Childhood Emotional Maltreatment and Maladaptive Daydreaming Among Adolescents: Mediating Role of Emotional Processing

The present study aimed to investigate the role of childhood emotional maltreatment and maladaptive daydreaming in relation to emotional processing among adolescents. The study was based on cross-sectional design and the sample comprised of 200 adolescents (100 male and 100 female), age ranges from 13-18 years from district Swabi. Childhood Emotional Maltreatment questionnaire (Clarke, 2015), 16-Item Maladaptive Daydreaming Scale (Somer et al., 2016) and Emotional Processing scale (Baker et al., 2009) were used to collect data. Results revealed that there is a positive relationship between childhood emotional maltreatment, maladaptive daydreaming and emotional processing. Furthermore childhood emotional maltreatment also predicts maladaptive daydreaming as well as emotional processing partially mediated the relationship between childhood emotional maltreatment and maladaptive daydreaming among adolescents. The findings of study will provide insight to the parents that they should made efforts to highlight child emotional needs in order to overcome their mental health issues. Findings will also help the practitioners in the development of prophylactic strategies for children who are emotionally maltreated based on parental training in emotional growth and positive or constructive daydreaming.

Adolescence is a critical developmental stage in human life during which individuals gain independence from their families and learn new skills to cope with constant change (Dar & Tali, 2014). Adolescents may be more vulnerable to mental health problems because of these challenges and issues (Siddique, 2017). Various studies investigated several crucial elements that prevent teenagers from mental health disorders (Van Loon et al., 2015) in which parenting is among the most important protective elements during this difficult era (Chu et al., 2015). Constructive parenting is associated with less mental health difficulties (Smokowski et al., 2015) however, when parents are overly strict and demanding, their children are unable to form deep bonds with their parents and suffer long-term psychological harm (Cooper, 2015). Such parents believe they were good parents because they meet all their children's needs, but they fail to respond to their children's emotions and feelings (Siegel & Hartzell, 2013).
In parent-child relationships, childhood emotional maltreatment is considered to impede with a child's fundamental human need for security, affection, affiliation, and positive regard and esteem (Hart & Brassard, 1998). Childhood emotional maltreatment is defined by the American Professional Society on the Abuse of Children (APSAC) as a consistent pattern of care provider behaviour or severe traumatic event(s) which thus impart to children that they really are valueless, blemished, unaccepted, unwelcome, jeopardised, and only of value in having met someone's requirements (APSAC, 1995). Acts of execution in emotional abuse include verbal antagonism, mocking, criticizing, and refusal. In contrast, emotional neglect is an omission: neglecting to meet the child's emotional needs. Parents that are emotionally negligent are emotionally unavailable, distant, nondirective, and unresponsive to their child's needs and interests (Egeland, 2009). A substantial body of literature documents the detrimental consequences of childhood emotional maltreatment. Short-term effects usually involve developmental breakdowns (emotionally child victims seem to be physically smaller and have far more difficulties completing developmental milestones on time than their non-abused peers) (Iwaniec, 2004), limited academic and vocational expectations in teen years, transnational and rehashed grades in elementary (Kelly, 1997), behavioral issues (Crittenden et al., 1994), disciplinary issues (Widom & White, 1997), and learning problems (Hall, 2002; Moran et al., 2004). Maltreatment of either kind seems to be more insidious and harder to detect than physical and sexual abuse or neglect. Emotional mistreatment of children is a specific sort of abuse. Hands, ropes, belts, or sexual behaviors are not used as weapons against them, but rather harsh, bitter words or icy, apathetic silence. Even if there is no physical pain or sexual contact, the ramifications can be as severe and long-lasting. Despite several decades of claims that childhood emotional maltreatment is perhaps the most common hazardous form of child maltreatment with adverse repercussions that greatly exceed other forms of childhood maltreatment that is physical assault, sexual molestation (Greenfield & Marks, 2010), it is the most invisible, rarely reported, and underexplored type of childhood maltreatment (Barnett et al., 2011). Childhood emotional maltreatment is present in about half of all confirmed abuse reports, yet it is typically the subject of the inquiry (Chamberland et al., 2011).
Early emotional maltreatment is associated with a variety of detrimental psychological effects, including maladaptive daydreaming (Somer & Lowell, 2016). Maladaptive daydreaming is extensive imaginative engagement that replaces connection with people and/or interferes with scholastic, relational, or vocational performance (Somer, 2002). Later it was described as a chronic illness that affects a significant wastage and a degree of stability, curtails day-to-day operations and the establishment and maintenance of relationships, and overall inhibits learning and career growth (Schimmenti et al., 2019). According to the study, the majority of maladaptive daydreaming stems from a child's early emotional pain management. This type of psychopathology (maladaptive daydreaming) is caused by adverse childhood events such as neglect and abuse (Abu-Rayya et al., 2020). People who engage in maladaptive daydreaming use deep fiction to distract themselves from traumatic memories that interfere with essential areas of functioning such as study, employment, and relationships. Maladaptive daydreaming stemmed from a coping strategy established in creative youngsters under pressure (Somer et al., 2020). Regular daydreaming is a common and well-studied mentation that is thought to develop as an everyday internalised kind of play. Maladaptive daydreaming, on the other hand, is a clinical concept with strong validity, reliability, sensitivity, and specificity that is strongly associated with numerous DSM-5 illnesses (Somer et al., 2017).
