All study participants were asked if they considered
themselves to be maladaptive or compulsive daydreamers, defined in the recruitment notice as ‘‘extensive, compulsive day-
dreaming that can cause distress or impair functioning.” Those who marked Yes (76%) formed the group of self-identified
MDers and those who marked No (24%) formed the non-MDer comparison group.
Across the two groups, proportions of males and females were similar, but we found other demographic differences
(possibly attributable, in part, to the different recruitment procedures): Compared to non-MDers, MDers were more likely
to be students, v2 (1, N = 442) = 9.58, p < .01, / = .15, had fewer years of education, t (422) = 7.90, p < .001, d = .89, and were
younger, U = 8316.00, p < .001, r = .40.
The study, along with the inclusion of minors, was approved by the Institutional Review Board (IRB) of the University of
Haifa. Participants completed the study online after reading IRB information and agreeing to study procedures.

2.2. Measures

2.2.1. Demographics
Participants provided general demographic information.

2.2.2. Qualitative daydreaming information

Participants were asked to describe recent or typical daydreams in their own words.

Table 1
Basic sample characteristics: total and split by continent.

N (%) Age M (SD) Female N (%) Years of Ever married N (%)

education M (SD)
North Americaa MDer 172 (78) 28.20 (12.50) 133 (78) 14.62 (3.55) 33 (19)
Non-MDer 49 (22) 42.20 (17.71) 39 (81) 17.06 (3.47) 29 (59)
Total 221 (100) 31.32 (14.97) 172 (79) 15.20 (3.69) 62 (28)
Europeb MDer 97 (90) 25.31 (9.50) 77 (79) 14.42 (2.82) 15 (16)
Non-MDer 11 (10) 38.45 (11.50) 8 (73) 18.00 (1.83) 5 (46)
Total 108 (100) 26.65 (10.45) 85 (79) 14.85 (2.98) 20 (19)
Oceaniac MDer 27 (47) 23.30 (7.14) 23 (85) 14.52 (2.97) 4 (15)
Non-MDer 30 (53) 38.87 (16.15) 25 (83) 17.10 (2.76) 15 (50)
Total 57 (100) 31.49 (14.84) 48 (84) 15.90 (3.14) 19 (33)
Asiad MDer 27 (87) 22.70 (8.10) 17 (63) 14.04 (3.22) 5 (19)
Non-MDer 4 (13) 43.25 (12.92) 4 (100) 18.00 (0.82) 2 (50)
Total 31 (100) 25.35 (11.07) 21 (68) 14.61 (3.30) 7 (23)
Africae MDer 8 (42) 33.13 (15.42) 5 (63) 16.75 (3.01) 3 (38)
Non-MDer 11 (58) 45.91 (11.84) 9 (82) 18.82 (2.48) 8 (73)
Total 19 (100) 40.53 (14.58) 14 (74) 17.95 (2.84) 11 (58)
South Americaf MDer 5 (100) 23.20 (7.60) 2 (40) 15.40 (3.05) 1 (20)
Non-MDer 0 (0) n/a n/a n/a n/a
Total 5 (100) 23.20 (7.60) 2 (40) 15.40 (3.05) 1 (20)
Total Sample MDer 341 (76) 26.51 (11.13) 261 (77) 14.57 (3.27) 61 (18)
Non-MDer 106 (24) 41.27 (15.86) 86 (82) 17.42 (3.01) 59 (56)
Total 447 (100) 30.08 (13.94) 347 (78) 15.30 (3.45) 120 (27)
Statistical test for differences F(5, 434) = 5.07, p < .001, v2(10) = 9.93, p = .45, F(5, 415) = 3.38, p < .01, F(5, 434) = 3.02, p < .05,
between continents g2 = .06 / = .15 g2 = .04 g2 = .03
Note. N = count; M = mean; SD = standard deviation; MDer = self-identified maladaptive daydreamer.
a
USA, Canada, and Mexico.
b
e.g., UK, The Netherlands, Germany, etc.
c
Australia and New Zealand.
d
e.g., India, Singapore, etc.
e
South Africa and Morocco.
f
Brazil, Argentina, and Colombia.
258 J. Bigelsen et al. / Consciousness and Cognition 42 (2016) 254–266

Table 2
Qualitative analysis identifying daydreaming content: main categories (based on coded subsample, n = 141; and split by MD status; MDer: n = 85; non-MDer:
n = 56).

Category Examples MD Status Difference

Test
Total sub sample MDer Non-MDer v2
n (%) n (%) n (%)
Romantic/sexual relationship – Relationship with professor, meeting his family, 37 (26.2) 29 (34.1) 8 (14.3) 6.86**
going on vacations and wedding.
– Sexual fantasies of a particular female that I
was once attracted to.
Celebrity/hero (being one, or in – I am rich and famous, living in L.A and engaged 33 (23.4) 31 (36.5) 2 (3.6) 20.38***
a relationship with one) to a super model name Sydney.
– Discovering I actually belonged to another fam-
ily and was related to a celebrity.
– There is some form of disaster and I rescue
many people.
Idealized version of self (main – I am really attractive, rich, intelligent, and have 31 (22.0) 29 (34.1) 2 (3.6) 18.37***
character is the daydreamer a strong personality. The other characters are
but with characteristics they always attractive or rich people that love me.
envy) – I am myself, but a much better version of me.
– My daydream self is an idealized version of
myself. She’s queen of a country, a singer,
actress, wife, mother, and overall genius.
Real life scenarios - Having conversations with a co-worker about 28 (19.9) 6 (7.1) 22 (39.3) 22.03***
an event at work.
- Planning my wife’s birthday party, envisioning
how it will go.
Wish fulfillment – My parents’ marriage is awful, so I daydream 24 (17.0) 5 (5.9) 19 (33.9) 18.80***
about life without one of them in the house;
happiness, control and a stable home with no
violence.
– Getting engaged or married. Sometimes to a
particular boyfriend.
– Winning the lotto and being able to clear all my
debts and those of people I care about.
Fictional characters taken from – Yearlong daydream based off of a video game 16 (11.3) 14 (16.5) 2 (3.6) 5.58*
another source (i.e. TV called Dragon Age Origins. I am Lenobia, and Alis-
show/book/movie/video tair, my love, and I cannot be together because he
game) has been named king for the good of Ferelden.
– I am a superhero (Black Widow) from the movie
The Avengers. The character looks like me with
a different plot line than the comic books. I’m
more bad ass, sexy, but also having a dark side.
Imaginary family/friend – I have an imaginary brother and 5 very close 16 (11.3) 15 (17.6) 1 (1.8) 8.44**
(daydreamer’s self is in these imaginary friends. I add it to real life, imagining
interacting with imaginary they are in social situations with me.
people) – I have current imaginary boyfriend since 2009.
We fight a lot and sometimes he’s a bully.
Popularity and receiving extra – Making friends and everyone liking me. 15 (10.6) 12 (14.1) 3 (5.4) 2.73+
attention (sometimes due to – Being in the hospital, receiving many cards and
illness/vulnerability) presents.
Imaginary world (daydreamer’s – A fictional family. All are given names, ages and 14 (9.9) 13 (15.3) 1 (1.8) 6.89**
self is not in these and occupations. One family focuses on five genera-
characters are original to the tions of females each born 25 years apart.
daydreamer) – It is based around a lady and her position
within her Mafia family. There is a full plot line,
and includes grandparents, dad and brothers.
Death, violence – Someone broke into my apartment and I was 13 (9.2) 10 (11.8) 3 (5.4) 1.66
trying to figure out how to fight back.
– Accidentally killing my sisters in a car wreck
and wailing at the funeral. I choose not to feel
the pain of their deaths, but I can feel the pity
I get from the people.
– A character named ’Seven’ who is trapped in an
18th- 19th century insane asylum, he eventu-
ally rebels and kills all the doctors and nurses
and finally sets the building on fire.
Negative feelings (revenge, – It’s of resentment and hate as there is a betrayal 12 (8.5) 8 (9.4) 4 (7.1) .22
vulnerability) of trust.
– Revenge fantasies against financial advisor who
financially devastated me.
 J. Bigelsen et al. / Consciousness and Cognition 42 (2016) 254–266 259

