Imaginative absorption in schizophrenia: a phenomenological case series and comparison with maladaptive daydreaming.
Igor J. Pietkiewicz, Radosław Tomalski
International journal of clinical and health psychology : IJCHP 2026 DOI: 10.1016/j.ijchp.2026.100729 (opens in new tab)
Study at a glance
AI-extracted from the abstract| Characteristics | Comparative case series Case report Peer reviewed |
|---|---|
| Sample size | 3 |
| Population | Individuals diagnosed with schizophrenia who report immersive fantasy experiences |
| Topics | Philosophy of mind |
| Keywords | Absorption Maladaptive daydreaming Mental imagery Psychosis Schizophrenia |
| Key findings | Immersive fantasies in three people with schizophrenia varied in organisation and control: two had limited agency over intrusive, distressing content that intertwined with hallucinations and delusions, while one retained authorship and reality awareness but struggled to disengage. Overlap with maladaptive daydreaming included prolonged absorption and regulation difficulty, but reduced agency and belief that imagined interactions were real distinguished the first two cases, suggesting diagnostic significance depends on how features are configured. |
Abstract
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.
Comparable studies
Other case reports and case series on philosophy of mind, most cited first.
| Study | Year | Design | Participants |
|---|---|---|---|
| How does it feel to lack a sense of boundaries? A case study of a long-term mindfulness meditator. A single long-term mindfulness practitioner (S) with 40 years of practice in... | 2015 | Qualitative case study | n = 1 |
| An extended case study on the phenomenology of sequence-space synesthesia Single adult with sequence-space synesthesia | 2014 | Phenomenological case study | n = 1 |
| "I can't tell whether it's my hand": a pilot study of the neurophenomenology of body representation during the rubber hand illusion in trauma-related disorders. Individuals with the dissociative subtype of posttraumatic stress disorder (PTSD) | 2016 | Case series | n = 3 |
| Neurophenomenology of an Altered State of Consciousness: An fMRI Case Study. A single research participant with self-proclaimed ecstatic Kundalini meditative... | 2016 | Case study | n = 1 |
| Multimodal neurophenomenology of advanced concentration absorption meditation: An intensively sampled case study of Jhana. One advanced meditator with over 23,000 hours of meditation practice | 2024 | Case study | n = 1 |
Citations in the library
Cites 6
- Psychosis as a state of aberrant salience: a framework linking biology, phenomenology, and pharmacology in schizophrenia. American Journal of Psychiatry 2003
- From Perception to Thought: A Phenomenological Approach to Hallucinatory Experience Schizophrenia Bulletin October 12, 2016
- Anomalies of Imagination, Self-Disorders, and Schizophrenia Spectrum Psychopathology: A Network Analysis. Frontiers in Psychiatry 2021
- Anomalies of imagination and development of psychosis: A phenomenological account. Schizophrenia Research February 1, 2024
- Maladaptive daydreaming should be included as a dissociative disorder in psychiatric manuals: position paper The British Journal of Psychiatry March 17, 2025
and 1 more in the library