A Case Report on Maladaptive Daydreaming

Galore International Journal of Health Sciences and Research Vol.4; Issue: 1; Jan.-March 2019 Website: www.gijhsr.com Case Report P-ISSN: 2456-9321

Dr Preethi Rebello1, Dr Karthika Johnson2, Dr Priyanka D’Souza2, Dr Pavithra P Rao3, Ms. S Malarmathi4

1Senior Resident, 2Post Graduate Resident, 3Assistant Professor, 4Clinical Psychologist, Department of Psychiatry, Father Muller Medical College, Kankanady, Mangalore - 575002, Karnataka.

Corresponding Author: Dr Preethi Rebello

ABSTRACT Attention deficit disorders and obsessive- compulsive symptoms, as well as positive Maladaptive Daydreaming (MD) is an under reinforcement comparable to processes in researched mental health disorder. It does not behavioral addiction disorders have been have a diagnostic criterion of its own. Most of found to be involved in MD. (1) The the studies are based on individuals who self difference between normal day dreaming identify themselves as having MD. Some studies have termed MD as a type of Behavioral and MD is the difference in terms of addiction disorder. It is characterized by quantity, content, experience, absorption in fantasy for several hours a day; controllability, distress, and interference this replaces human interaction and causes with life functioning. It is an under- socio-occupational impairment. Studies have acknowledged clinical phenomenon that reported this disorder to have comorbid requires scientific and clinical attention. (2) Attention Deficit Disorders (ADD), Dissociative Another characteristic of MD which makes disorders and Anxiety disorders including us to consider it a type of behavioral certain other Obsessive compulsive spectrum addiction disorder is the experience of disorders. This case report is one of the few case intense yearning for it and the feeling of reports of a patient who presented for compulsion to extensively extend and repeat consultation at a Psychiatry outpatient (3) department for problems with his socio- the action. There is an irresistible urge occupational functions due to Maladaptive reported by some to engulf themselves in Daydreaming. the world of fantasy immediately on waking up and to continue with it even when Key words: Maladaptive Day dreaming, Social interrupted at the cost of impairment of Anxiety Disorder, Comorbidity normal day to day activities. (2) Like any other behavioral addiction disorders the INTRODUCTION dreamers are also worried about losing Maladaptive Day dreaming is a control over fantasizing and they make dysfunctional form of imaginative many unsuccessful attempts to cut down. involvement which may be expressed (4,5) There are no particular guidelines as to through extensive book reading, watching the management of MD. One case study films and gaming. It has been studied and reported improvement in symptoms with researched on by many researchers. MD is fluvoxamine (6) which is a Selective characterized by fanciful daydreaming for Serotonin Reuptake Inhibitor (SSRI). hours on end which is often vivid and Studies have found Serotonin levels to be causes the individual to neglect real-life possibly involved in the development or relationships and responsibilities. This maintenance of this condition. Some report results in distress and impairment in social utilizing response prevention techniques for and occupational functioning. Research has curbing or intercepting unwanted been scarce on MD and mostly relies on daydreaming. (1) Avoiding triggers, being cross-sectional or case study designs. aware of the symptoms and CBT have also Dissociative Disorders, Anxiety Disorders, found to helpful in treatment of MD. (7) This

Galore International Journal of Health Sciences and Research (www.gijhsr.com) 33 Vol.4; Issue: 1; January-March 2019 Preethi Rebello et.al. A Case Report on Maladaptive Daydreaming case report discusses about the diagnosis friends and family and preferred to stay and management of a patient with MD. alone at home as he would get more time to get involved in his activity. Patient had CASE DESCRIPTION noticed that he had got fewer friends than A 24 year old single male educated before now and had been having upto predegree reported alone to Psychiatry interpersonal problems with his father in Outpatient department with complaints of particular because of his day dreaming. decreased sleep and difficulty in After not clearing a few of his tests patient concentration since 2 years. He reported that realized he has to cut down on his since 2 years he had difficulty concentrating daydreaming as he should spend more time on his studies as he was preparing for studying. He was unable to cut down and Language tests to work abroad. It had every time would start day dreaming after a initially started with minimal day dreaming trigger. Patient reported that he found day but after a period of 6 months he was dreaming pleasurable and felt a compulsion spending excessive time on his day to day dream at the next opportunity he gets. dreaming. After he would watch a movie or Those thoughts were his own thoughts, ego a music video he would think how he would syntonic and not anxiety causing. have acted in the movie and then go to his Patient met criteria for Social room, close the door and act out scenes Anxiety disorder since 2 years. He did not from the movies adding new dialogues and meet criteria for any other anxiety disorder, scenes. He would also act like a cricketer substance use or mood disorder. There was giving commentary by self and bowling and no significant past and family history. His batting and imagining applause from the Mental status examination was within imaginary audience. He would do the same normal limits. A thorough physical for football also. He would imagine how he examination and investigations which were could have bettered the movie or the match done were within normal limits ruling out and would act out speeches on imagining any general medical condition that would be winning matches or awards. When he would the cause for the same. go to bathroom also he would spend 2 hours He was diagnosed with Maladaptive as he would be imagining and acting out the Daydreaming and a comorbid Social scenes he has just watched. He would be Anxiety disorder. He was started on reprimanded by his parents for spending his Escitalopram 5 mg and Cognitive Behavior time locked up in his room and bathroom. Therapy was also initiated. He was also He would get into frequent fights with his advised to avoid triggers which cause him to parents when they would interfere in his day dream, thought stopping methods, make activity. Sleep onset would take time as he a time table for regular activities and keep would be preoccupied with daydreaming only a restricted amount of time for day during that time as well. Over the past year, dreaming everyday and then gradually in a day he would spend approximately 3 to decrease the time. 4 hours acting out the scenes and the rest of Patient reported for further follow the hours he would be preoccupied by how ups and reported improvement. he was going to act out the next scene next Escitalopram was increased and maintained time. On an average patient reported that he on 10mg. Over a period of 5 months patient spent 6 to 8 hours preoccupied by these day reported improvement in both the disorders. dreams. He would not be able to concentrate He was spending only less than 15 minutes in his classes as he would day dream about a day on his day dreaming and there was movies and matches there as well. He had improvement in his social anxiety been performing badly in tests as every time symptoms as well. he would sit to study he would end up day dreaming. He would avoid going out with

