Body Movements During Maladaptive Daydreaming: A Thematic Analysis of Asynchronous Email Interviews

: Objectives : This study aimed to shed light on the lived experience of stereotypical body movement and gesturing during maladaptive daydreaming (MD). Method : Forty-one individuals with probable MD participated in asynchronous in-depth email interviews. Results : Four themes describing the movement experience in MD emerged: Need, Variety, Awareness and Agency, and Functions. Conclusion: The analyses revealed two main findings about the bi-directional effect of movement on MD. First, kinesthesia may enhance the daydreamers’ experience by deepening their fantasy immersion through improved focus featuring self-hypnotic characteristics. In addition, respondents reported that their body movements enhanced the daydreaming experience by embodying the protagonists' actions. MD-related motions were associated with occasional loss of agency, suggesting unintentional neuromuscular activation.

movements (Freeman et al., 2010;West et al., 2021). Adults with MD tend to seek privacy when daydreaming to avoid scrutiny and ridicule (Somer et al., 2016a) in response to their facial and body movements. Indeed, physical activity during MD is consistently reported in the literature (Somer et al., 2016b). In fact, two items describing body gestures and movement were included in the 16-item Maladaptive Daydreaming Scale (MDS-16, Somer et al., 2017). Items 3 and 14 of the MDS-16 ask, respectively: "How often are your current daydreams accompanied by vocal noises or facial expressions (e. g., laughing, talking, or mouthing the words)?" and "How often are your current daydreams accompanied by physical activity such as pacing, swinging, or shaking your hands?." Still, the role and meaning of body movement in the experience of people who engage in immersive and maladaptive fantasies are not yet understood. This qualitative inquiry aims to shed light on the lived experience of stereotypical body movement and gesturing during MD.

Method Participants
A call for English-speaking participants aged 18 or older was sent out to 200 individuals who self-identified as coping with MD and had previously written to the author indicating their interest in MD research. Fifty-two respondents expressed interest in the research topic and received informed consent forms with a detailed study description.
We emailed these individuals the 16-item Maladaptive Daydreaming Scale. Forty-one respondents with a mean MDS-16 score ≥ 40, the cutoff mean score indicative of probable MD (Soffer-Dudek, 2021), were invited to partake in an asynchronous email interview study.
According to Patton (2002), to maximize the use of limited resources, qualitative research should use purposeful sampling to select cases with the most information on a topic of interest. To this end, the author interviewed 41 consenting individuals at least 18 2023, Vol. 3, No. 2, pp. 267-299 mental health practitioners misdiagnose MD or minimize the problem, resulting in suboptimal treatment and heightened loneliness and distress (Bigelsen & Schupak, 2011).
MD and dissociative phenomena share common phenomenological characteristics, including double consciousness, vivid sensory imagery, and the activity of internally narrated characters. The protagonists in MD are occasionally experienced as having independent agency, but unlike the identities in dissociative identity disorder (DID) these imaginary personae typically do not take control of the individual's behavior.
Soffer-Dudek and  concluded that high dissociative absorption is a common risk factor shared by several dissociative disorders, such as depersonalization/ derealization disorder, DID, and MD. Similar to individuals with dissociative disorders, many persons with MD report that their earliest experiences of MD began during childhood, independently of childhood trauma (Somer et al., 2016a), implying an innate predisposition to absorptive immersion in fantasy (Schimmenti et al., 2019). The trait that enables a convincing sense of presence in fantasy also can facilitate mental escape from childhood adversities (Ross et al., 2020) and their memories , or a painful current reality . MD is highly comorbid with attention deficit hyperactivity disorder, obsessive-compulsive and related disorders, anxiety disorders, and depression , and is associated with high rates of suicidality (Soffer-Dudek & Somer, 2018). The suffering associated with this form of mental activity has led to multiple online forums dedicated to MD. One of them, on Reddit, serves over 102,000 participants (Retrieved from https://www.reddit.com/r/MaladaptiveDreaming/ on August 17, 2023).
One of the sources of misdiagnosis of MD is the concomitant feature of kinesthesia . For example, many children who display repetitive movements are diagnosed with a stereotypical movement disorder or autism spectrum disorder. These children often report engaging in enjoyable daydreaming as they engage in physical P A G E 2 7 1 P A G E 2 7 2 Journal of Anomalous Experience and Cognition (JAEX)