Emotional maltreatment in children has been shown to interfere with the development of appropriate emotional processing (Somer & Lowell, 2016). It is the ability of an individual to encounter events, situations and stimuli which arouse emotional responses (Howells, 2013). Emotions provide contextual information to prepare for a behavioural reaction that, depending on the circumstance, produces hunger or defence systems (Bradley et al., 2001). Emotional processing occurs when a person goes through an emotionally upsetting incident and is capable of coping with it over time to the point that new experiences (either stressful or not) can occur without returning to the previous suffering (Arnold, 2019). Maltreated children (those who have been physically, neglectfully, or sexually abused) have been found to have specific difficulties in understanding, detecting, and showing emotions, including being at risk for social impairments, empathy deficiencies, and decreased engagement in pro-social action (Koenig & Rogosch, 2004). Neglecting parents were less expressive and participated in minimal interchange of emotional information with their children in interactions, and so offered less assistance in learning to comprehend emotions more broadly (Bousha & Twentyman, 2001). Poor social and emotional environments, which are typical in neglect instances, impede the development of adequate emotional abilities and may result in a blunted pattern of emotional response (Pollak et al., 2000). Youngsters who had been emotionally abuse and neglected had more difficulties identifying emotional expressions than children who had been physically mistreated (Baglivio et., 2014). Individuals report having happy emotions when daydreaming (Somer, 2002), and a daily diary research found a connection between the intensity and volume of daydreaming on a particular day and spikes in negative feelings on that same day (Soffer-Dudek & Somer, 2018). Additionally, maladaptive daydreaming has been associated with emotional relationship issues, notably impetuous conduct when agitated, along with low degree of emotional awareness and emotional control capacities (West & Somer, 2019). Furthermore, the particular relationship between the various forms of emotional regulation issues and diverse maladaptive daydreaming indicators have still not been studied. Individuals who have been emotionally maltreated find it challenging to face events, circumstances, and stimuli that elicit emotional responses (Somer & Lowell, 2016). Previous research also determined the linked between inadequate emotional possessing and the development of maladaptive daydreaming (Soffer-Dudek & Somer, 2018), while no such study performed that used emotional processing as a mediating variable between childhood emotional maltreatment and maladaptive daydreaming.
The long-term mental health implications of sexual and physical abuse are widely understood and researched; however, the long-term ramifications of emotional maltreatment are unknown (Owens et al., 2013). According to research, emotional maltreatment is reported about twice as frequently as physical or sexual abuse, thus the potential mental health consequences of childhood emotional maltreatment are especially essential to consider (Chamberland et al., 2011). The current study aims to identify that how childhood emotional maltreatment experiences effect an individual's present life through numerous factors such as maladaptive daydreaming and poor emotion processing and how poor emotional processes contribute in maladaptive daydreaming. Regular daydreaming is a common and well-studied mentation that is thought to develop as an everyday internalised kind of play. Maladaptive daydreaming, on the other hand, is a clinical concept with strong validity, reliability, sensitivity, and specificity that is strongly associated with numerous DSM-5 illnesses (Somer et al., 2017). The purpose of this study is to discover the role of early emotional maltreatment in the development of maladaptive daydreaming and poor emotional processing among adolescents. Researches revealed that maltreated children have been found to have specific difficulties in understanding, detecting, and showing emotions, including being at risk for social impairments, empathy deficiencies, and decreased engagement in pro-social action (Koenig & Rogosch, 2004). However, the literature discusses the relationship between childhood emotional maltreatment and maladaptive daydreaming and emotional processing separately, while both maladaptive daydreaming and emotional processing are as a result of childhood emotional maltreatment, according to Somer & Lowell, (2016).
The current study aims to highlight the importance of emotional needs, as well as to investigate the relationship between emotional maltreatment, maladaptive daydreaming, and emotional processing as well as to investigate the mediating role of emotional processing in relation between childhood emotional maltreatment and maladaptive daydreaming among adolescents.

