The Role of Internalized Stigma and Self-Esteem in Maladaptive Daydreaming (MD)

It shouldn't be too surprising that my focus tends to veer into the Inattentive ADHD. 

On one hand the Hyperactive and Impulsive side of ADHD is relatively well established, with a strong focus on behavioural challenges, but little attention is paid to the internal maelstrom that tends to be our inner world.

This journey started out in Mind-wandering, but a recent research article (The Daydream Spectrum*) introduces us to the concept of Maladaptive Daydreaming - an escape into fantasy as a means of avoidance and escapism.

While the article focuses on MD, internalised stigma and self-esteem, it is worth considering how this impacts on social anxiety.

The article primarily examines how emotional dysregulation, internalised stigma, and self-esteem contribute to maladaptive daydreaming (MD) in adults with ADHD, autism spectrum disorder (ASD), and a dual diagnosis (AuDHD). Among these, internalised stigma and self-esteem play critical roles in the prevalence and intensity of MD.

Internalised Stigma and Maladaptive Daydreaming

Internalised stigma refers to the process by which individuals accept and integrate the negative stereotypes and prejudices of society about their condition.

For neurodivergent individuals, including those with ADHD and ASD, internalised stigma can stem from the social exclusion, discrimination, and misconceptions about their abilities and behaviours.

In this study, internalised stigma was significantly correlated with maladaptive daydreaming across all groups (ADHD, ASD, and AuDHD). People who internalised negative societal views about their neurodivergent condition were more likely to use daydreaming as an avoidance or escapist mechanism.

Daydreaming can act as a compensatory mechanism for the negative emotions triggered by stigma. Many individuals create idealised fantasy worlds to cope with feelings of rejection, alienation, or shame, particularly those linked to social situations where they feel misunderstood or judged.

In this context, MD allows them to dissociate from the real-world pain caused by stigma, imagining scenarios where they are more successful, socially accepted, or heroic.

Self-Esteem and Maladaptive Daydreaming

The study also found a strong link between low self-esteem and maladaptive daydreaming. Self-esteem in this context is divided into two dimensions:

• Self-liking: A sense of being socially valuable or worthy.
• Self-competence: A belief in one’s ability to accomplish tasks and achieve goals.

Neurodivergent individuals often experience low self-esteem due to both their personal struggles with executive function and the external reinforcement of failure or inadequacy through stigma.

The researchers found that individuals who scored lower on self-esteem measures were more likely to engage in maladaptive daydreaming.

The daydreaming functions as a way to temporarily boost their self-perception, allowing them to experience imaginary successes or validation that they don’t experience in reality.

Interestingly, self-liking (feeling socially accepted) predicted maladaptive daydreaming in the ADHD group, while self-competence (a sense of efficacy) was more relevant in the ASD group.

This distinction suggests that while ADHD individuals might fantasise to feel more accepted or socially valuable, those with ASD might use MD to compensate for a perceived lack of real-world competence or goal achievement.

Maladaptive Daydreaming and Social Anxiety

Although the study didn’t directly link social anxiety with MD, the findings strongly suggest such a connection. Social anxiety, often characterised by a fear of judgment or rejection in social settings, aligns with the avoidance tendencies described in MD.

The article discusses how MD helps individuals escape negative social experiences, which parallels the avoidance behaviours seen in social anxiety.

Individuals with both ASD and ADHD are at heightened risk for social anxiety disorder (SAD) due to difficulties in social interactions and executive dysfunction.

The internalization of social stigma could exacerbate this anxiety, causing individuals to retreat into fantasy worlds to avoid the emotional pain of real-world social interactions.

One could hypothesise that internalised stigma not only fosters self-criticism but also amplifies social fears of rejection or judgment, which, in turn, could contribute to both increased social anxiety and the likelihood of engaging in MD.

Supplementary research has shown that low self-esteem is one of the strongest predictors of social anxiety.

The role of shame and self-criticism in social anxiety disorders further underscores this connection, suggesting that MD could provide a temporary relief from the emotional stress of social interactions for neurodivergent individuals.

Maladaptive Daydreaming: Is There an Overlap with the Default Mode Network?

The article defines maladaptive daydreaming (MD) as a form of daydreaming characterised by:

1. Vivid fantasy: An immersive and often elaborate alternative world.
2. Time-consuming nature: Daydreaming becomes difficult to control and interferes with daily functioning.
3. Emotional consequences: Individuals experience distress when interrupted, and the daydreaming often acts as an avoidance mechanism to manage emotional pain.

This definition raises important questions regarding whether MD is a distinct phenomenon or part of an overactive default mode network (DMN), the brain system responsible for spontaneous, self-generated thought, such as mind-wandering.

The DMN is activated when individuals are not focused on external tasks and is thought to be the neural basis for daydreaming and mind-wandering.

However, the key difference between maladaptive daydreaming and the DMN-related mind-wandering could lie in the emotional intensity and content of the fantasies.

• Maladaptive Daydreaming: Involves elaborate, goal-oriented fantasy, often filled with emotion and vivid imagery. It is an intentional escape into an imagined world, which can be emotionally gratifying but disruptive.
• Overactive Default Mode Network (DMN): In contrast, DMN-related mind-wandering often involves fragmented, fleeting, and less structured thoughts that may not have the narrative or emotional intensity of MD. The DMN’s activation typically happens when people are resting or not engaged in focused tasks, but the content may be more neutral or related to simple distraction, rather than deliberate fantasy.

The key distinction is that MD is purpose-driven (even if subconscious) and emotionally loaded, whereas mind-wandering linked to an overactive DMN is often spontaneous and less organized.

Furthermore, MD can cause distress, especially when the individual feels out of control or the daydreaming interferes with real-world responsibilities, something not typically seen with DMN activity.

The DMN and MD: A Blurred Line?

While MD is defined as distinct, the distinction might not be as clear-cut as suggested.

Research shows that people with ADHD, for instance, have an overactive DMN, which can lead to excessive mind-wandering. There is a possibility that in some cases of ADHD or ASD, the overactivity of the DMN might develop into structured and vivid daydreams if the brain is primed to seek emotional or psychological compensation through elaborate fantasy.

Broadening the Understanding of Maladaptive Daydreaming

While the study gives us a good understanding of the factors contributing to MD, particularly internalised stigma and self-esteem, there’s still much to explore. Maladaptive daydreaming appears to be a more extreme and emotionally charged form of daydreaming than mind-wandering related to an overactive DMN.

Future research could further explore how social anxiety interacts with MD and how emotional and executive dysfunction might cause the DMN to shift from random mind-wandering to structured fantasy.

Understanding these connections could have practical implications for addressing escapism, emotional dysregulation, and the stigma that drives people into these excessive fantasies in the first place.

*Pyszkowska, A., Nowacki, A., & Celban, J. (2024). The Daydream Spectrum: The Role of Emotional Dysregulation, Internalized Stigma and Self-Esteem in Maladaptive Daydreaming Among Adults With ADHD, ASD, and Double Diagnosis. Journal of Attention Disorders, 0(0). https://doi.org/10.1177/10870547241290901