Interview Process
Email interviewing is a relatively new research method that offers excellent potential for qualitative researchers (Hawkins, 2018). The two main email interview categories are asynchronous and synchronous (Gibson, 2017). In asynchronous interviews, respondents can receive questions by email or video, which they can reply to at their convenience. In synchronous interviews, the interviewer and interviewee are online simultaneously and questions are posed sequentially in real-time (Gibson, 2017).
Asynchronous email interviews can take place over various time intervals (hours, days, weeks, or months) and offer more flexibility than synchronous email approaches (Golding, 2014). It is for this and other reasons that we employed this research method.
The merit of asynchronous email interviews for health research has been discussed in the literature (e. g., Amri et al., 2021), including optimization of anonymity, relief from time pressure, and the opportunity to think carefully the wording of each response.
Participation in this study was voluntary as no compensation was offered to respondents. The author emailed the interview questions to consenting participants and requested that they try to respond within 48 hours. If no response was received within 72 hours, I sent a reminder. The research interview followed a pre-prepared interview guide but occasionally diverged from it to explore spontaneously shared information or seek clarification. The interview guide included the following general issues that were presented as more specific inquiries, followed up by further requests for clarification or elaboration: • Tell me what your body does when you daydream. • Describe the experience of what your body does. • How does your movement affect your daydreaming? • How does your daydreaming affect your movement? • What is the meaning of your body movement? • How would it affect your experience if you were motionless during daydreaming? • Tell me about your sense of control over your body and mind when daydreaming.
• What were people's reactions to your physical movement during daydreaming? 2023, Vol. 3, No. 2, pp. 267-299 years old who met the MDS-16 criterion for probable MD and agreed to share their thoughts about physical movement during MD. This purposeful homogeneous sample promised to offer a deeper insight into the topic of interest. Participants in this study came from five continents: Asia (13), North America (11), Europe (8), South America (6), and Africa (3). Eleven participants were male, the others female. Their mean age was 31.3 (SD = 10.3), ranging from 18 to 62. Thirty-one respondents indicated their marital status as single; three were divorced, one was a widow, and six were married or in a relationship.
Nine participants had a high school degree, some college education, or a diploma; 17 had completed a Bachelor's degree or were graduate students; 10 had a Master's degree, and 5 respondents had completed their doctoral-level education. Twenty-two individuals were employed, and one was retired. The rest were unemployed. The mean MDS-16 score of the sample was 61.4 (SD = 12.4), range: 40 -99. In sum, this is a culturally diverse sample. The typical respondent was a well-educated, unmarried female in her thirties with an MD score well above the clinical cutoff score of 40. This sample was characterized by a 46% unemployment rate, perhaps reflecting the impairment of functioning associated with MD.

Measure
The Maladaptive Daydreaming Scale-16 (MDS-16;. is a self-report measure commonly used in MD research. It has 11 points on a scale ranging from 0% (never, no distress) to 100% (extreme distress, extremely frequent). The scale includes four factors: a yearning to engage in daydreaming, impaired functioning, an urge for physical movements (kinesthesia), and listening to music (Soffer-Dudek et al., 2020). It has been validated as a reliable measure in several languages (e. g., Jopp et al., 2018;Pietkiewicz et al., 2023;Sándor et al., 2020).

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Results
The analysis produced four themes describing the movement experience in MD: Need, Variety, Awareness and Agency and, Functions. These four themes were further divided into sub-themes, as shown in Figure 1. The quoted respondents are identified with numerical codes.

