In the Somer and colleagues ( 12) study, the frequency of dissociative disorders in the sample of maladaptive daydreaming participants was 12.8%. Fully understanding the relationships between two disorders requires knowing the rates of comorbidity in both directions. Also, if disorder A is commonly comorbid with disorder B, but B is rarely comorbid with A, this will affect the need to measure both disorders in research, depending on whether disorder A or B is the focus of the research. The relative rates of comorbidity may increase the index of suspicion for the other disorder more in one direction than in the other. To date, no studies have reported on the reciprocal relationships between maladaptive daydreaming and disorders comorbid with it: how frequent is maladaptive daydreaming in samples of individuals with various Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM‐5) disorders ( 27)? It is important to know the frequency of comorbidity between two disorders in both directions because disorder A may commonly accompany B while disorder B rarely accompanies disorder A. At this point, these are simply clinical observations and thoughts, not formal theories. Perhaps, in a subset of individuals with maladaptive daydreaming, attention deficit hyperactivity disorder is a consequence of so much attention being turned to daydreams and the inner world. Clinically it appears that maladaptive daydreaming often provides an escape from life circumstances that are depressing and anxiety‐provoking, and the daydreaming is often described as being compulsive in nature. At present, the authors do not have a theory to explain why these are the most common forms of comorbidity. The most frequent forms of comorbidity in maladaptive daydreaming, in one study, were attention deficit hyperactivity disorder (76.9%), anxiety disorders (71.8%), major depressive disorder (56.4%), and obsessive‐compulsive disorder (OCD 53.9% 12). The daydreaming has an addictive or compulsive aspect to it, but the person realizes that it is an internal fantasy world and does not confuse the fantasy with external reality. The daydreaming involves a complex inner world with many characters and elaborate plots. It can be differentiated from normal daydreaming with both self‐report measures and a structured interview that incorporates proposed diagnostic criteria for the disorder ( 11, 13). Somer and colleagues ( 12) found that maladaptive daydreaming is characterized by extensive daydreaming that occupies many hours per day, causes significant subjective distress and interferes with function, and is accompanied by extensive comorbidity ( 12). Maladaptive daydreaming may help us understand cases of dissociative identity disorder with large numbers of ‘personalities’. Inversely, individuals with dissociative disorders have high levels of maladaptive daydreaming. Individuals with maladaptive daydreaming have high levels of dissociation.
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