Table 2 (continued)

Category Examples MD Status Difference

Test
Total sub sample MDer Non-MDer v2
n (%) n (%) n (%)
Life course changes (fixing past – I am going back into the past with the knowl- 11 (7.8) 6 (7.1) 5 (8.9) .16
or imaging the future) edge I have now and reworking the decisions
I’ve already made.
– The future. How my children will look like and
what they will be doing.
Sci-Fi/Futuristic or not in – I am transported into the past through a portal. 10 (7.1) 9 (10.6) 1 (1.8) 3.97*
present time period From stone age through old west time periods.
– 9 alien worlds with 30–40 reoccurring charac-
ters and plot lines.
– Time-travel romance. Heroine finds ship-
wrecked male from 19th century on the beach.
Does not daydream – I don’t get daydreams. 11 (7.8) 0 (0) 11 (19.6) 18.11***
– No recent daydreams at all.

Note. Fisher’s Exact tests were conducted for the categories Negative feelings, Life Course Change, SCI-FI, and Does not daydream, as frequency in specific
cells was too small. +p < .10.
*
p < .05.
**
p < .01.
***
p < .001.

2.2.3. Daydreaming-specific questions

Thirty-eight questions addressing aspects of the daydreaming experience were developed after reviewing the original
data from Bigelsen and Schupak (2011) and Somer (2002). We administered these preliminary items to 10 MDers and soli-
cited their feedback, changing the wording of some items based on that feedback. These questions addressed quantity of
daydreaming; its content, type, and experience; the urge to daydream/ability to control daydreaming; experienced distress
due to daydreaming; interferences of the daydreaming with life functioning; and perceived benefits of daydreaming (Table 3;
items available from the authors). Example items are ‘‘How often do you return to recurring daydreams that involve similar
people or storylines?”, ‘‘When the real world interrupts one of your daydreams, on average how annoyed do you feel?”,
‘‘How often does daydreaming interfere with your relationships with friends, family, co-workers and others?” Participants
answered each item on a scale ranging from 0% to 100% in 10% intervals (0% = never/none of the time, 100% = all of the
time/extreme amounts).

2.2.4. Obsessive–compulsive symptoms

The Obsessive–Compulsive Inventory-Revised (OCI-R; Foa et al., 2002) is an 18-item self-report measure assessing symp-
toms of obsessive–compulsive disorder. It includes six subscales: washing, checking, ordering, obsessing, hoarding, and neu-
tralizing. A sample item is: ‘‘I get upset if objects are not arranged properly”. Answering options range from 0 = Not at all to
4 = Extremely.

2.2.5. ADHD symptoms

The World Health Organization’s ADHD Self-Report Scale (ASRS; Kessler et al., 2005) is a six-question standardized mea-
sure based on the DSM (4th ed., text rev.; DSM-IV-TR; APA, 2000) criteria. An example item is: ‘‘How often do you have trou-
ble wrapping up the final details of a project, once the challenging parts have been done?” Answering options range from
0 = Never to 4 = Very often.

2.2.6. Psychotic symptoms

The Psychosis Screener (PS; Degenhardt, Hall, Korten, & Jablensky, 2005) evaluates the presence of psychotic symptoms
and comprises elements of the Composite International Diagnostic Interview (CIDI; Robins et al., 1988). The measure
includes seven items, six of which cover features of psychotic disorders including delusions of control, thought interference,
passivity, delusions of reference or persecution, and grandiose delusions. An additional item records a prior diagnosis of
schizophrenia. Affirmative responses are summed, and a score of 1 or more indicates possible psychosis.

2.2.7. Sense of presence and immersion

To assess sense of presence while daydreaming and the degree of felt immersion we derived seven questions from tools
designed to measure presence in virtual reality worlds (Slater, Steed, McCarthy, & Maringelli, 1998; Witmer & Singer, 1998).
For sense of presence, participants were asked to think back to the last two weeks, choose their longest daydream, and
answer seven questions regarding their sense of ‘‘being there” in the daydream and involvement of their senses (1 = not
at all, 7 = totally involved). The three immersion questions were selected from the Immersive Tendency Questionnaire
260 J. Bigelsen et al. / Consciousness and Cognition 42 (2016) 254–266

Table 3
Differences between MDers (n = 341) and non-MDers (n = 106) for all specific quantitative maladaptive daydreaming questions.