Hypotheses

Following are the hypotheses that are phrased according to the objectives:

1. There will be positive association between childhood emotional maltreatment, maladaptive daydreaming and emotional processing.
2. There will be a positive relationship between maladaptive daydreaming and emotional processing among adolescents.
3. Childhood emotional maltreatment will be a positive predictor of maladaptive daydreaming among adolescents.
4. Emotional processing will mediate the relationship between childhood emotional maltreatment and maladaptive daydreaming among adolescents.

Method

Sample

The research was conducted using a cross-sectional survey approach. Purposive sampling technique was used to collect a sample. Initially the data has been collected from around 427 individually and recruiting are done through Childhood Emotional Maltreatment Questionnaire (cutoff scores 30) and the data of 200 adolescents has been retained for further process (100 boys & 100 girls). Data has been collected from Private Schools and Colleges in district Swabi (KPK) that is Pakistan International Public school and College Swabi, Quaid-e-Azam International Model School and college Swabi, Quaid-e-Azam Public School and College Swabi, Dar-e-Arkam school and The Peace School and College Swabi. Only those Participants have been selected who had age range of 13-18 years, 8th grade and higher reading ability and having total score above on cutoff scores (i.e., 30) on Childhood Emotional Maltreatment questionnaires. Participants having lower than 8th grade reading level, below age 13 and above age 18, history of brain injury, neurological or movement disorders ware excluded from the study.

Measures

To assess the study variables; a demographic questionnaire comprises of age, gender, education, family type, city and history of different disorders was used.

Childhood Emotional Maltreatment Questionnaire

The 16-Item Maladaptive Daydreaming Scale
Somer et al. (2017) developed the Maladaptive Daydreaming Scale (MDS-16; 2016). The Maladaptive Daydreaming Scale-16 is a 16-item self-report questionnaire designed to measure Maladaptive Daydreaming. A 16-item maladaptive daydreaming measure replaces the preceding 14-item maladaptive daydreaming scale. The scale varied from 0% to 100%, with 10% intervals (0 % = never to 100% = all of the time). A score of 40 or higher indicates clinical-level maladaptive daydreaming suspicion which successfully discriminated self-identified maladaptive daydreamers from non-maladaptive daydreamers, and it displayed good internal consistency and temporal stability (test-retest reliability, r = .92). Maladaptive Daydreaming Scale-16 scores were linked to global psychopathology, traumatic experiences, maladaptive personality characteristics, dissociation, shame feelings, and anxious attachment styles. A cut-off score of 60% can accurately distinguish between excessive and typical daydreamers. Alpha coefficient of .79 was acquired for this scale in the present study.

