Maladaptive Daydreaming in Light of fMRI Findings

Written by: Ayşe Ela Erol

Edited by: Ayush Halder

(Image from: https://medium.com/@ayieragwendo/maladaptive-daydreaming-1268b1d6d67d)

Introduction

Daydreaming is one of the most ordinary yet mysterious activities of the human mind. Most of the time, it is harmless, even seen as part of creativity and problem-solving. However, in some cases, daydreaming can exceed its function and become a difficult-to-control state that disrupts a person's relationship with reality. The concept used in recent years to describe this condition is maladaptive daydreaming (Somer, 2002).

Maladaptive daydreaming is a condition characterized by a person's immersion in prolonged, intense, and highly detailed fantasy worlds (Somer, 2002). Individuals consciously maintain these daydreams, which are typically vivid and follow recurring themes. The common problem is that this mental activity significantly impacts a person's academic, social, or emotional functioning. Although classification systems such as the Diagnostic and Statistical Manual of Mental Disorders (DSM) have not yet included maladaptive daydreaming as an official diagnosis, a growing number of studies in psychology and neuroscience in recent years show that this phenomenon has characteristics too distinct to dismiss as simply "daydreaming too much" (Somer et al., 2016).

The study examined in this article is one of the rare works that investigates maladaptive daydreaming using brain imaging techniques (Mamah et al., 2025). It presents a detailed case analysis based on the experience of a 20-year-old woman and offers important clues about the possible neurobiological foundations of maladaptive daydreaming.

(Mamah et al., 2025)

The Case Study

The story of the case study’s participant clearly illustrates how maladaptive daydreaming can affect daily life (Mamah et al., 2025). The participant reported experiencing increasingly prolonged and intense daydreaming episodes from childhood and adolescence onward. These daydreams typically revolved around specific narratives, containing recurring characters and scenarios. For example, one excerpt from the study describes the situation as follows:

Her daydreams often involved fantastical and romantic elements, including a male character who was a mix of a real person and an animated character, with whom she had a relationship. At other times, she daydreamed about living as a successful professional. Although she generally felt happier when immersed in her fantasy world rather than engaging with reality, she was sometimes troubled by feelings of guilt about being in an imaginary relationship. (Mamah et al., 2025).

The daydreaming process distorted her sense of time and caused her to disconnect from daily responsibilities, negatively affecting her academic performance and social relationships.

The researchers also examined this individual's clinical history in detail (Mamah et al., 2025). The case shows depressive symptoms and obsessive features accompanying maladaptive daydreaming. This is significant because maladaptive daydreaming frequently co-occurs with other psychiatric conditions, which complicates the differential diagnosis (Somer et al., 2016). The core aim of the study is to question whether maladaptive daydreaming can be addressed independently of these co-occurring conditions.

One of the most striking aspects of the study is the observation of how different psychotropic medications affect maladaptive daydreaming (Mamah et al, 2025). As shown in Figure 1, some drugs affecting the dopaminergic system appear to increase daydreaming behavior, while certain antipsychotic medications appear to reduce its intensity. This finding suggests that maladaptive daydreaming may not merely be a psychological habit but may also be related to neurochemical processes. Particularly given dopamine's relationship with reward, motivation, and internal thought processes, these results provide a meaningful framework (Mamah et al, 2025).

Figure 1

Daydreaming severity over time in response to medication

Note. Figure presents the patient's estimated daily maladaptive daydreaming duration throughout a 120-week treatment period alongside psychopharmacological interventions. Symptom severity decreased markedly following treatment with antipsychotic agents (aripiprazole, risperidone, and lurasidone) and increased during periods involving dopaminergic medications (lisdexamfetamine and bupropion), highlighting a possible dopaminergic contribution to maladaptive daydreaming symptom expression. (Mamah et al., 2025)

Figure 2

Cortical surface maps and distribution plots comparing the reported maladaptive daydreaming (MD) case with a normative reference sample.