Item Short text MDers Non-MDers Independent-samples t-test

Mean SD Mean SD t df p d 95% CI
Quant1 % of time DDing on typical day 56.85 25.05 15.70 19.87 12.50 445 <.0013 1.83 [34.69, 47.60]
Quant2 % of time DDing on ‘‘high daydreaming” day 68.56 23.34 20.07 21.74 13.69 445 <.0013 2.15 [41.55, 55.43]
Quant3 % of time DDing in moving vehicle 71.22 28.77 27.79 29.24 9.72 445 <.0013 1.50 [34.67, 52.19]
Quant4 % of time DDing when alone 73.19 23.17 23.15 27.37 12.16 445 <.0013 1.97 [41.97, 58.11]
Quant5 % of time DDing when in public 34.95 26.07 9.82 16.50 8.30 445 <.0013 1.15 [19.20, 31.07]
Qual1 Freq. that DD include fictional characters or plots 73.37 35.37 19.19 28.24 12.80 445 <.0013 1.69 [45.89, 62.49]
Qual2 Freq. that DD include people not personally known 67.16 38.49 14.18 24.30 12.77 445 <.0013 1.65 [44.85, 61.11]
Qual3 Freq. return to DD involving similar people/plots 85.51 23.67 35.26 33.31 11.17 445 <.0013 1.74 [41.43, 59.07]
Pos Freq. content is positive/pleasurable 72.18 24.84 50.98 36.57 4.41 445 <.0013 0.68 [11.78, 30.61]
Neg Freq. content is negative/disturbing 35.93 27.78 20.77 24.62 3.83 445 <.0013 0.58 [7.40, 22.91]
Qual4 Freq. current DD accompanied by physical activity 54.21 39.79 9.58 22.53 10.69 445 <.0013 1.38 [36.45, 52.81]
Qual5 Freq. childhood DD accompanied by physical activity 50.75 40.14 17.33 29.91 6.96 445 <.0013 0.94 [24.02, 42.84]
Qual6 Freq. current DD accompanied by vocal noises 63.20 33.73 14.22 27.02 11.06 445 <.0013 1.60 [40.30, 57.66]
Qual7 Freq. childhood DD accompanied by vocal noises 57.48 36.32 19.24 29.62 8.33 445 <.0013 1.15 [29.24, 47.24]
C10 Freq. confuse DD with reality 14.28 25.14 7.31 16.92 2.27 445 .024 0.33 [0.96, 13.00]
Ctrl1 Difficulty keeping DDing under control 66.14 31.45 9.77 22.28 14.55 445 <.0013 2.07 [48.78, 63.96]
Ctrl2 Strength of urge to return to interrupted DD 66.60 31.80 21.54 29.31 9.91 445 <.0013 1.47 [36.15, 53.98]
Ctrl3 Ability to influence direction of DD 80.97 25.69 54.73 38.74 5.05 445 <.0013 0.80 [16.06, 36.44]
Ctrl4 Strength of urge to start DDing after waking up 62.44 35.10 15.10 27.62 10.63 445 <.0013 1.50 [38.61, 56.08]
Ctrl5 Difficulty staying on-task for something important 63.34 33.11 18.38 25.48 10.73 445 <.0013 1.52 [36.74, 53.17]
Ctrl6 Difficulty staying on-task for something boring 77.81 25.72 26.26 27.82 12.96 445 <.0013 1.92 [43.76, 59.35]
Ctrl7 Difficulty focusing on what others say 34.28 30.36 9.29 21.08 6.78 445 <.0013 0.96 [17.77, 32.22]
Dis1 Annoyance at having DD interrupted 51.76 32.71 13.57 22.22 10.62 445 <.0013 1.37 [31.14, 45.24]
Dis2 Distressed about amount of time spent DDing 63.02 32.43 4.57 15.22 21.28 445 <.0013 2.31 [53.07, 63.84]
Dis3 Distressed about DDing in general 54.62 35.80 5.36 15.92 16.83 445 <.0013 1.78 [43.52, 55.00]
Dis4 Distressed by content of DD 29.09 33.72 12.76 21.11 4.72 445 <.0013 0.58 [9.54, 23.11]
Dis5 Ashamed to tell others about DD 83.50 25.62 21.58 31.51 14.50 445 <.0013 2.16 [53.56, 70.30]
Dis6 Distressed when unable to find time to DD 49.36 35.56 9.35 19.97 11.74 445 <.0013 1.39 [33.34, 46.70]
Ben1 Rather DD than be social or engage in hobbies 59.07 31.22 13.17 25.73 10.74 445 <.0013 1.60 [37.53, 54.27]
Ben2 DD adds creativity to life 55.04 36.76 29.68 31.30 5.55 445 <.0013 0.74 [16.40, 34.33]
Ben3 Find DD comforting/enjoyable 79.68 26.75 42.35 33.57 8.05 445 <.0013 1.23 [28.24, 46.41]
Ben4 DDing helps you deal with everyday life 54.50 36.08 25.99 31.66 6.11 445 <.0013 0.84 [19.37, 37.65]
Ben5 Life is more interesting because of DDing 53.58 37.62 25.13 31.97 5.93 445 <.0013 0.81 [18.98, 37.72]
Func1 DDing interferes with sleep 47.24 33.82 14.94 25.06 7.94 445 <.0013 1.08 [24.32, 40.27]
Func2 DDing interferes with doing basic chores 58.87 32.26 11.01 19.31 14.64 445 <.0013 1.80 [41.45, 54.26]
Func3 DDing interferes with relationships 54.94 34.50 8.67 18.23 13.85 445 <.0013 1.68 [39.71, 52.81]
Func4 DDing interferes with academic/occupational goals 60.97 36.77 12.92 21.07 12.35 445 <.0013 1.60 [40.42, 55.67]
Func5 DDing interferes with life goals 63.11 35.56 6.32 17.08 16.81 445 <.0013 2.04 [50.17, 63.41]

Note. DD = daydreaming; M = mean, SD = standard deviation, t = t-statistic, df = degrees of freedom, p = p-value, d = Cohen’s d. Quant = Quantity,
Qual = Quality, Pos = Positive, Neg = Negative, C10 = Psychosis, Ctrl = Control, Dis = Distress, Ben = Benefits, Func = Functioning. Bonferroni-corrected sig-
nificance level is .0013. 95% CI is the 95% confidence interval for the mean difference.

(Witmer & Singer, 1994) and asked questions regarding how involved participants were when watching a TV show or movie
and the strength of their ability to block out external distractions when involved in a task or activity.

2.2.8. Dissociative experiences

The Dissociative Experiences Scale (DES; Bernstein & Putnam, 1986), the most widely used measure of dissociative expe-
riences (Somer, Dolgin, & Saadon, 2001), assesses the frequency of dissociative experiences using 28 self-report items. An
example is: ‘‘Some people have the experience of finding themselves in a place and have no idea how they got there. Circle
a number to show what percentage of the time this happens to you.” Answering options range from 0% = Never to 100% = All
the time, in increments of 10%.

2.2.9. Fantasy proneness

The Creative Experiences Questionnaire (CEQ; Merckelbach, Horselenberg, & Muris, 2001) is a 25-item self-report mea-
sure to assess fantasy proneness. Items assess profound involvement in fantasy, developmental antecedents of fantasy
proneness, and the consequences of fantasizing. Participants indicate yes or no to statements such as: ‘‘As a child, I thought
that the dolls, teddy bears, and stuffed animals that I played with were living creatures.” A higher sum score of affirmative
answers (1 = Yes, 0 = No) indicates higher levels of fantasy proneness.