The Emotional Processing Scale

The Emotional Processing Scale (Baker et al., 2009) is a 25-item questionnaire that assesses signs of poor emotional processing. After reflecting on the previous week's experiences, participants are presented with 25 statements and asked to rate the degree to which the statement accurately describes their affective responses over the preceding week on a 10-point scale ranging from 0 = completely disagree to 9 = completely agree. The current 25-item measure assesses five factors: suppression, indicators of unprocessed emotion, emotion controllability, avoidance, and emotional experience. Cronbach's alpha (α) 0.9 was used to establish internal consistency. High scores represent problems in emotional processing.  Alpha coefficient of .73 was acquired for this scale in the present study

Procedure

The goal of the study was described to all participants, and informed permission was obtained from all participants ahead of time. Before the survey, the participants were also informed there would be no right or incorrect answers, that all information gathered would be kept secret, and that their names would not be exposed. After agreeing to participate in the study, the participants were handed demographic questionnaires as well as test scales. After collecting all of the data, it was coded and entered into SPSS for statistical analysis.

Results

The relationship between childhood emotional maltreatment, maladaptive daydreaming and emotional processingmong adolescents were investigated using co-relational analysis. Gender variations were investigated by using independent sample t-tests. Regression analysis was used to study the impact of Childhood Emotional Maltreatment on Maladaptive Daydreaming among adolescents. In conjunction, mediation analysis and moderation analysis was also used in this study.
To guarantee that the data was acceptable for the ensuing studies, it was first verified for missing values, normality, outliers, and multicollinearity concerns. Later, descriptive variables for the research were computed (see Table 1).

Table 1
Correlation Matrix For All Variables (N = 200)

**p < 0.01 

Table 1 shows that the Pearson Product Moment correlation of child emotional maltreatment, maladaptive daydreaming and emotional processing.

Table 2
Mediating Effect of Emotional Processing in Predicting Maladaptive Daydreaming Among Adolescents (N = 200)

For step 1: F = 105.05, For step 2: F = 172.74.

Results in Table 2 showed mediating effect of emotional processing in relationship between child emotional maltreatment and maladaptive daydreaming. Model 1 showed that child emotional maltreatment positively predicts maladaptive daydreaming and explains 35% of its variation. The child emotional maltreatment positively predicts poor emotional processing (Table 2).
Model 2 showed that the direct effect i.e., whilst controlling for the effect of emotional processing, the childhood emotional maltreatment has a significant positive relationship with maladaptive daydreaming (Table 2). The R2 tells us that both emotional processing and childhood emotional maltreatment explain 63% variation in maladaptive daydreaming. A comparative analysis of model 1 and 2 showed that the direct effect (path c’ = .23**) is smaller than the total effect (path c = .93), although both are significant, suggested partial mediation. There was significant direct effect of child emotional maltreatment on maladaptive daydreaming as well as a significant mediating effect of emotional processing in relationship between childhood emotional maltreatment and maladaptive daydreaming.