Need for Movement in MD
Physical movements served essential functions in the daydreaming experience of most. Although many respondents utilized movement to enhance their daydreaming, smaller groups either could not generate any fantasies without movement or required no physical activity to trigger or maintain their daydreaming.

No Need
About 10% of the sample indicated not needing movement to activate and sustain the daydreaming (because the themes are based on open verbal reports, the 2023, Vol. 3, No. 2, pp. 267-299 Cooperation was excellent, and particular questions were rarely left unanswered.
Each of the 41 respondents received an average of five emails, each containing about five questions, totaling about 1,025 questions asked and answered, showing excellent cooperation. Only two of the requests for information were disregarded by two individuals, with a negligible missing data ratio of less than .002% and no obvious pattern of missingness.
Numbers substituted respondents' names. Answers were copied from the email messages without the corresponding names and email addresses. The responses were then marked with the respective identifying number and compiled by question. All identifying details were removed from the answers to preserve anonymity. The University of Haifa Faculty of Social Welfare and Health Studies Ethics Committee approved the study (Certificate 407/22).

Data Analysis
The data were submitted to an inductive thematic analysis (Braun & Clarke, 2006) that included the compilation of email interview responses and followed coding stages.
Initially, the author read and re-read the email responses to identify potential themes. The second analysis level involved reviewing these initial codes with a research assistant. We focused on retaining the initial codes' range while producing sub-themes. The analysis of the data was informed by the research question: What is the lived experience and function of movement during MD? In the third analysis stage, the author identified quotes congruent with the identified themes and then defined the themes and sub-themes after reviewing them.

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Journal of Anomalous Experience and Cognition (JAEX) limited, and so is the pleasure (15)." This respondent connects the intensity and pleasure of the fantasy and her movements. Here is another example: "I don't need movement to daydream, but my daydreams are only vivid if I spin in circles. If I'm still…I can daydream, but it's not realistic at all." (41).
The results suggest that MD-related motions serve at least two roles: intensifying In short, although some participants can daydream motionless, most choose movement because of its intensifying effect on MD. When presenting the theme describing MD's functions, I will elaborate on this issue. Respondents reported a wide range of MD-related movements. The following theme describes the plethora of motions and gestures displayed during MD. numerical summaries may not be exhaustive as they are based on provided responses.
The reported frequencies may also add up to more than 100% because some respondents reported more than one theme in a category). For example: "I don't believe movement significantly influences my daydreaming. I can start daydreaming while walking, but the two are not inter-connected. I daydream without movement all the time" (30); "MD can intrude in my life even when I am still. It begins the moment that I wake up in the morning. While in bed, I can daydream for hours with little movement" (38). Respondent 16 indicated an advantage to motionless daydreaming: "I don't have any associated movement. Not at all. Fortunately. That allows me to daydream in public." But this subgroup was the exception. For most respondents, kinesthesia was essential in their daydreaming experience, and their stories comprise the rest of this research article.

Movement Is Necessary
About 8% of the respondents indicated that they could not daydream unless they moved. For example, respondent 12 categorically determined that moving and vocalizing during MD is a requisite: "Daydreaming while not moving or making sounds? I've tried. That's impossible. It didn't work." For her, daydreaming is simply impossible without the involvement of her body. A similar reaction: "I have noticed that I cannot daydream freely and comfortably when not moving… I do not understand why, but I just cannot. If I sit idly, I may daydream for a few minutes, but then I would have to get up and start walking" (40).

Movement Is Preferred
Eighty-two percent of respondents talked about their preference for movement because of its beneficial effect on the daydreaming experience. Here is one explanation: "It seems that sitting down while daydreaming is impossible. The more movements I make, the more I get immersed in that inner world…When I am still, the immersion is

Variety of Movement in MD
Stereotypical movements are manifested in several psychiatric disorders, such as tic (Udea & Black, 2021), stereotypical movement (Freeman et al., 2010), and autism spectrum (Singer, 2011) disorders. Maladaptive daydreaming also features kinesthesia as a typical behavioral feature . Our respondents described several categories of body motion employed. The most prominent of them were pacing and walking.