Galore International Journal of Health Sciences and Research (www.gijhsr.com) 34 Vol.4; Issue: 1; January-March 2019 Preethi Rebello et.al. A Case Report on Maladaptive Daydreaming

CASE DISCUSSION CONCLUSION There are no specific criteria in ICD Though there has been no definitive 10 (International Statistical Classification of evidence of maladaptive Daydreaming Diseases and Related Health Problems 10th being a distinct disorder. This disorder Revision) and DSM 5 (The Diagnostic and requires further investigations and studies. Statistical Manual of Mental Disorders, This disorder is comorbid with various other Fifth Edition) for the diagnosis of MD. Most disorders and the time and resources of the studies are done on self identified invested cause not only functional distress maladaptive day dreamers and recruited but also emotional distress. Further studies through online volunteering for the studies. are required to develop therapy guidelines In this case a patient reported for for individuals battling MD, so that they consultation due to the socio-occupational will be able to take control over their distress he was going through. He met the compulsion to daydream. proposed criteria given by Somer et al for diagnosis of maladaptive day dreaming. (8) REFERENCES Dissociative disorders, Anxiety disorders, 1. Soffer-Dudek N, Somer E. Trapped in a ADD and Obsessive compulsive symptoms Daydream: Daily Elevations in Maladaptive are found to be comorbid with MD. (1) In Daydreaming Are Associated With Daily this case we found comorbid Social Anxiety Psychopathological Symptoms. Front Psychiatry. 2018; 9: 194. Published online disorder which is in corroboration with 2018 May 15. doi: 10.3389/fpsyt.2018. certain previous studies. Social Anxiety has 00194 found to stimulate and as well as been found 2. Bigelsen J, Lehrfeld JM, Jopp DS, Somer E. to be a potential development pathway for Maladaptive daydreaming: Evidence for an (9,10) Maladaptive Daydreaming. This is under-researched mental health disorder. consistent with this case also. There are no Conscious Cogn. 2016 May;42:254-266. particular guidelines as to the management doi: 10.1016/j.concog.2016.03.017. Epub of Maladaptive Daydreaming. Based on 2016 Apr 12. previous studies patient was started on 3. Somer E, Somer L, Jopp DS. Parallel lives: Escitalopram and CBT and he reported A phenomenological study of the lived improvement in his symptoms following experience of maladaptive daydreaming. Journal of Trauma & Dissociation. 2016 this. (6,7) ;17(5) :561–576.doi:10.1080/15299732. This case is unique in a way that it 2016.1160463 shows that though daydreaming is a 4. Bigelsen J, Schupak C. Compulsive fantasy: common mental activity it can cause distress Proposed evidence of an under-reported when it becomes excessive and impairs day syndrome through a systematic study of 90 to day functions. This disorder has no self-identiﬁed non-normative fantasizers. current diagnostic validity in diagnostic Consciousness and Cognition.2011; 20(4): manuals but it is a well defined 1634–1648. doi:10.1016/j.concog.2011. phenomenon which has been under study 08.013 since sometime. Another reservation with 5. Pietkiewicz I J, Necki S, Banbura A, this disorder is that it may represent an Tomalski R. Maladaptive daydreaming as a new form of behavioral addiction. Journal extreme variant of normal daydreaming. But of Behavioral Addictions, DOI: when a patient reports of distress and 10.1556/2006.7.2018.95 needing help it may need further 6. Schupak C, Rosenthal J. Excessive management. It may be of concern to us and daydreaming: a case history and discussion it is worthy of further discussion and of mind wandering and high fantasy investigation. proneness. Conscious Cogn. 2009 Mar;18(1):290-2. doi: 10.1016/j.concog.2008.10.002.

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7. Somer E. Maladaptive daydreaming: University Students of Pakistan. Foundation ontological analysis, treatment rationale; a University Journal Of Psychology. 2018; pilot case report. Frontiers in the 2(2): 140-180 Psychotherapy of Trauma and Dissociation. 10. Somer E, Herscu O. Childhood Trauma, 2018; 1(2):1–22 Social Anxiety, Absorption and Fantasy 8. Somer E, Soffer-Dudek N, Ross CA, Dependence: Two Potential Mediated Halpern N. Maladaptive Daydreaming: Pathways to Maladaptive Daydreaming. J Proposed Diagnostic Criteria and Their Addict Behav Ther Rehabil .2017; 6(4) doi: Assessment with a Structured Clinical 10.4172/2324-9005.1000170 Interview. Psychology of Consciousness: Theory, research, and Practice. 2017; 4 (2): How to cite this article: Rebello P, Johnson K, 176-189 D’Souza P et al. A case report on maladaptive 9. Anwar M, Aqeel M, Shuja K H. Linking daydreaming. Galore International Journal of Social Support, Social Anxiety and Health Sciences & Research. 2019; 4(1): 33-36. Maladaptive Daydreaming: Evidence from

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