Maladaptive Daydreaming: The Current

Have you ever spent hours somewhere that doesn't exist, with people who aren't real, feeling things that are completely genuine? And then come back, and had no idea how to explain any of it to anyone?

This episode is about maladaptive daydreaming. Not regular mind-wandering. The kind where people spend four or more hours a day in a vivid internal world, hide it from everyone around them, and spend years being misdiagnosed with depression, anxiety, or ADHD because clinicians don't have a name for what they're actually describing.

We're looking at Soffer-Dudek and Somer's daily diary study, published in Frontiers in Psychiatry in 2018. The study tracked 77 people over 14 days and measured not just whether maladaptive daydreaming correlated with other symptoms, but which direction the relationship actually runs. What pushes someone toward the daydream? What gets worse the day after they come back? The findings point to a specific cycle, and they change how you think about why this is so hard to walk away from.

We also get into why this condition has lived without a clinical home for so long, what the treatment research actually says, and what the communities that formed around this knew before researchers found them.

This episode is for anyone who has felt the pull. And for anyone who loves someone who has.

Transcript

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Have you ever been in the middle of a conversation and realized that your mind has been wandering for the past ten minutes? You're not necessarily distracted, but you're somewhere very specific. It's very familiar with its own people, its own storyline, and its own emotions. You were in a meeting or you were eating or driving home and a part of you was completely somewhere else, living out something that felt more vivid, more real, more alive than any room that you were actually sitting in. It's very common to hear that I was daydreaming, and most people experience that occasionally. They're able to shake it off and come back. But for other people, that somewhere else is not a passing place. It's actually a destination. They've been going there since childhood. And they don't just go there for a couple minutes, they go there for hours every single day. They have characters there that they've known for years, storylines running so long that the characters have also aged alongside them. They feel real emotions, they laugh, they cry, they grieve things that happen to other people who don't exist outside their own mind. And the whole time they're sitting at a desk or walking down a street and nobody around them has any idea. In fact, they hide it so well from everybody, from their parents, their partners, their families, their colleagues, and most often even their therapists, because they've learned through enough dismissal, through enough blank looks and wrong diagnosis that most people don't have a map for what they're describing. And they're right, most clinicians may not actually have a clear map for what it is yet. This is called maladaptive daydreaming. And the reason most people haven't heard of it is not because it's rare, it's because it's been living without a clinical name for a very long time. Before I get into the research, I actually want to read you something. A researcher received this as an email from a 20-year-old student who was searching for years for someone who might understand what she was experiencing. She says, I have been lost in daydreams for as long as I can remember. Some daydreams involve people I know. Others don't include me at all. These daydreams tend to be stories for which I feel real emotions, usually happiness or sadness, which have the ability to make me laugh and cry. They're as important a part of my life as anything else. I can spend hours alone with my daydreams. I often feel as if I cannot turn off my mind. Running, walking, and driving are more effective at invoking daydreams than sitting or lying still. And I sometimes pace the floor of my room while I daydream. I'm careful to control my actions in public so it's not evident that my mind is constantly spinning these stories. I can sustain normal relationships with friends, co-workers, and family, although I often neglect those relationships in favor of replaying or elaborating on my daydreams. I am torn between the love of my daydreams and the desire to be normal. That's such an interesting line that she ends with. I am torn between the love of my daydreams and the desire to be normal. And honestly, this episode is based on that specific line. I'm your host, Nafisa Golwala. I'm not a clinician, I'm someone who believes good research deserves a wider audience and that most people, given clear and honest information, are capable of doing something meaningful with it. Today's paper is Scoffer Dudek et al. Trapped in a daydream. Daily elevations in maladaptive daydreaming are associated with daily psychopathological symptoms published in the Frontiers in Psychiatry in 2018. Okay, quick catch-up if you're new or coming back after a gap. We've been following an arc on autism spectrum disorder across the last three episodes. Today we're taking a little bit of a detour. And honestly, I want to stay here for a while. The masking episode is coming, I promise, but just not yet. I hope you're as excited about this episode as I am. Let's get into it. If you've listened to the Autism Spectrum Disorder episodes, you realize that I painted the scene using an airport. For this episode, I actually want to paint the scene for you in the ocean. So bear with me here. I want you to picture the ocean. Everyone's in it, swimming, floating, moving around. Most people drift a little. You wouldn't think anything of it. You think it's normal. But underneath the surface, in certain parts of the ocean, there's a current. Most