Pacing and Walking
This type of kinesthetics is often reported on the Internet by MD sufferers (Somer et al., 2016b) and was described by 23 (51%) respondents in this study. For example, participant 4 recounted, "I always like to move, and while daydreaming, I like to walk. I walk continuously for hours and hours while daydreaming without any pain, irritation, or discomfort to my body." Participant 14 wrote: "Regarding repetitive movement, I pace around (most persistent movement) and mess with my hair (touching it constantly). I also carry my phone in my hand with me all the time as I pace around while changing the music volume constantly." Several respondents stated that pacing had characterized their daydreaming since its onset in childhood.
When I started maladaptive daydreaming (around 12), I would pace in a circle in my room and talk to myself out loud. I daydreamed about having conversations with my friends as in real life, I was too shy and quiet and was quite a lonely girl.
As a grown-up, I still prefer to pace in my room and fantasize about social life (35).
As is evident in theme 3, movement can facilitate the onset of an MD episode and boost its vividness. However, since movement can also draw unwanted attention to the daydreamer, walking could be the most inconspicuous form of movement safely P A G E 2 7 7 P A G E 2 7 8 Journal of Anomalous Experience and Cognition (JAEX) employed. This issue will be discussed later in the sub-theme titled "Movement suppression during public self-consciousness."

Limb Movement
Eleven (27%)   In such a case, I find myself still rocking my foot or swaying back and forth slightly." (20).
Other data suggests that the movement is not only a facilitator of the daydreaming state but can also reflect the behavior and emotions of the protagonist in the daydream.
Below are subthemes that represent these properties.

Mouthing
Three participants reported mouthing words: "I almost never move my body.

Laughing/Crying
Here are quotes from 2 participants who tend to physically express their daydreamed emotions: "I often daydream funny scenarios and would be so immersed that I would silently laugh until my throat or stomach hurts. I would also mutter to myself and make expressions." (9); "I am crying as a tragic scene plays out." (10).

Hugging/Kissing
Acting out romantic gestures was mentioned by two participants: "When I daydream, I move all the time, I act, I talk, and I even pretend I am hugging someone… (18)  She has a general awareness of her body during MD. However, focusing inwardly on her fantasy is incompatible with monitoring her body, and body awareness precludes MD.

Awareness and the Sense of Agency in MD
Because she prefers MD, she must ignore her body. This automatization seems unsafe and also implies a reduced sense of agency.
Participant 14 reported a similarly delayed awareness: "The urge to pace around pulls me out of bed. Sometimes when I have already got up to start pacing, I am not even aware that I got up in the first place. It is like going into another dimension for a few moments. Rarely, when I become aware, can I snap out of it." It is not she that gets out of bed. Without much awareness, "The urge to pace" pulls her out of bed, leaving her incapable of controlling the situation.

Sense of Agency
Body unawareness during MD was reported by participant 6: "I don't think I am always aware I am doing it. After filling in the first questionnaire today, I became more aware of the movements and how frequently I engage in them." The compromised body awareness during MD is sometimes associated with a reduced sense of agency, as well.
As participant 29 says: "Pacing, facial expressions, swinging torso back and forth are induced when I daydream. This isn't a conscious decision; often I only notice that I'm moving when I break out of the daydream." The interlocutor describes an "induced" movement and delayed awareness of her kinesthesia. Not only does she not feel she initiated the movement, but she also becomes aware of it only after emerging from her daydreaming state.

The Function of Movement in MD
Respondents spontaneously described two main functions associated with their kinesthesia: Enhancing the focus and attention on the unfolding MD storyline and reifying MD scenes by acting them out. A third theme emerged from probing questions about the effect of suppressed movement on MD.