2.2.10. Traumatic experiences

The Trauma History Screen (THS; Carlson et al., 2011) was used to assess exposure to high magnitude stressor events. The
measure includes a list of stressful events, such as forced sexual contact as a child or adult, where the participant is asked
 J. Bigelsen et al. / Consciousness and Cognition 42 (2016) 254–266 261

whether they have experienced the event and if answered affirmatively to report the number of times the event had
occurred. The sum of the number of traumatic events reported was used as indicator.

2.3. Data-analytic plan

Qualitative data analysis was conducted following procedures described as ‘‘open coding” in grounded theory (Glaser &
Strauss, 1967) as well as ‘‘clustering” or ‘‘theme identification” (Miles & Huberman, 1994). Specifically, we developed a cod-
ing scheme reflecting common themes using answers of 10 randomly chosen participants. We then discussed and refined the
coding schema on the basis of the answers of another 10 randomly chosen participants, and continued this procedure until
no new major categories emerged, indicating saturation. The final coding schema had 14 main categories, and was used by
two well-trained coders. Inter-rater reliability was high (Kappa = .96).
Quantitative analyses were done in SPSS 22 and R (R Core Team, 2013). Due to a significant difference in age between
MDers and non-MDers, we employed a propensity score analysis, to correct for these mean differences while conducting sig-
nificance tests and effect size estimates. Propensity score analysis (Rosenbaum & Rubin, 1983) is appropriate to use when
comparing groups that are non-equivalent at the outset of the study, a common occurrence in observational studies. We esti-
mated propensity scores using the R package twang (Ridgeway, McCaffrey, Morral, Burgette, & Griffin, 2015), which imple-
ments generalized boosted regression.
Our propensity score model was a logistic regression model. We used a propensity score model with age and race. This
model converged, and resulted in weighted data that no longer containing significant differences between the two groups on
age and race, as well as education level and student status.
Group differences in mean scale scores and in mean responses to individual items were analyzed with propensity score-
adjusted independent-samples t-tests. When conducting multiple tests for specific items of a scale, we used a Bonferroni
correction on the p-values. The significance level used in Table 3 was equal to the desired level (.05) divided by the number
of MD-related items (38), i.e. p = .05/38 = .0013, and the level used in Table 4 was equal to the desired level (.05) divided by
the number of other clinical scale and subscale scores (17), i.e. p = .05/17 = .0029. Our hypothesis regarding lack of group dif-
ferences in number of traumatic childhood events was tested with the Rao and Scott (1987) adjustment to the chi-square
statistic test for independence between two categorical variables.

3. Results

3.1. Qualitative information on daydreaming themes

Content of daydreaming was analyzed using the answers to open-ended questions on daydreams from 141 randomly
selected study participants (MDers: n = 85, 60%; non-MDers: n = 56, 40%; see Table 2 for themes and examples). Among
MDers, the three most popular daydream themes included being a celebrity or having a relationship with a celebrity
(37%), having an idealized version of self (34%), and being involved in a romantic relationship (34%). These content topics
were significantly less often mentioned by non-MDers. MDers also reported more daydreams of ongoing stories with fic-
tional characters, such as daydreams with characters borrowed from favorite TV shows/books/movie/videos (17%), having
an imaginary family/friend (18%), or fantasy world daydreams with original fictional characters (15%). Instead, daydreams
of the non-MDers were more often based in real life (39%) or concrete wish fulfillment (34%), such as winning the lottery
or having differing outcomes to current problems at work.

3.2. MD specific questions

MDers and non-MDers differed on all aspects addressed by the daydreaming-specific quantitative questions, including
daydreaming content, accompanying behavior (i.e. kinesthetic activity), immersion/absorption, the ability to limit day-
dreaming, experienced distress due to daydreaming, interferences of the daydreaming with life functioning; and perceived
benefits. Specifically, MDers endorsed all MD-related items at significantly higher rates than non-MDers (all ps < .0013; see
Table 3), except for the item about confusing daydreams from reality (labeled C10).
MDers spent a large amount of their lives engaging in fantasy activities: on an average daydreaming day MDers reported
spending 57% (SD = 25%) of their waking hours in fantasy activities compared to 16% (SD = 20%) of the hours for non-MDers, t
(445) = 12.50, p < .0013, 95% confidence interval (CI) for the mean difference = [34.69%, 47.60%], d = 1.83. On ‘‘high day-
dreaming days”, this percentage went up to 69%. The daydreaming activities of MDers increased in moving vehicles (71%
of the time, SD = 29%) and when alone (73% of the time, SD = 23%).
The content of the daydreams differed between the two groups as well, supporting findings from the qualitative analysis.
MDers reported daydreaming about fictional characters or historical figures 73% (SD = 35%) of the time, compared to non-
MDers who reported doing this only 19% (SD = 28%) of the time, t (445) = 12.80, p < .0013, 95% CI for the mean differ-
ence = [45.89%, 62.49%], d = 1.69.
Kinesthetic activity accompanied the daydreaming activities of MDers frequently. 82% of MDers reported engaging in
repetitive movements, such as pacing, or rocking, for at least 10% of the time. Also, MDers were more likely to vocalize while
262 J. Bigelsen et al. / Consciousness and Cognition 42 (2016) 254–266

Table 4
Performance of self-reported MDers (n = 341) and non-MDers (n = 106) on other clinical measures.

Scale MDer Non-MDer Independent-samples t-tests

M SD M SD t df p d 95% CI
CEQ 13.32 4.01 9.11 5.52 5.36 445 <.0029 0.87 [2.67, 5.75]
ASRS total 3.57 1.54 2.14 1.66 6.00 445 <.0029 0.89 [0.96, 1.89]
Inattention 2.75 1.25 1.66 1.32 5.66 445 <.0029 0.85 [0.71, 1.47]
Impulsivity 0.82 0.76 0.48 0.61 3.77 445 <.0029 0.48 [0.16, 0.51]
OCI-R total 20.05 13.14 12.24 10.67 4.74 445 <.0029 0.65 [4.58, 11.05]
Washing 1.53 2.59 1.39 2.03 0.44 445 .661 0.06 [ 0.50, 0.80]
Checking 3.16 3.10 1.61 1.98 4.87 445 <.0029 0.60 [0.93, 2.18]
Ordering 3.56 3.32 2.64 2.64 2.25 445 .025 0.31 [0.12, 1.73]
Hoarding 4.05 3.24 2.74 2.33 3.78 445 <.0029 0.46 [0.63, 1.98]
Obsessing 6.09 3.73 3.15 3.46 5.73 445 <.0029 0.82 [1.94, 3.95]
Neutralizing 1.67 2.43 0.71 1.28 4.18 445 <.0029 0.49 [0.50, 1.40]
DES Total 28.40 17.28 15.16 17.52 4.66 445 <.0029 0.76 [7.52, 18.44]
Absorption 43.87 22.37 22.32 23.31 5.73 445 <.0029 0.94 [13.92, 28.41]
Amnesia 8.77 12.68 6.76 16.81 0.68 445 .498 0.13 [ 3.57, 7.36]
Depersonalization 18.38 22.08 7.42 13.36 5.23 445 <.0029 0.60 [6.77, 14.89]
Psychosis screener 0.77 1.16 0.67 1.09 0.59 445 .555 0.10 [ 0.25, 0.46]
SPD 3.62 1.19 1.93 1.27 8.78 445 <.0029 1.38 [1.31, 2.07]