people never feel it, but some people do. And once you felt it, once you know it's there and you know where the current takes you, the water never feels the same again. That current is what this episode is about. So let's talk about maladaptive daydreaming and how is it different from just having a rich inner life? That distinction matters because most people, when they hear about it, just say, but everyone daydreams. And they're right. Mind wandering is normal, it's widespread, and it probably serves as real functions. It helps people with creativity, planning, rest, finding meaning and experiences. A large study actually found that our minds drift from what we're doing in almost half of our waking thoughts. Half. So what we're learning here is that everyone's drifting. That's just like being in the water. But that's not the current. That's not what we're talking about. With maladaptive daydreaming, it's something specific. It's immersive, fanciful. It it goes on for hours every day and gets in the way of real relationships and responsibilities. And it genuinely causes the person distress and functional impairment. The key word is maladaptive. The daydreaming has stopped serving its purpose. The person dreaming has gone so far out that the shore is barely visible. And getting back is getting harder every single time. And what the current takes you to is very vivid and emotionally real. Some people describe elaborate storylines with characters they've known for years, characters who age, develop, have their own histories. Others describe idealized versions of themselves in scenarios the real world hasn't even given them yet. The emotional experience is genuine. People laugh, they cry, they feel things in that internal world as real as anything external. This is also not the same as like fanciful proneness, which is a related concept where some people have highly vivid daydreams, but may also believe in paranormal things, or they blur the line between fantasy and reality. People with maladaptive daydreaming almost universally know the difference between where the current's taking them and where they actually are. That awareness is actually part of what makes it so painful. It's because you know exactly how far out you've gone. You know how long you've been there, you know what's happening on shore while you're away, and the current doesn't stop pulling. Maladaptive daydreaming is not in the DSM V. The DSM V is the main diagnostic statistical manual that most clinicians use to diagnose individuals, and the research shows that there are no official diagnostic criteria most therapists would recognize. Researchers usually have proposed criteria, a structured clinical interview that has been developed, but most clinicians may not yet be familiar with. This part of the ocean is not on any official map. In episode one, we talked about what it means to be on the outside of the diagnostic system. We talked about how a diagnosis gives people language, access to support, a framework for treatment. Without it, people usually fall through the gaps. That's exactly what's been happening here for decades. Therapists have reportedly dismissed it, offered no help or treatment, or treated it as something else entirely. Either depression, anxiety, ADHD, disassociation. All of those may genuinely co-occur, but none of them name the current. So people found each other while threading water long before clinicians found them. Internet communities formed around shared experiences, over 10,000 members in one network alone. And the most common thing new arrivals said was, I finally found a description that fits. I thought I was the only one who felt this. This proves that MD is not a wellness trend. It's a clinical gap with the community quietly filling it. Let's go back into the ocean. You're fighting the current. You keep fighting the current. When you stop fighting the current, it doesn't feel like drowning. That's the thing people on the shore don't understand. It feels like relief. The resistance stops. The water carries you. You don't have to try anymore. You are in the warmest part of the ocean, moving in exactly the direction you want to go. From shore, you just look like someone floating. Nobody can really see how far out you've really gone. This study followed 77 people who identified as experiencing maladaptive daydreaming. Every evening for 14 days, they reported how intense their daydreaming had been, how many hours they'd spend in it, and a range of other measures, depression, anxiety, OCD, disassociation, social anxiety, positive and negative emotions. On average, participants reported spending over four hours in the current on a single day. More than a quarter of their waking time. Four hours. And most of them had jobs, studies, relationships, full lives running on shore alongside this. The current also has specific conditions that make it stronger. Two come up consistently in the research. Repetitive physical movement, such as pacing, rocking, rhythmic motion, and evocative music. These aren't random habits. They seem to be part of how the pull actually works for most people who feel it. The body gets involved, the music opens something, and then the water takes over. If you've ever watched someone pace and wondered where they went, this might be part of the answer. They found conditions that let them go. Now, here's what the surface doesn't show. 87% of participants were above the clinical threshold for suspected MD. Over two-thirds had been in therapy at some point. More than half had at least one psychiatric diagnosis, and I'm sure you guessed it anxiety, depression, PTSD, or ADHD. Almost half were unemployed. Over a quarter had attempted suicide at least once. These are not small numbers. This is not a quirky personality trait or a habit someone could stop if they really wanted to. This is