Enhanced Focus and Self-Hypnosis
Eight respondents (20%) very explicitly described the role of their movements in focusing their attention inwardly. The ultimate aim of self-hypnosis here is to facilitate a fully immersed fantasy experience.
Self-induced altered states of consciousness are enhanced by embodying the daydreamed chatter and behaviors with corresponding muscular activity to create the ultimate virtual reality experience.

Embodiment: Acting Out Scenes
The fantasy enactment in MD is eloquently described in the following excerpts: "I constantly do the movements that correspond to the scene in my daydreaming.  (14) These qualitative data align with findings from quantitative research that demonstrated that proprioceptive input, for instance, posture (Cuddy et al., 2018), gestures (Cacioppo et al., 1993), and facial expressions, such as smiling or pouting, (Duclos & Laird, 2001) can influence affective responses. Furthermore, Van Geest et al.
(2021) reported results from a study showing that a specific movement sequence based on movement elements associated with a particular emotion executed with a dance movement therapist can significantly enhance the corresponding affective state. In other words, some individuals with MD generate the "emotional score" of their fantasy and intensify it by performing in vivo the daydreamed action.
The themes of Enhanced focus and self-hypnosis and the Acting out scenes fit well with the bidirectional sensory-cortical embodiment model presented in Figure 2 above. The reported synchronized movement produces afferent neural stimulation.
These bottom-up stimuli deepen the daydream experience by intensifying both the affect and the bodily experience. Participant 8 described the experience: "With a kissing daydream, I press the thumb and forefinger together to create a parallel sensation. The fingers are nimble enough to enhance the romance and sensuality of the experience." With his fingers, he intentionally recreates the physical likeness of lips, so that when

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Journal of Anomalous Experience and Cognition (JAEX) something like my bed, pillow, or sheets. It is easier to pretend that someone is there with me. Those are the only times when I can daydream while being still. It feels like a highly protective environment and an even more immersive daydream.
She daydreams herself to sleep by creating a facsimile of an intimate bed scene. First, she deliberately suppresses vigorous body motions incompatible with the desired scene and the ensuant sleepiness (efferent stimulation from the sensorimotor cortex). She then incorporates the tactile stimulation of her soft bed linen into her fantasy (afferent sensory stimulation to the brain), resulting in a highly immersive but calm daydream experience.
The deviant case analysis of the data on movement suppression during bedtime supported the notion that the body plays a crucial role in MD even when its movements are restricted. This notion was further substantiated in MD situations where public selfconsciousness precluded conspicuous actions.

Movement Suppression During Public Self-Consciousness
The bi-directional nature of physical activity in MD was evident in my respondents' reports on movement inhibition in public. For example: "I force myself not to move when I daydream in public; it relaxes and helps me cope with social anxiety. If I daydream while lying in bed, it helps me fall asleep." (21) It is unclear if this participant's movement restriction serves as an anxiolytic or if it eases her public self-consciousness about being "discovered." The following quote suggests that movement restrictions in MD can compromise the quality of the experience by forcing duller and less immersive daydreams: The less movement I do, the less vivid the daydream and the easier it is for me to get taken out of the daydream…at night, when my daydreams are rarely intense, not moving much doesn't seem to inhibit my daydreams. I find that daydreaming simultaneously kissing a woman in his daydream and his fingers he generates a realistic multi-sensory stimulation that mimics the thrill of an actual sensual experience.