Note. MDer = self-reported maladaptive daydreamer, non-MDer = self-reported non-MDer. M = mean, SD = standard deviation, t = independent-samples t-
statistic, df = degrees of freedom, p = p-value, d = Cohen’s d. CEQ = Creative Experiences Questionnaire; ASRS = ADHD (Attention Deficit/Hyperactivity
Disorder) Self-Report Scale; OCI-R = Obsessive-Compulsive Inventory – Revised; DES = Dissociative Experiences Scale; SPD = Sense of Presence in Day-
dreaming. Bonferroni-corrected significance level is .0029. 95% CI is the 95% confidence interval for the mean difference.

daydreaming. MDers reported doing this 63% of the time (SD = 34%) while non-MDers reported doing this 14% of the time
(SD = 27%), t (445) = 11.06, p < .0013, 95% CI for the mean difference = [40.30%, 57.66%], d = 1.60.
Furthermore, the results demonstrated that MDers felt substantially hindered in everyday functioning. MDers indicated
that their daydreaming caused interference with their life goals in 63% (SD = 36%) of the time, while non-MDers reported this
problem only 6% of the time (SD = 17%), t (445) = 16.81, p < .0013, 95% CI for the mean difference = [50.17%, 63.41%], d = 2.04.
For the other areas of functioning, MDers reported interference by their daydreaming in 47% (sleep) to 61% (academic/occu-
pational goals) of the time, while non-MDers reported interference much less often (between 9% and 15% of the time). When
combining all functioning items (i.e., sleep, chores, relations, academic/occupational goals, life goals), we found that almost
all MDers (i.e., 97%) reported interference in any of these areas, while only one third (34%) of the non-MDers reported similar
issues. (In comparison to the kinesthetic activities, we used a somewhat stricter criterion of 20% of the time, given ‘‘normal”
daydreaming may also interfere with desired activities).
There were also some interesting similarities in endorsement rates between MDers and non-MDers. Differences between
both groups were quite small for items on valence (frequency of positive/pleasurable or enjoyable content), feeling distress
by content of daydreams, and daydreaming adding creativity and interest to life.

3.3. Links between MD and other disorders

As shown in Table 4, MDers and non-MDers differed significantly on the studied clinical scales, with MDers scoring higher
on all measures. The strongest effect size was for the questionnaire measuring a sense of presence during daydreaming
(d = 1.38) and the DES Absorption subscale (d = 0.94). The smallest difference between MDers and non-MDers was on the
OCI-R Washing subscale (d = 0.06) and the psychosis measure (d = 0.10). Also, there were no significant differences between
the groups on diagnoses of schizophrenia. The mean psychosis screener score among MDers fell below the empirically
derived cutoff scores of 3, suggesting no comorbidity of schizophrenia among MDers (Degenhardt et al., 2005).
As is shown in Table 4, MDers scored higher than non-MDers on total OCD score, t (445) = 4.74, p < .0029, 95% CI for the
mean difference = [4.58, 11.05], d = 0.65. However, it is evident that the group differences were much larger for the obsessing
subscale (t (445) = 5.73, p < .0029, 95% CI for the mean difference = [1.94, 3.95], d = 0.82) than for subscales such as washing
(results given above) and ordering (t (257.51) = 4.78, p < .001, 95% CI for the mean difference = [0.80, 1.91], d = 0.44). The
mean OCI-R total score among MDers fell below the empirically derived cutoff scores of 21 (Abramowitz, David, Tolin, &
Diefenbach, 2005), suggesting no comorbidity of OCD among MDers.
MDers also endorsed both the inattention subscale (t (445) = 5.66, p < .0029, 95% CI for the mean difference = [0710, 1.47],
d = 0.85) and impulsivity subscale (t (445) = 3.77, p < .0029, 95% CI for the mean difference = [0.16, 0.51], d = 0.48) of the ASRS
at significantly higher rates than non-MDers. However, the two most highly endorsed items by the MDers were inattention
items, items 2 and 4, with ds = 0.87 and 0.90, respectively. Both samples scored within the low negative range for ADHD
(Kessler et al., 2005), suggesting no comorbidity of ADHD among MDers.
MDers also scored higher than non-MDers on the DES overall (t (445) = 4.066, p < .0029, 95% CI for the mean difference =
[7.52, 18.44], d = 0.76). However, MDers and non-MDers differed most on the absorption subscale (t (445) = 5.73, p < .0029,
 J. Bigelsen et al. / Consciousness and Cognition 42 (2016) 254–266 263

95% CI for the mean difference = [13.92, 28.41], d = 0.94). The mean DES total score among MDers fell below the empirically
derived cutoff scores of 30 (Somer et al., 2001), demonstrating an unlikely comorbidity of known dissociative disorders
among MDers.
Finally, MDers scored higher on the CEQ compared to non-MDers (t (445) = 5.36, p < .0029, 95% CI for the mean differ-
ence = [2.67, 5.75], d = 0.87). However, items that were explicitly related to the quantity or quality of daydreams, such as
Item 9 (‘‘I spend more than half the day fantasizing or daydreaming”; t (445) = 13.28, p < .0029, 95% CI for the mean differ-
ence = [0.59, 0.79], d = 1.89), resulted in larger between-groups differences in endorsement rates. By contrast, items assess-
ing belief in paranormal activity, such as Item 22 (‘‘I often have the experience of thinking of someone and soon afterwards
that particular person calls or shows up”; t (445) = 1.18, p = .24, 95% CI for the mean difference = [ 0.22, 0.06], d = 0.17),
were actually endorsed more often by non-MDers than by MDers.

3.4. Links between traumatic childhood events and MD

A Rao–Scott chi-square test of independence (the correction yields an F-statistic) showed that there was not a signifi-
cantly different distribution of the total number of childhood traumatic events between MDers and non-MDers,
F (4.25, 1895.60) = .91, p = .46. More specifically, 43% of MDers and 48% of non-MDers reported no traumatic childhood events.

