Obsessive compulsive disorder - OCD treatment and therapy from NOCD

Maladaptive Daydreaming and OCD

By Andrea Fine

Dec 29, 20227 minute read

What is maladaptive daydreaming?

Sometimes people who struggle with OCD will also struggle with something called Maladaptive Daydreaming. Maladaptive Daydreaming (MD) is when a person makes a conscious decision to retreat into a world of fantasy or a narrative daydream. This use of their imagination can be an unrestricted way to escape fear. In some cases, it is a way to escape the anxiety caused by obsessions in OCD. 

Maladaptive Daydreaming is not a recognized mental health disorder at this time. There is a need for more peer reviewed research on this topic, but it is starting to become well known in the world of psychology and mental health. The phrase was coined in 2002 by Eli Somer, an Israeli Professor of Clinical Psychology at the University of Haifa. There is some thought that Maladaptive Daydreaming can be a coping or safety-seeking behavior for people with OCD, ADHD, and trauma and anxiety disorders. Maladaptive Daydreaming is a way for a person to dissociate from the reality of their day to day life. It is considered maladaptive because it can interfere with a person’s social life, work, and mental health, becoming compulsive and excessive. A person who engages in MD may even spend hours engaging in an imagined world filled with specific plots, characters, and settings. 

Consider an example: 

Jed works in the computer industry, and struggles with moral scrupulosity and perfectionism themes in OCD. Throughout his life he has also had what his parents, teachers and other loved ones would call an “active imagination.” 

When he was younger, Jed imagined a world of fantasy and adventure where he was the main character. In this fantasy he would need to rescue someone (usually a friend or crush from school). There would be obstacles to face like evil magicians and monsters that Jed would spend hours crafting the details in his mind. In the end of the fantasy, Jed would rescue the friend and be deemed a hero, loved by all. Often Jed would act out movements from his daydream, or whisper phrases that character’s might say. Jed would sometimes have facial movements or twitches when he engaged in his daydreams. 

As Jed got older the content of his daydreaming changed. These daydreams were like going to the movies. Jed would choose to enter the world of his daydream when he was anxious. If his OCD symptoms were loud, he couldn’t wait to just lay in his bed and enter his imaginary world. He would become distressed if he was in a daydream and was interrupted by a parent, friend or teacher. The older he got, the more isolated he became from the world around him. He now goes to work and often finds himself slipping into his daydream world. He will spend hours thinking about the details of his imagined world. 

The problem is that Jed’s OCD has gotten worse. He feels like whenever he has intrusive thoughts of acting wrongly or struggles with perfectionism and repeating behaviors at work, he needs to escape into his world of fantasy in order to feel okay. His maladaptive daydreaming has become a compulsion, and it interferes with nearly every area of his life. His work is affected and he often feels like he is losing time. His daydreams are an escape from reality and fear. In his scenarios there is no need to feel anxious or face consequences of hard choices. 

This maladaptive pattern is causing problems in his relationships with his parents, friends, and coworkers, and people wonder why he has no desire to engage with them. Jed knows that if he engages in his real relationships there is a chance his OCD will be triggered. He would rather avoid triggers and live in the world he creates. 

Common behaviors in Maladaptive Daydreaming include:

  • A strong urge to engage in daydreams 
  • Trouble concentrating on things in the real world
  • Loss of time spent daydreaming
  • Dissociation from reality
  • Trouble focusing or getting work done
  • Acting out behaviors in daydream, repetitive movements, whispering or talking to oneself
  • Becoming irritated if a daydream is interrupted 
  • Urges to “finish the story” in the daydream
  • Using MD as an escape from anxiety, distress, or trauma

A person with OCD might use MD to escape or distract from their fears, and MD can be a safety behavior or compulsion in OCD. MD can be triggered by other things as well, including any source of distress, discomfort, or anxiety.

Currently there is no official diagnosis for Maladaptive Daydreaming. However, as more research surfaces, it is apparent that more information about Maladaptive Daydreaming is needed. A scale has been developed by experts to use as an indicator of MD behaviors, but it is not a diagnostic tool. This is called the Maladaptive Daydreaming Scale, or MDS.

Common obsessions

OCD is characterized by a cycle of obsessions, anxiety and distress caused by obsessions, and compulsions done in an attempt to relieve this anxiety and distress. Obsessions are intrusive, unwanted thoughts, images, or urges that are often persistent.

MD can be used as a safety behavior or compulsion in any subtype of OCD. As a result, obsessions experienced by people with OCD who turn to Maladaptive Daydreaming as a safety behavior or compulsion may vary greatly. 

Maladaptive Daydreaming as a compulsion or safety behavior:

When people with OCD experience obsessions and fear, they often engage in compulsions in an attempt to find certainty or relieve anxiety. Although compulsions may temporarily reduce anxiety or distress, they lead to increasingly more distress, anxiety, and uncertainty in the long run. Engaging in compulsions reinforces the idea that the obsessions pose a threat or danger, so the more a person engages in compulsions, the more persistent and distressing their obsessions become. A person with OCD becomes trapped in this vicious cycle of distress, anxiety, and uncertainty.

Maladaptive daydreaming is a compulsion for some people with OCD. A person with OCD might engage in maladaptive daydreaming because they feel that it is the only time they can escape the fear and anxiety caused by OCD. Because of their OCD obsessions and fears, they may feel that the real world is too scary or dangerous, and believe they can only feel safe in their daydreams. 

How do I know if I’m using MD as a compulsion or safety behavior in OCD, and not something else?

To better determine if you’re struggling with OCD, it’s important to take a look at the diagnostic criteria for OCD. To help determine if you may be struggling with OCD, you can ask yourself the following questions:

  • Are you experiencing unwanted, intrusive thoughts, images, or urges? How persistent are they?
  • Do you engage in actions to reduce or eliminate distress or anxiety or prevent a feared outcome?
  • How much time do your obsessions and compulsions take? Do they take up more than an hour per day on average?
  • Do obsessions and compulsions cause significant levels of distress?
  • Do obsessions and compulsions impact your daily functioning

Access therapy that’s designed for OCD

I’ve personally helped many people who struggled with OCD regain their lives. I encourage you to learn about accessing ERP therapy with NOCD.

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How to treat maladaptive daydreaming

OCD involving compulsive maladaptive daydreaming can be debilitating, but all presentations of OCD are highly treatable, and treatment of underlying OCD can also help you reduce compulsive behaviors like MD. ERP is the leading evidence-based treatment for OCD and it has been empirically validated by decades of clinical research. 

By doing ERP over time, most individuals experience a decrease in OCD symptoms, reduced anxiety and distress, and improved confidence in their ability to confront their fears and tolerate anxiety. In ERP, the trained therapist will work with you to build a hierarchy of your OCD fears. The therapists will guide you in gradually facing your fears, starting with the fears that are less anxiety-provoking and building up to more anxiety-provoking fears as you learn the process of ERP and build confidence. When you practice exposures, you then resist engaging in compulsions and safety behaviors, including MD, in response. Modification or reduction of compulsions may also be used, such as purposely creating negative outcomes in MD before resisting it altogether.

If you’re struggling with OCD, As an OCD specialist, I’ve used ERP to help many people regain their lives from OCD. I encourage you to learn about NOCD’s accessible, evidence-based approach to treatment with the NOCD care team to learn how a licensed therapist can help. At NOCD, all therapists specialize in OCD and receive ERP-specific training. ERP is most effective when the therapist conducting the treatment has experience with OCD and training in ERP.

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