Discussion

Childhood emotional maltreatment is perhaps the most common and devastating type of child maltreatment, with negative implications that extend beyond other types of childhood maltreatment (e.g., physical abuse, sexual assault) and into adulthood. The current study seeks to determine how childhood emotional abuse experiences affect an individual's present life via a variety of aspects including maladaptive daydreaming and poor emotion processing, as well as how poor emotional processes lead to maladaptive daydreaming. This study used the Childhood Emotional Maltreatment Scale (Clarke, 2015), the 16-Item Maladaptive Daydreaming Scale (Somer & Lowell 2016) and the Emotional Processing Scale (Baker et al., 2009) to assess the relationship between childhood emotional maltreatment, maladaptive daydreaming and emotional processing. These scales were distributed to 200 teenagers from Swabi's various schools and institutions.
According to the study's first hypothesis, childhood emotional maltreatment is connected with maladaptive daydreaming in teenagers. In a sample of 200 teenagers, the findings of this investigation indicated that childhood emotional maltreatment has a substantially positive link with maladaptive daydreaming (Table 1). Somer et al. (2017) discovered that people who are recovering from drug use disorder and have a history of early emotional abuse and emotional neglect engage in more intense and profound daydreaming, which can approach pathological levels (maladaptive daydreaming).
Parents that emotionally abuse their children tend to separate themselves and their children from the other people, providing their children with fewer non-parental models of emotional communication (Hammer & Rosario, 2002). A kid who receives inconsistent or harsh care has difficulty forecasting the ramifications of his or her actions, which may manifest as difficulties interpreting emotional information. Maltreated children have been found to have unique issues comprehending, experiencing, and expressing feelings, and also a higher risk of social delays, empathy deficiencies, and reduced participation in pro-social activities (Kim & Cicchetti, 2010). Neglecting parents were less communicative and exchanged less emotional information with their children, resulting in less aid in learning to interpret emotions more widely (Pollak et al., 2000).
The second hypothesis of the study is that childhood emotional abuse relates to decreased emotional processing in adolescence. Childhood emotional abuse, according to the study's findings, is highly positively associated with emotional processing. Milaniak and Widom (2014) discovered that children (ages 0-11) with documented cases of abuse and neglect were less accurate in overall emotion processing, as well as in processing positive and neutral images, indicating that childhood physical abuse predicted worse accuracy in neutral photos and childhood sexual abuse and emotional neglect predicted lower accuracy in positive picture recognition.
The study's third hypothesis indicated that childhood emotional maltreatment predicts maladaptive daydreaming in teens. The current study found that in a sample of teenagers, both male and female,  is positively indicating maladaptive daydreaming suggesting that childhood emotional maltreatment is responsible for 35 percent of the change in maladaptive daydreaming. Children with the natural dissociative capacity might use their inherent abilities under persistent pressure or neglect to cause forgetfulness, modifying their identity or dissociativity, and speculating about imaginary companions or alternate universes (Somer et al., 2017). Certain maladaptive daydreamers indicate that they are always dealing with the consequences of traumatic childhood events or continuing social and emotional challenges (Somer & Lowell 2016). Somer et al. (2020) observed that a background of childhood emotional and physical neglect, along with emotional abuse, was linked to the use of daydreaming to cope with emotional discomfort. Childhood physical and emotional maltreatment were linked to an increased risk of fantasizing about an idealistic view of their original families, but childhood emotional neglect was linked to fantasizing about taking revenge.
According to the third hypothesis of the study, emotional processing mediates the link between childhood emotional maltreatment and maladaptive daydreaming in teenagers. The study's findings revealed that emotional processing had a substantial mediating influence in the link between childhood emotional maltreatment and maladaptive daydreaming.
According to the present study's findings, childhood emotional maltreatment disrupts the development of proper emotional processing, which leads to maladaptive daydreaming. Maltreated children (those who have been physically, neglectfully, or sexually abused) have been found to have specific deficits in understanding, recognizing, and reacting, including being at risk for a range of social delays, empathy deficits, and decreased engagement in pro-social action (Koenig & Rogosch, 2004). Poor emotional processing also leads to maladaptive daydreaming. Dudek and Somer (2018) found a link between the intensity and quantity of daydreaming on a particular day and increases in unpleasant feelings on the same day. According to West and Somer (2019), Maladaptive Daydreaming is associated with emotional relationship issues, notably impulsive conduct when disturbed, poor levels of emotional clarity, and weaker emotional regulation abilities.

