Maladaptive Daydreaming: Ontological Analysis, Treatment Rationale; a Pilot Case Report

This paper describes the course of psychotherapeutic treatment of a 25-year-old man presenting with maladaptive daydreaming (MD), from analysis of the underlying rationale through the treatment process to the outcomes. MD, a condition marked by highly absorptive daydreaming , consumed many hours of his day and produced distress, dysfunc-tion, and excessive Internet use. Ontological analysis resulted in classifying MD characteristics under several categories: as a dissociative disorder of absorption, as a behavioral addiction, and as an obsessive-compulsive spectrum disorder producing significant attention deficits. The therapy plan was derived from evidence-based treatment modalities for conditions elucidated in the ontological analysis and included cognitive behavioral interventions as well as mindfulness meditation. Therapy was provided for a predetermined period of six months. MD and relevant indices were measured before and after therapy, as well as at a two-month follow-up. The data show that the client was able to reduce his daydreaming time by over 50% and his time spent on the Internet by over 70%. He reported an improvement of over 70% in his work and social adjustment. Nevertheless, his maladaptive daydreaming scale score and his self-assessed pleasure derived from daydreaming showed more modest gains. I discuss this discrepancy and suggest future research directions.