Prevalence of maladaptive daydreaming and its association with dissociative experiences among Pakistani medical students: a cross-sectional study

Maladaptive daydreaming (MD) is an emerging psychological condition characterized by excessive immersive fantasy that causes functional impairment and has been associated with several psychiatric conditions, including dissociative experiences. However, this relationship has not been investigated among Pakistani medical students, a population at increased risk of psychological distress. This study aimed to determine the prevalence of MD and examine its association with dissociative experiences. A multicenter cross-sectional study was conducted over six months among medical students in Pakistan, recruited by convenience sampling. Participants completed an online questionnaire comprising the Maladaptive Daydreaming Scale-16 (MDS-16) and Dissociative Experiences Scale-II (DES-II). Internal consistency was assessed using Cronbach’s alpha, ​Pearson correlation, chi-square test, independent t-test, one-way ANOVA, and multiple linear regression were performed in SPSS version 25. Regression analysis was adjusted for age, gender, and year of study. Among 350 participants (27.1% males, 72.9% females), 36.6% met the criteria for probable maladaptive daydreaming and 33.4% met the cutoff for dissociative experiences. The MDS-16 and DES-II showed excellent internal consistency (Cronbach’s α = 0.941 and 0.961, respectively). Among probable maladaptive daydreamers,​ 68.0% experienced dissociative symptoms. Maladaptive daydreaming was significantly associated with dissociation (X² =108.19, p < 0.001), and MDS-16 scores showed a positive correlation with DES-II scores ( r = 0.665, p < 0.001). In exploratory analyses, males had higher DES-II scores than females ( p = 0.032), and first-year students had higher DES-II scores than fourth-year students ( p = 0.032). In multiple linear regression, MDS-16 score remained a significant independent correlate of dissociative experiences (B = 0.582, p < 0.001) after adjusting for age, gender and year of study. The model explained 46.4% of the variance in DES-II scores (R²=0.464, adjusted R²=0.452). Probable maladaptive daydreaming was observed in a substantial proportion of this predominantly ​female sample of medical students in Pakistan. Higher maladaptive daydreaming severity was significantly associated with greater dissociative symptoms, supporting the need for increased awareness and further longitudinal research to clarify the clinical significance of this relationship.