a condition with serious clinical weight sitting largely unrecognized inside other diagnoses, visible from the shore as someone else entirely. On top of that, there is enormous shame attached to how far out people go. Communities built around MD identify three specific sources of distress. So the first step would be the difficulty controlling the urge to enter the water. The second, the way being out there interfered with real relationships and responsibilities. And the third, the exhaustive constant effort to keep it hidden from everybody, including the therapist they were paying to help them. Now, you might think that this is kind of strange. Hiding it from the person they went to for help, because experience had taught them that most people don't know that the current exists. But here is the part that any treatment approach has to reckon with. The water is genuinely good. That is not incidental. That is central to this condition. The experience feels rewarding in the moment, which is part of why it's hard to disengage even though there's so much distress around it. People with maladaptive daydreaming describe the daydreams as pleasurable, rewarding, addictive, not something they want to erase, something they are torn about. That quote from the opening said it exactly, torn between the love of my daydreams and the desire to be normal. That tension is not weakness. It is the honest shape of what this is. You cannot help someone leave the water by pretending it isn't warm. Any approach that treats the current as a problem to simply eliminate it is going to miss the reason swimming back is so hard. Here's what nobody tells you about the current. It doesn't just pull you out, it also pulls you back in. You swim to the shore, the shore is loud and uncomfortable and full of things that you don't like. And something about standing there, the friction, the pressure, the discomfort of just being present makes the water look very good again. And going back in makes the shore harder to tolerate when you return. That is not a metaphor for weakness. That is the mechanics of the undertow. This is the finding I want to spend the most time on because I think it is the most important in this paper and the least understood thing about this condition. The study wasn't asking whether MD correlates with other symptoms. It was tracking direction. Which symptoms are elevated the day before the current is strongest and which are elevated the day after. That is a completely different and much more specific question, and the answers change how you think about the whole condition. First, what happens on the same day the current is at its most intense? On days when MD was highest, every single measure was worse. More disassociation, more OCD, more depression, more anxiety, more social anxiety, more negative emotions, less positive emotions. Every variable in the expected direction. The current doesn't travel alone, it carries everything with it. That tells you something about the weight of it, but it doesn't tell you which way the water flows. So the researchers asked, what is elevated the day before the current is strongest? What is pushing someone towards the water? Out of everything measured, depression, anxiety, social anxiety, disassociation, negative emotions, one thing consistently predicted a high MD day the following day. Obsessive compulsive symptoms. OCD consistently across both how intense the daydreaming was and how many hours were spent in it. Okay, so say for example you have OCD symptoms on Tuesday. The current gets stronger on Wednesday, the urge, the checking, the mental repetition, the sense that something is unresolved and won't let go, and the next day, the pull towards the water intensifies. And then the other direction, what's elevated the day after someone has been far out in the current? Three things went up on the day following intense daydreaming, even after controlling for same-day levels. OCD symptoms, again, the shore gets more uncomfortable the day after you've been in the water, disassociation, that slightly untettered feeling of not being fully present in your own body, of things not of not quite landing as solid or real, and negative emotion, the shame, the regret, the full awareness of how far out you went and how long you were there. So here is the undertow laid out plainly. Something on the shore gets uncomfortable. The pull towards the water strengthens. You go in, you come back, and the shore feels worse than when you left. The OCD symptoms higher, the disassociation pulling you slightly away from yourself, the shame of how far you went sitting on top of it all, which makes the water look better, which makes the shore harder, which then strengthens the current again. The undertow doesn't just pull you out, it pulls you back in the moment you try to return. The researchers call this a vicious cycle, OCD symptoms and MD reinforcing each other, each one feeding the next. They point to serotonin regulation as a plausible shared mechanism. One case study treating a patient with MD using an SSRI for over 10 years, reportedly helping to control the pull towards the water. That's one case, not a recommendation, but a medication influencing serotonin. Serotonin helping is a meaningful signal. It suggests shared neurochemistry underlying both the OCD symptoms and the current itself. The disassociation piece deserves its own moment here. Spending hours immersed in an internal world, especially attending to characters who are not you, appears to compromise the sense of presence in reality the following day. The paper suggests that inhabiting non-self entities in a vivid internal narrative may impair normal embodiment, your sense of being in your own body, of your experience belonging to you. You come back from a long drift and the ground doesn't feel entirely solid under your feet. And the