Limitations and Suggestions

The first and most important factor is the small sample size. The study's population was only comprised of Swabi teenagers; however, in order to generalize the findings, data from adolescents from many other cities throughout Pakistan should have been obtained by random assessment. Interviews should also be utilized to collect detailed information about participants and to increase validity. Due to the epidemic scenario across the country, the majority of data collecting is done using Google Forms. It is suggested that future research collect data through personal visits so that participants' behavior may also be observed. Future study should look at participants under the age of 13 and those above the age of 18, as well as the content of their Daydreaming.

Implications

The current study provides data on adolescent childhood emotional maltreatment, maladaptive daydreaming, emotional processing, and trait mindfulness. The observation that emotional abuse in childhood leads to emotional impairment and maladaptive daydreaming in teens gives relevant and therapeutically significant information in terms of therapies, preventative strategies, and research paths. There has been little study on the long-term and harmful effects of childhood emotional abuse and neglect on the development of sufficient emotional processing and maladaptive daydreaming. This study might help with the development of prophylactic strategies for children emotional abuse based on parental training in emotional growth and positive or constructive daydreaming.
This study's findings may also serve as a guide for therapies that include emotional functioning skills as part of therapy for children who are currently inside an abusive or neglectful setting, as well as adults who have a history of childhood emotional abuse. Furthermore, the revelation that child emotional maltreatment may also be used to anticipate maladaptive daydreaming gives a route for future study as well as a potentially major contribution to the field of childhood emotional abuse and neglect. Recognizing emotional needs can assist parents in considering and prioritizing their child's emotional needs, and failure to do so will most likely result in not just long-term behavioral troubles but also mental health concerns. The outcomes of this study might help parents understand how crucial it is to spend quality time with their children and to recognize their minor successes.

Conclusion

To summarize, there is a positive association between childhood emotional maltreatment, maladaptive daydreaming, and emotional processing. Additionally, childhood emotional maltreatment predicts maladaptive daydreaming. Emotional processing, according to the mediation study, mediated the link between childhood emotional maltreatment and maladaptive daydreaming. In light of the current study's findings, it is proposed that efforts be made to highlight the child's emotional needs in order to overcome their mental health concerns.

References

Abu-Rayya, H. M., Somer, E., & Knane, H. (2020). Maladaptive daydreaming is associated with intensified psychosocial problems experienced by female survivors of childhood sexual abuse. Violence Against Women, 26(8), 825-837.

Arnold, J. J. A. (2019). Emotion based music recommendation system. Emotion, 6(3), 212-218.

Baglivio, M. T., Epps, N., Swartz, K., Huq, M. S., Sheer, A., & Hardt, N. S. (2014). The prevalence of adverse childhood experiences in the lives of juvenile offenders. Journal of Juvenile Justice, 3(2), 128-132.

Baker, M. (2009). Loneliness and social isolation as risk factors for mortality: a meta-analytic review. Perspectives on psychological science, 10(2), 227-237.

Barnett, L. M., Lubans, D. R., Morgan, P. J., Cliff, D. P., & Okely, A. D. (2011). Fundamental movement skills in children and adolescents. Sports Medicine, 40(12), 1019-1035.

Bousha, S., & Twentyman, I. (2001). Maternal personality and distress as predictors of child neglect. Journal of Research in Personality, 35(4), 537-545.

Bradley, M. M., Codispoti, M., Sabatinelli, D., & Lang, P. J. (2001). Emotion and motivation: Sex differences in picture processing. Emotion, 1(3), 300-310.

Chamberland, C. Laporte, L., Jiang, D., &  Pepler, D. J.  (2011). The relationship between adolescents’ experience of family violence and dating violence. Youth & Society, 43(1), 3-27.

Chu, J. T. W., Bullen, P., Farruggia, S. P., Dittman, C. K., & Sanders, M. R. (2015). Parent and adolescent effects of a universal group program for the parenting of adolescents. Prevention Science, 16(4), 609-620.

Clarke, S. (2015). Emotional abuse and emotional neglect in childhood: Subtypes, ecological correlates, and developmental tasks of emerging adulthood, (Unpublished Doctoral Dissertation), University of Minnesota, USA.