Note. Panels A and B display the left and right hemispheres, respectively, with colored vertices indicating regions showing unusually large (red) or small (blue) functional network sizes relative to the reference cohort. Panels C and D present scatterplots and histograms illustrating the distribution of network size measurements across the normative sample, with the MD case highlighted. The findings demonstrate marked deviations in cortical network organization, particularly within higher-order association networks. (Mamah et al., 2025)

Figure 3

Functional network parcellation of the cerebral cortex in the reported maladaptive daydreaming case.

Note. Distinct colors represent canonical large-scale brain networks, including the Default Mode, Frontoparietal, Dorsal Attention, Salience, Language, Sensorimotor, Visual, Auditory, and Cingulo-opercular networks. Lateral and medial views of both hemispheres are shown. This individualized network map illustrates the spatial distribution and organization of functional brain systems in the participant. (Mamah et al., 2025)

Table 1

Comparison of functional network sizes

Note. Percentile rankings of functional network sizes in the maladaptive daydreaming case relative to three comparison cohorts: the Human Connectome Project Young Adult sample (n = 1003), a second healthy control cohort (n = 27), and a psychiatric cohort with schizophrenia and bipolar disorder (n = 41). The left Default Mode Network falls within the upper percentile range (97.6th–99.9th percentile), whereas the left Frontoparietal Network falls within the lowest percentile range (0.1st–1.9th percentile), indicating unusually large Default Mode and unusually small Frontoparietal network representations relative to both healthy and clinical comparison groups. (Mamah et al., 2025)

Perhaps the most novel contribution of the research is the functional magnetic resonance imaging (fMRI) findings (Mamah et al, 2025). The researchers analyzed the fMRI data using resting-state network analyses to study patterns of neural activity across brain regions that work together while the brain is at rest. The study found that the default mode network, the network associated with internal thought and daydreaming, was markedly expanded in the individual with maladaptive daydreaming (Mamah et al., 2025). In contrast, the frontoparietal network, associated with attention and cognitive control, was found to be weaker.

These findings make a neurobiological explanation of maladaptive daydreaming possible. When the default mode network is dominant, the mind orients toward internal thoughts rather than external stimuli. If cognitive control networks cannot sufficiently regulate this inward orientation, the person may spend extended periods in their fantasy world. This also explains why those affected often describe maladaptive daydreaming as an "uncontrollable" experience (Mamah et al, 2025).

Implications

The significance of this case study lies in its treatment of maladaptive daydreaming not merely as a subjective experience but as a phenomenon linked to measurable brain processes. Of course, researchers cannot draw generalizations from a single case, but studies like this provide an important starting point for future large-scale research. In particular, this kind of neuroimaging data allows researchers to discuss whether maladaptive daydreaming constitutes a separate clinical entity.

Conclusion

The study demonstrates that maladaptive daydreaming is too complex a phenomenon to reduce to mere "excessive daydreaming" (Somer, 2002; Mamah et al., 2025). To fully understand this condition, researchers and clinicians must consider the interplay among brain networks, neurochemical processes, and subjective experience (Raichle et al., 2001; Mamah et al., 2025). This case is a reminder that maladaptive daydreaming demands serious clinical and neuroscientific attention.

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References

Mamah, D., Chen, S., Gomez-Lopez, A., & Alexander, S. (2025). A pharmacotherapeutic and neuroimaging case study of maladaptive daydreaming. Psychiatry Research Case Reports, 4(1), 100249. https://doi.org/10.1016/j.psycr.2025.100249

Raichle, M. E., MacLeod, A. M., Snyder, A. Z., Powers, W. J., Gusnard, D. A., & Shulman, G. L. (2001). A default mode of brain function. Proceedings of the National Academy of Sciences, 98(2), 676–682. https://doi.org/10.1073/pnas.98.2.676

Somer, E. (2002). Maladaptive daydreaming: A qualitative inquiry. Journal of Contemporary Psychotherapy, 32(2–3), 197–212. https://doi.org/10.1023/A:1020597026919

Somer, E., Lehrfeld, J., Bigelsen, J., & Jopp, D. (2016). Development and validation of the Maladaptive Daydreaming Scale (MDS). Consciousness and Cognition, 39, 77–91. https://www.sciencedirect.com/science/article/abs/pii/S1053810015300611?via%3Dihub