An article in press for Consciousness and Cognition reports the case of a 36 year-old woman with a long history of excessive daydreaming where she’d spent long periods of time wrapped up in a fantasy world.
Importantly, the patient has no significant signs of mental illness and can easily distinguish fantasy from reality but just gets caught up in her internal reveries.
The subject of this case report is a professionally accomplished 36-year-old female presenting with a long history of excessive and highly structured daydreaming which she states has contributed to considerable distress during periods of her life. The patient is single, does not smoke, drink or use illegal drugs, and comes from a supportive and healthy family, reporting no abuse or trauma in her history.
Her distress, though subjectively reported as significant enough to seek and continue psychiatric treatment, remains difficult for us to diagnose. The imaginative episodes and their content are experienced as neither dysphoric nor intrusive, and the patient has been rigorously assessed for contributing or comorbid symptoms of mood, anxiety, personality, schizotypal, dissociative, and attentional disorders; indeed we have monitored her for over ten years, and have employed all clinical psychiatric measures available to consistently rule out comorbidity or mental status change in her case.
We have tenuously viewed her symptoms as indicating possible features of obsessive-compulsive behavior, reflected in the prescription of 50 mg/day of fluvoxamine, an antidepressant believed to influence obsessiveness and/or compulsivity. The medication has been continued for 10 years, as the patient affirms this treatment has made her daydreaming much easier to control. She reports that occasionally the amount of time spent daydreaming will rise and she will increase her dosage of fluvoxamine briefly until it subsides…
Recently, the patient discovered a website containing a surprising number of anonymous postings on the topic of excessive or uncontrolled daydreaming. Numerous posters described patterns and tendencies that appeared remarkably consistent with the patient‚Äôs experience (including the original pacing behavior) and emphasized the stress of concealing their imaginary lives and the attendant shame, confusion, and difficulty in controlling their divided realities.