water, which is warm and familiar and exactly what you know, is right there. Nobody learns to swim back by being told the water is bad. You know the water is bad. You have you've known it longer than almost anyone on the shore has known you. The question is not whether the current is real, it is. The question is whether someone can help you build the strokes that get you back, and whether the shore can become somewhere worth returning to. What does the research say about what might actually help? The honest answer is first, this is very early. There is no large randomized control trials for treating MD. It is not in the standard diagnostic manual. Most clinicians are working without a map of this part of the ocean. The paper is clear about that. I want to be clear about that too. But the findings point in specific directions. So, because OCD symptoms are both what pushes someone towards the water and what rises after they return, the research suggests approaches developed for OCD, specifically exposure and response prevention, ERP, although the evidence is still early. The core idea is learning to stand at the water's edge when the current is pulling you and not go in. To sit with the discomfort of the urge rather than resolving it by entering the water. One case study applied ERP informed techniques directly to MD, including deliberately changing the endings of daydream narratives to aversive ones, reducing their pull. This is way too early to make any causal conclusions, but the rationale comes directly from what this study found about the OCD cycle and how the undertoes work, which is also something that we discussed. Mindfulness training also appears as a direction and it says it tackles the problem directly. Staying present on the shore, being in your own body in the moment you're actually in, which essentially just means to stop following the current, it has shown benefit for OCD symptoms, which, as we've established, is the mechanism that strengthens the pull in the first place. On the neurochemical side, the SSRI case study, while just one case points somewhere. A patient treated with fluvoxamine for over 10 years found it helped control the pull towards the current. SSRIs affects serotonin. However, this is just one case study that found improvement, which raises the possibility of shared biological mechanisms, but it's not conclusive. But that response is a signal pointing towards shared biology between MD and OCD spectrum disorders. It tells us something about what the current is actually made of, even if we don't have the full picture yet. And then there's the community, which the clinical data cannot fully capture, but which this paper makes visible. People found others who felt the same current before researchers knew it existed. They built spaces online, found language for something without a clinical name, and showed up for scientific studies motivated not by payment. There were none. But by wanting to advance understanding of something they knew was real. The research that exists happened partly because people who felt the current decided to help map it. Finding even one other person who knows the water, who knows what the current gives you and what it costs changes what it means to be standing on the shore. It doesn't eliminate the pool, but you're not the only one who's ever felt it. And that matters more than most clinical frameworks account for. The paper closes with a call more rigorous research, larger samples, validated diagnostic tools in the hands of clinicians who have been trained to look for this. Because right now, the people most affected are sitting in therapy for depression or anxiety, both of which are real, but without anyone naming the current. And you cannot help someone learn to swim back from something you don't even know they're in. Okay, so that was a lot of information. Let's summarize what this paper gave us. This paper gave us a name for something that has been moving underneath the surface of clinical practice for a very long time. It gave us a picture of the daily mechanics, what pushes someone towards the current, what it costs to come back, why the undertow keeps running, why the pull gets stronger the moment you try to leave the water. It gives us early directions for treatment. And it gives us evidence that this is real, not a character flaw, not a failure of discipline, not something a person could stop by just deciding to. It's a condition with a cycle, with a community that already knew it existed long before the clinical world started looking. If you're a parent or you care for someone, if there is a person in your life who seems to disappear for hours, who paces in music in their room, who is present but somehow always somewhere else, this research might be part of what you've been missing. It doesn't explain everything, but it names something. And something matters. If you recognize the current from the inside, if you heard that quote in the opening and something in you went very quiet, this is for you. You're not the only one who has spent years hiding it. You're not broken. Not failing at reality. There is a name for what you feel. There are people working on how to help. And there is a community of people who have been in the same water and know exactly what it's like to be torn between staying and coming back. And if you're here honestly because you want to understand, because someone you love has been out there longer than you know, the most useful thing you can offer is not telling them to come back. It's making the shore somewhere worth returning to. We said we were gonna go into masking next. And we will get there. But for now, I want to stay in this space for a little longer. There's more here worth exploring. So I'll see you in the next one. And remember, things can be redesigned. They just have to be built brick by brick.