4. Discussion

The present study provides evidence of the existence of a distinct population of daydreamers who engage in extensive
daydreaming activities that they find enjoyable, but also distressing and hindering to life functioning. We demonstrated that
MD differs significantly from normative daydreaming in terms of quantity, content, accompanying behavior (i.e. kinesthetic
activity), immersion/absorption, controllability, distress, and interference with life functioning.

4.1. Daydreaming quantity and themes

Using questions that excluded any off-task thought and instead focused on fantasy, MDers reported spending on average
57% of their waking hours in fantasy activity (compared to 16% of the hours for non-MDers). This finding is consistent with
Bigelsen and Schupak (2011) who found that MDers spent 56% of their waking hours in fantasy activity. Findings further
indicated that the fantasy content of the two groups also differed greatly. MDers reported more daydreams with fictional
characters and elaborate plots, often occurring in different time periods or using specific fictional genres (i.e., cartoon,
science fiction), whereas the daydreams of non-MDers seem to be based in reality or wish fulfillment and were usually
devoid of fictional characters. The more entertaining and creative nature of the fantasy among MDers may help explain
why this manner of daydreaming is both more enjoyable and difficult to limit. Interestingly, there were some study partic-
ipants who did not self-identify as MDers, but who still described highly detailed fantasies that appeared similar to those of
MDers. It is, therefore, conceivable that a third group of daydreamers exists that has the ability to engage in enhanced, highly
detailed daydreams but who are not distressed by them.

4.2. Experience of daydreaming (kinesthetic activity/immersion)

Similar to Bigelsen and Schupak (2011), over 80% of MDers reported that kinesthetic activity accompanied at least some
of their daydreaming activities. This is consistent with Robinson et al. (2014) who have theorized that the movement can
increase sensory stimulation, which potentially could facilitate the imagery process. Alternatively, it could also be the case
that kinesthetic activities may facilitate a deeper, almost hypnotic-like daydream state, and make it easier to block out real
world stimuli, which would correspond to anecdotal reports from MDers in our sample.
The largest differences between the groups were on items regarding the sense of presence and absorption in the day-
dreaming. There were also large differences in the degree of involvement of the visual and auditory experiences. Several
MDers reported that their daydreams would often make them laugh or bring them to tears, providing further corroboration
for the emotional properties of many MD fantasies. This finding demonstrates that it is not only the themes and quantity of
daydreaming that differentiates MDers from non-MDers, but also the depth and engulfing nature of the fantasy experience.
MDers seem to have an ability to completely immerse themselves in a daydream world that is not shared by non-MDers,
which appears to be the biggest difference between the two groups. This capacity to feel present in an alternate self-
scripted world may be another reason why it is so compelling and so difficult to control. The high levels of absorption
are consistent with Glicksohn and Barrett (2003) who found that the trait of absorption underlies hallucinatory experiences,
which can include vivid daydreams.

4.3. Control/distress and interference with life functioning

Other large differences between the research groups involved difficulty in limiting the daydreaming and feeling
distressed over time spent daydreaming. MDers seem to crave these daydream experiences to such a degree that they have
264 J. Bigelsen et al. / Consciousness and Cognition 42 (2016) 254–266

difficulty limiting it, as indicated by MDers reporting to daydream all day including at night, thereby compromising quality
of sleep (and in the long-run their health). Over half of the MDers reported a strong urge to immediately start daydreaming
upon waking up or to immediately return to a daydream after being interrupted by an event in the real world. It is this dif-
ficulty in keeping the daydreaming under control and out of the way of real life pursuits that have MDers continuing to seek
help. Interestingly, one of the smallest differences between MDers and non-MDers involved the ability to control the day-
dream when being with other people, thereby demonstrating that MDers may be able to reduce daydreaming when neces-
sary (i.e., when socially inappropriate), thereby showing some degree of control over this mental activity. In other words,
MDers seem to be able suppress their daydreaming when they absolutely have to (i.e., when in public or when their atten-
tion resources are captured by urgent or compelling real world demands), but experience difficulty fighting the urge to day-
dream in other circumstances.
One of the main causes of distress associated with MD was reported interference with achieving life goals. If one is spend-
ing an average of 57% of his or her waking hours on under-controlled fantasy activity, it is not surprising that it is also jeop-
ardizing fulfillment of life goals that take time and attention to achieve, underscoring the need learn more about MD and to
find appropriate treatments.

4.4. The Relationship between MD and other clinical constructs

Our finding that MDers endorsed higher levels of symptomology on all subscales of both the ADHD and OCD measures
was not expected, as we had assumed to find a pattern including significant differences in inattention and obsessive symp-
toms and non-significant differences in impulsivity and compulsive behaviors. The present findings may indicate a more
general higher level of distress for this frustrated group of sufferers. However, the specific links between the MD questions
and the OCI-R were far stronger for the obsessive symptoms than for the compulsive symptoms associated with the behav-
ioral facet of OCD. In fact, one of the smallest differences between the two groups was on compulsive behavior such as wash-
ing. This demonstrates that the response pattern does not reflect a mere endorsement response bias and that the mental
activity of MD is more similar to thought rumination than to ritualistic behavior.
There were also larger effects for the differences between the groups on the ASRS items measuring inattention than those
measuring hyperactivity. This is not surprising considering attention would be expected to be depleted when it is being
divided between external and imaginal activities. The differences in attention between the two groups corresponds with
new research by Robinson, Woods, Cardona, and Hedderly (2016) which found that children who presented with stereotypic
movements/kinesthetic activity in conjunction with intense imagery/fantasy activity demonstrated impaired performance
on tests of attention but strengths in memory or oral expression.
The psychosis questions produced the smallest effect sizes among the measures, and there was no difference between
confusing the daydreaming with reality or diagnoses of schizophrenia. This demonstrates that the fantasies therefore do
not seem to resemble hallucinations that are usually more circumscribed and experienced as involuntary, but rather
reported as intentional weaving of engaging stories where the daydreamer is fully aware that they are only imaginings.
Although MDers scored highly on fantasy proneness, they were more likely to endorse fantasy proneness items related to
extensive enjoyment of fantasy and much less likely to endorse items describing belief in the paranormal. MDers seem to
only be ‘‘fantasy prone” when considering those items that directly measure fantasy.
Overall, findings suggest that MDers endorse certain features of several other disorders, suggesting some overlapping
symptoms. However, none of the measures seem to adequately capture all of the features of MD, and only some of the ele-
ments/subscales of each measure seem relevant to MD. Additionally, the mean scores of all measured mental health scales
among MDers fell below the pathological threshold, demonstrating MD clinical distinctness and no comorbidity of MD with
related psychopathologies. However, given that this is the first study of its kind, more research is warranted to ascertain
whether MD is an unrecognized unique disorder or if it is a little discussed symptom of a currently known disorder.

