Diagnosing Maladaptive Daydreaming Disorder – Part 2

In last week’s post, I reviewed the MDS-16, which is a simple questionnaire that anyone can complete to get a feel for whether their daydreaming could be classified as maladaptive. On the ICMDR website there is also a link to the Structured Clinical Interview for Maladaptive Daydreaming (SCIMD). The ICMDR website recommends that “To establish if an individual [scoring over 50 on the MDS-16] meets the suggested diagnostic criteria for MD, the person should be interviewed with the Structured Clinical Interview for Maladaptive Daydreaming (SCIMD)”. In other words, although the MDS-16 gives a good indication of whether someone has Maladaptive Daydreaming Disorder (MaDD), it shouldn’t be used on its own but should be followed by an interview with a health professional knowledgeable about MaDD who will then make the diagnosis. Given the general lack of awareness about MaDD, this could be a barrier to diagnosis for many people, but because the SCIMD is freely available online, you can still make a guess as to whether you would receive a diagnosis of MaDD following such an interview.

The SCIMD begins with a clear concise definition of daydreaming:

…we define daydreaming as fantastical mental images and stories that are not currently part of your life. With fantastical we mean that the content of the experience is wishful or unrealistic in some way. For example, imagining hanging out with a favorite celebrity, winning a gold medal in the Olympics (unless you are an Olympic level athlete), having a romantic affair with an attractive co-worker, who is not interested in you, living in a parallel fantasy world, imagining violent, scary or tragic events that had never happened to you, engaging in heroic or rescue actions, or any daydreams involving either fictional characters or real people in scenarios that wouldn’t happen in real life

The MDS-16 doesn’t delve into what we daydream about, but instead is more focussed on the amount of time spent daydreaming and the level of control we have over it. But I have always felt that daydreaming about things that “are not currently part of your life” or “scenarios that wouldn’t happen in real life” is what sets immersive and maladaptive daydreamers apart from normative daydreamers. So it’s helpful to have this set out so clearly at the beginning of the SCIMD.

The questions in the SCIMD are divided into four sections:

Section A

Section A asks about the nature of the daydreams, how often we daydream and how long we have daydreamed for. The questions in section A should clearly differentiate immersive/maladaptive daydreamers from normative daydreamers. There is also a special category for people who have been daydreaming for less than six months, which is a subtle acknowledgement that for many of us, our unique style of daydreaming begins in childhood and persists throughout our lives.

Section B

Section B investigates how we daydream and how it affects other aspects of our lives. There are eight questions and only if all eight are “no” would a diagnosis of MaDD be ruled out. The questions are wide-ranging, and although I suspect maladaptive daydreamers will score more highly on this section than immersive daydreamers, both maladaptive and immersive daydreamers are likely to answer yes to question 1 “While daydreaming, have you experienced an intense sense of immersion (being completely absorbed), that includes visual, auditory (sound) or affective (feelings and emotional) properties?”. Because of the way the SCIMD is evaluated, a “yes” answer here effectively renders the rest of the questions in section B irrelevant.

Section C

This is the key part of the SCIMD. There is only one question, and it must be answered “yes” for a diagnosis of MaDD to be made:

Does your daydreaming cause significant distress or does it impair your social, academic, occupational, or other important areas of functioning?

This question differentiates maladaptive daydreamers from immersive daydreamers. It reflects a common theme in psychology that for something to be classified as a disorder, it must involve suffering. No matter how unusual your thought patterns, if you are happy and successful, you don’t have a disorder.

Section D

The final part of the SCIMD checks that the daydreaming is not better explained by some other condition. There are no fixed questions in this section, and I assume the exact questions asked would depend on what other condition the interviewer suspects that the person being assessed might have. However, it is worth noting that a 2017 study found a high rate of comorbidity among maladaptive daydreamers. For example, 76.9% met the criteria for ADHD, 71.8% anxiety and 66.7% depression. So it is clear that a diagnosis of MaDD can be made alongside other mental health diagnoses.

In summary, sections A and B establish that the daydreaming is immersive/fantastical in nature (i.e. these sections should rule out normative daydreamers). Section C asks whether the daydreaming causes distress or prevents someone from living their best life – this will distinguish maladaptive daydreamers from immersive daydreamers. Maladaptive daydreamers will be rated “yes” on sections A, B and C. Immersive daydreamers will only be rated “yes” on sections A and B.

If you want to use the SCIMD yourself to judge whether your daydreaming would be classified as immersive or maladaptive, I suggest focussing on two points:

1) If you relate to the paragraph at the beginning of the interview (quoted above) as being descriptive of the way you daydream most or all of the time, then you are very likely to be either an immersive or a maladaptive daydreamer.

2) If you answer yes to the question in section C, you could justifiably consider your daydreaming to be maladaptive. If you answer no, you are more likely to be an immersive daydreamer.

It’s worth pointing out that distress and functional impairment are both, to a certain extent, subjective. You are the best person to judge how your daydreaming affects you, and therefore arguably, how you classify your daydreaming is the only “diagnosis” that matters. If your daydreaming upsets you, you are perfectly entitled to consider yourself a maladaptive daydreamer, even without discussing your situation with a mental health professional. On the other hand, if you enjoy your daydreaming and don’t feel it hampers you, then you shouldn’t let anyone else convince you that there is anything wrong with it.

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