Imaginative absorption in schizophrenia: a phenomenological case series and comparison with maladaptive daydreaming

Some individuals diagnosed with schizophrenia report vivid, immersive inner scenarios that may resemble maladaptive daydreaming (MD). However, the organisation, psychological functions, and relationships of such experiences with psychotic phenomena remain poorly understood.

This study examined the phenomenology and psychological functions of immersive imaginative experiences in individuals with schizophrenia and compared these experiences with published phenomenological descriptions of MD.

A theory-driven comparative case-series design was used. Three individuals with schizophrenia reporting immersive fantasy experiences participated in semi-structured clinical interviews. Cases were analysed across dimensions of agency and control, reality attribution and perceptual qualities, psychological function, and relationships with psychotic phenomena, and then compared across cases and with published descriptions of MD.

Prolonged, immersive fantasies differed substantially in their organisation. Patrick and Kate showed limited agency over intrusive, often distressing imaginative content that could unfold autonomously and become intertwined with hallucinations and delusional interpretations. Dominic retained authorship and awareness of the imagined nature of his technical visualisations but had difficulty regulating and disengaging from them. Across cases, content reflected emotionally salient concerns and different psychological functions, including the expression of conflict and emotional compensation. Features overlapping with MD included prolonged absorption and difficulty regulating engagement, whereas reduced agency over content and believing that imagined interactions or communications were genuinely occurring more clearly distinguished Patrick's and Kate's experiences.

Similarities with MD may coexist with marked differences in agency, reality attribution, and relationships with other psychopathological phenomena, suggesting that their diagnostic significance depends on how these features are configured.