4.5. Childhood traumatic events

Somer (2002) proposed that MD could be a coping strategy in response to aversive childhood experiences. Yet, the pre-
sent study found no significant differences in reported traumatic experiences. As this study assessed a wide range of trau-
matic experiences, future studies should investigate whether different types of trauma or their severity may be associated
with MD. It is possible that severe trauma may increase the motivation of young victims capable of vivid fantasizing to
escape their harsh realities into their imaginary worlds. However, consistent with Bigelsen and Schupak (2011), the current
results demonstrate that childhood trauma is not a prerequisite to developing MD.

4.6. Limitations

Despite the novelty and strengths of the present study, some limitations must be acknowledged. Although our sample
was large and internationally diverse, as MD is a yet unrecognized clinical phenomenon, there is currently no other way
to recruit large groups of MDers other than to use Internet sites dedicated to MD. Additionally, prior to the completion of
this study there was no criterion or tool to objectively identify MD, and we therefore had to rely on self-report to determine
MD status. As these individuals are seeking out help and self-identifying as suffering from a disorder, they may be expected
 J. Bigelsen et al. / Consciousness and Cognition 42 (2016) 254–266 265

to have overall higher rates of mental health issues than participants who do not self-report MD. However, the results
demonstrated the strongest differences between the groups were for features thought to be most associated with MD, as
opposed to an overall higher endorsement bias or overall higher rates of mental illness. Most importantly, as a primary pur-
pose of the study was to paint a picture of what those who think they have MD are experiencing and how it differs from the
experience of the general population, for this particular study, the recruitment methods, albeit unusual, were what was nec-
essary to describe this phenomenon and understand its symptomology.
Another potential issue related to our recruitment strategy was that MDers were less educated than the individuals form-
ing the comparison group, which seems due to the fact that the MDers were more likely to be students and younger in age.
Although it would have been desirable to recruit groups of identical mean age and education, we used propensity scores to
statistically control for these differences between MDers and non-MDers. Yet, we found similar mean level differences across
both group, whether or not we controlled for these underlying basic characteristics.
Given the strong evidence collected in this study that MD may indeed be a unique clinical syndrome, we utilized this data
set to develop an MD questionnaire (Somer, Lehrfeld, Bigelsen, & Jopp, 2016) to provide researchers with a measure able to
reliably identify MD for future studies. Thus, future studies could recruit representative samples and investigate levels of MD
or prevalence rates in the wider population.

5. Conclusions

The present study is the largest investigation to date to shed light on maladaptive daydreaming behavior reported by
thousands of individuals around the world on a multitude of websites, most likely indicating an untold number of others,
including those who are not accessing the Internet or who do not speak English. Many of these individuals correspond fre-
quently with us asking for help and often describe being rebuffed by members of the mental health community who are
unaware of this phenomenon. Thus, learning more about the specific symptoms involved and developing methods to assess
MD is urgently needed to raise the awareness of mental health professionals and to develop intervention approaches.
We are hopeful that our study will spawn a new line of research so that those with MD will no longer feel misunderstood
when seeking help and will one day have the benefit of reliable assessment and evidence-based treatment. In the future,
studies are needed that address the prevalence of MD in the general population, its etiology, and potential benefits, such
as increased creativity. Future studies should also investigate how often childhood stereotypic movement disorder leads
to MD in adulthood and the possible existence of a third group of extensive daydreamers that may have enhanced enjoyment
of daydreaming but who do not seem to be hampered by it.

References

Abramowitz, J. S., David, F., Tolin, D. F., & Diefenbach, G. J. (2005). Measuring change in OCD: Sensitivity of the obsessive-compulsive inventory-revised.
Journal of Psychopathology and Behavioral Assessment, 27, 317–324. http://dx.doi.org/10.1007/s10862-005-2411-y.
American Psychiatric Association (2000). Diagnostic and statistical manual of mental disorders (4th ed. text rev.)Washington, DC: American Psychiatric
Association.
American Psychiatric Association (2013). Diagnostic and statistical manual of mental disorders (5th ed.)Arlington, VA: American Psychiatric Publishing.
Bernstein, E. M., & Putnam, F. W. (1986). Development, reliability, and validity of a dissociation scale. J. Nerv. Ment. Dis., 174, 727–735. http://dx.doi.org/
10.1097/00005053-198612000-00004.
Bigelsen, J., & Kelley, T. (2015). When daydreaming replaces real life. The Atlantic <http://www.theatlantic.com/health/archive/2015/04/when-
daydreaming-replaces-real-life/391319/#disqus_thread> Retrieved May 9, 2015.
Bigelsen, J., & Schupak, C. (2011). Compulsive fantasy: Proposed evidence of an under-reported syndrome through a systematic study of 90 self-identified
non-normative fantasizers. Consciousness and Cognition: An International Journal, 20, 1634–1648. http://dx.doi.org/10.1016/j.concog.2011.08.013.
Carlson, E. B., Smith, S. R., Palmieri, P. A., Dalenberg, C., Ruzek, J. I., Kimerling, R., ... Spain, D. A. (2011). Development and validation of a brief self-report
measure of trauma exposure: The Trauma History Screen. Psychological Assessment, 23, 463–477. http://dx.doi.org/10.1037/a0022294.
Degenhardt, L., Hall, W., Korten, A., & Jablensky, A. (2005). Use of a brief screening instrument for psychosis: Results of an ROC analysis. NDARC Technical
Report No. 210.
Foa, E. B., Huppert, J. D., Leiberg, S., Langner, R., Kichic, R., Hajcak, G., & Salkovskis, P. M. (2002). The obsessive-compulsive inventory: Development and
validation of a short version. Psychological Assessment, 14, 485–496. http://dx.doi.org/10.1037/1040-3590.14.4.485.
Freeman, R. D., Soltanifar, A., & Baer, S. (2010). Stereotypic movement disorder: Easily missed. Developmental Medicine and Child Neurology, 52, 733–738.
http://dx.doi.org/10.1111/j.1469-8749.2010.03627.x.
Glaser, B., & Strauss, A. (1967). The discovery of grounded theory: Strategies for qualitative inquiry.Chicago, IL: Aldine.
Glicksohn, J., & Barrett, T. R. (2003). Absorption and hallucinatory experience. Applied Cognitive Psychology, 17, 833–849. http://dx.doi.org/10.1002/acp.913.
Kessler, R. C., Adler, L., Ames, M., Demler, O., Faraone, S., Hiripi, E., ... Walters, E. E. (2005). The World Health Organization adult ADHD self-report scale
(ASRS): A short screening scale for use in the general population. Psychological Medicine, 35, 245–256. http://dx.doi.org/10.1017/S0033291704002892.
Killingsworth, M. A., & Gilbert, D. T. (2010). A wandering mind is an unhappy mind. Science, 330, 932. http://dx.doi.org/10.1126/science.1192439.
Klinger, E. (1971). Structure and functions of fantasy.Oxford, UK: Wiley.
Klinger, E. (1990). Daydreaming: Using waking fantasy and imagery for self-knowledge and creativity.Los Angeles, CA: J.P. Tarcher.
Klinger, E. (2009). Daydreaming and fantasizing: Thought flow and motivation. In K. D. Markman, W. M. P. Klein, & J. A. Suhr (Eds.), Handbook of imagination
and mental simulation (pp. 225–239). New York, NY: Psychology Press.
Mahone, E. M., Bridges, D., Prahme, C., & Singer, H. S. (2004). Repetitive arm and hand movements (complex motor stereotypies) in children. Journal of
Pediatrics, 145, 391–395. http://dx.doi.org/10.1016/j.jpeds.2004.06.014.
Merckelbach, H., Horselenberg, R., & Muris, P. (2001). The creative experiences questionnaire (CEQ): A brief self-report measure of fantasy proneness.
Personality and Individual Differences, 31, 987–995. http://dx.doi.org/10.1016/S0191-8869(00)00201-4.
Miles, M. B., & Huberman, A. M. (1994). Qualitative data analysis: An expanded sourcebook (2nd ed.)Beverly Hills, CA: Sage Publications Inc..
National Institute of Mental Health (2012). Attention Deficit Hyperactivity Disorder (ADHD) (Brochure).Bethesda, MD: National Institute of Mental Health.
R Core Team (2013). R: A language and environment for statistical computing. R Foundation for Statistical Computing, Vienna, Austria. <http://www.R-project.
org/>.
266 J. Bigelsen et al. / Consciousness and Cognition 42 (2016) 254–266