Movement Suppression for Induced Relaxation
In an attempt to perform a deviant case analysis (Patton, 2002), About 65% of the sample spontaneously indicated that they experienced a complete sense of agency over their MD movement and suggested an opposite direction of causality, namely that movement facilitated their daydreaming. Embodiment theories can help explain this opposite MD-movement causality link. Body and movement are considered vital elements of thinking, feeling, perception, and action in embodiment theories and research (Winkielman et al., 2015). According to an embodiment model of MD (see Figure 2), the body's sensations and movements contribute to subjective experiences such as vivid daydreams (Neumann & Strack, 2000). In accordance with the James-Lange theory (1922), this movement behavior also influences our emotional experience through kinesthetic body feedback (Koch et al., 2014). The body receives and supplies sensory data to the brain through the central nervous system, which forms neural patterns. As a result, they contribute to the experience of emotions and feelings (Bechara and Damasio, 2005). which aligns with the assumption that motor imagery activation patterns largely overlap with motor execution activity (Jeannerod, 2006). It is conceivable that immersive daydreaming, with its intense sensory-emotional characteristics, generates similar concurrent activation in the sensorimotor cortex. However, unlike sleep-related dreaming associated with REM sleep paralysis (Mainieri et al., 2021), MD does not occur during sleep.
Hence, the intense and often irresistible urges to move in synch with the unfolding daydream story.

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Journal of Anomalous Experience and Cognition (JAEX) The data presented in this paper suggest that body awareness and the sense of agency during MD-related kinesthetics can be compromised while attention is focused on the unfolding fantasy storyline. Based on work in the cognitive neuroscience of action awareness and motor control, Evans et al. (2015) conducted experiments introducing spatiotemporal conflicts between cortical motor signals and their resultant sensory consequences during real-time brain control of a visual cursor. Their two experiments associated congruent brain-machine interfaces with a robust sense of agency. The sense of agency was undermined when the researchers introduced neuro-visual delay, and the curser responded to movement commands in a belated mode. They concluded that bodily and brain-machine interface actions rely on common mechanisms of sensorimotor integration for agency judgments. Future neuroscience research should examine whether body movement unawareness in MD is also associated with perturbed proprioceptive feedback. Disturbed proprioceptive feedback in MD could impair the sense of agency in body movement. Because kinesthetics in MD is also intentional in many cases, I was curious how respondents understood its role.
To add rigor to this qualitative inquiry and explore the full range of the investigated

Clinical Implications
These results build on existing evidence that movement is common in MD as a significant number of participants identified body movement as a prominent feature associated with maladaptive daydreaming. This observation suggests that kinesthetic experiences may be a relevant factor to consider in understanding MD. Although adults are better at concealing the telling movements, these results should be considered in pediatric psycho-neurology clinics. Stereotypical movements in children could also be symptomatic indicators of potential MD (Freeman et al., 2010;Robinson et al., 2016).
The evidence suggests that some individuals with MD might control their fantasies by curbing their concomitant movements. One possible implication of this finding pertains to the employment of movement suppression in the treatment protocol for MD.
Future research could shed light on the impact of body movement control on the recovery from MD.
The findings of this study have to be seen in light of some limitations. First, although the presented data provide a detailed description of the investigated phenomenon, the findings cannot be extended to the broader population of individuals suffering from MD, and its generalizability is limited. Though only future research can shed light on how individuals with MD who do not move while daydreaming differ from the current sample, evidence shows that 79% of individuals with MD report daydreaming-related kinesthesia (Bigelsen & Schupak, 2011). In other words, the present findings offer new inductive notions 2023, Vol. 3, No. 2, pp. 267-299 Journal of Anomalous Experience and Cognition (JAEX) on the possible roles movement plays in MD that should be the basis of hypothesis formulations for future deductive research.
The sample size in this study was modest compared to the standard in quantitative studies, adding a further challenge to the universality of the findings (Vasileiou et al., 2018). However, achieving data saturation, not statistical significance, is the prevailing principle in designing qualitative research. Theoretical saturation, as achieved in the current investigation of 41 interviewees, often occurs in homogeneous samples as small as 12 (Boddy, 2016). The following research step should involve replication studies and larger-scale hypothesis-driven studies on the function movement in MD. The