Rao, J. N. K., & Scott, A. J. (1987). On simple adjustments to the chi-square tests with sample survey data. Annals of Statistics, 15, 385–397. http://dx.doi.org/
10.1214/aos/1176350273.
Ridgeway, G., McCaffrey, D., Morral, A., Burgette, L., & Griffin, B. A. (2015). Toolkit for weighting and analysis of nonequivalent groups: A tutorial for the
twang package. Retrieved from <https://cran.r-project.org/web/packages/twang/vignettes/twang.pdf>.
Robins, L. N., Wing, J., Wittchen, H. U., Helzer, J. E., Babor, T. F., Burke, J., ... Towle, L. H. (1988). The Composite International Diagnostic Interview: An
epidemiologic instrument suitable for use in conjunction with different diagnostic systems and in different cultures. Archives of General Psychiatry, 45,
1069–1077. http://dx.doi.org/10.1001/archpsyc.1988.01800360017003.
Robinson, S., Woods, M., Cardona, F., Baglioni, V., & Hedderly, T. (2014). Intense imagery movements: A common and distinct paediatric subgroup of motor
stereotypies. Developmental Medicine and Child Neurology, 56, 1139–1140. http://dx.doi.org/10.1111/dmcn.12518.
Robinson, S., Woods, M., Cardona, F., & Hedderly, T. (2016). Intense Imagery Movements (IIM): More to motor stereotypies than meets the eye. European
Journal of Paediatric Neurology, 20, 61–68. http://dx.doi.org/10.1016/j.ejpn.2015.10.006.
Rosenbaum, P. R., & Rubin, D. B. (1983). The central role of the propensity score in observational studies for causal effects. Biometrika, 70, 41–55. http://dx.
doi.org/10.1093/biomet/70.1.41.
Ross, C., Joshi, S., & Currie, R. (1990). Dissociative experiences in the general population. American Journal of Psychiatry, 147, 1547–1552. http://dx.doi.org/
10.1176/ajp.147.11.1547.
Ross, C., Joshi, S., & Currie, R. (1991). Dissociative experiences in the general population: A factor analysis. Hospital & Community Psychiatry, 42, 297–301.
http://dx.doi.org/10.1176/ps.42.3.297.
Schupak, C., & Rosenthal, J. (2009). Excessive daydreaming: A case history and discussion of mind wandering and high fantasy proneness. Consciousness and
Cognition: An International Journal, 18, 290–292. http://dx.doi.org/10.1016/j.concog.2008.10.002.
Singer, J. L. (1966). Daydreaming: An introduction to the experimental study of inner experience.New York, NY: Random House.
Singer, J. (1975). The inner world of daydreaming.New York, NY: Harper & Row.
Slade, P. D., & Bentall, R. P. (1988). Sensory deception: A scientific analysis of hallucination.London, UK: Croom Helm.
Slater, M., Steed, A., McCarthy, J., & Maringelli, F. (1998). The influence of body movement on subjective presence in virtual environments. Human Factors,
40, 469–477. http://dx.doi.org/10.1518/001872098779591368.
Smallwood, J., Obonsawin, M. C., & Heim, D. (2003). Task unrelated thought: The role of distributed processing. Consciousness and Cognition: An International
Journal, 12, 169–189. http://dx.doi.org/10.1016/S1053-8100(02)00003-X.
Somer, E. (2002). Maladaptive daydreaming: A qualitative inquiry. Journal of Contemporary Psychotherapy, 32, 197–212. http://dx.doi.org/10.1023/
A:1020597026919.
Somer, E., Dolgin, M., & Saadon, M. (2001). Validation of the Hebrew version of the Dissociative Experiences Scale (H-DES) in Israel. Journal of Trauma and
Dissociation, 2, 53–66. http://dx.doi.org/10.1300/J229v02n02_05.
Somer, E., Lehrfeld, J., Bigelsen, J., & Jopp, D. S. (2016). Development and validation of the Maladaptive Daydreaming Scale (MDS). Consciousness and
Cognition: An International Journal, 39, 77–91. http://dx.doi.org/10.1016/j.concog.2015.12.001.
Wilson, S., & Barber, T. X. (1981). Inventory of childhood memories and imaginings.Framingham, MA: Cushing Hospital.
Wilson, S., & Barber, T. (1982). The fantasy-prone personality: Implications for understanding imagery, hypnosis, and parapsychological phenomena. PSI
Research, 1, 94–116.
Witmer, B. G., & Singer, M. J. (1994). Measuring immersion in virtual environments (ARI Technical Report 1014).Alexandria, VA: US Army Research Institute for
the Behavioral and Social Sciences.
Witmer, B. G., & Singer, M. J. (1998). Measuring presence in virtual environments: A presence questionnaire. Presence, 7, 225–240. http://dx.doi.org/10.1162/
105474698565686.