Cooper, A. (2015). Reflective parenting: A guide to understanding what's going on in your child's mind. New York, USA: Routledge.

Crittenden, P. M., Claussen, A. H., & Sugarman, D. B. (1994). Physical and psychological maltreatment in middle childhood and adolescence. Development and Psychopathology, 6(1), 145-164.

Dar, I. A., & Tali, L. A. (2014). Adjustment   problems among Kashmiri adolescents. International Journal of English Language, Literature, and Humanities, 1(5), 99-107.

Greenfield, E. A., & Marks, N. F. (2010). Identifying experiences of physical and psychological violence in childhood that jeopardize mental health in adulthood. Child Abuse & Neglect, 34(3), 161-171.

Hall, J. (2002). The care of my child with cancer: Parents' perceptions of caregiving demands. Journal of Pediatric Oncology Nursing, 19(6), 218-228.

Hammer, S., & Rosario, M. (2002). Aggressive behavior in response to violence exposure: Is it adaptive for middle-school children?. Journal of Community Psychology, 36(8), 1008-1025.

Hart, S. N., & Brassard, M. R. (1998). A major threat to children's mental health Psychological maltreatment. American Psychologist, 42(2), 160-166.

Howells, G. (2013). Emotional processing and episodic memory, (Unpublished Doctoral dissertation), Bournemouth University, UK.

Iwaniec, D. (2004). Research review: Risk and resilience in cases of emotional abuse. Child & Family Social Work, 11(1), 73-82.

Kelly, D. M. (1997). High school is like a soap opera: Gender and disengagement in two continuation high schools, (Unpublished doctoral dissertation), Stanford University, USA.

Kim, J., & Cicchetti, D. (2010). Longitudinal pathways linking child maltreatment, emotion regulation, peer relations, and psychopathology. Journal of Child Psychology And psychiatry, 51(6), 706-716.

Koenig, A. L., & Rogosch, F. A. (2004). Moral development: The association between maltreatment and young children's prosocial behaviors and moral transgressions. Social Development, 13(1), 87-106.

Milaniak, I., & Widom, C. S. (2015). Does child abuse and neglect increase risk for perpetration of violence inside and outside the home? Psychology of Violence, 5(3), 246-254.

Moran, C, Azziz, R., Sanchez, L. A., Knochenhauer, E. S. (2004). Androgen excess in women experience with over 1000 consecutive patients. The Journal of Clinical Endocrinology & Metabolism, 89(2), 453-462.

Owens, R. L., & Patterson, M. M. (2013). Positive psychological interventions for children: A comparison of gratitude and best possible selves approaches. The Journal of genetic psychology, 174(4), 403-428.

Pollak, S. D., Cicchetti, D., Hornung, K., & Reed, A. (2000). Recognizing emotion in faces: Developmental effects of child abuse and neglect. Developmental Psychology, 36(5), 679.

Schimmenti, A., Jonason, P. K., Passanisi, A., La Marca, L., Di Dio, N., & Gervasi, A. M. (2019). Exploring the dark side of personality: Emotional awareness, empathy, and the Dark Triad traits in an Italian Sample. Current Psychology, 38(1), 100-109.

Siddique, M. (2019). Perceived parental acceptance–rejection in childhood predict psychological adjustment and rejection sensitivity in adulthood. Psychological Studies, 64(4), 447-454.

Siegel, D. J., & Hartzell, M. (2013). Parenting from the inside out: How a deeper self-understanding can help you raise children who thrive. Boston, USA: Penguin.

Smokowski, P. R., Bacallao, M. L., Cotter, K. L., & Evans, C. B. (2015). The effect of positive and negative parenting practices on adolescent mental health outcomes in a multicultural sample of rural youth. Child Psychiatry & Human Development, 46(3), 333-345.

Soffer-Dudek, N., & Somer, E. (2018). Trapped in a daydream: Daily elevations in maladaptive daydreaming are associated with daily psychopathological symptoms. Frontiers in Psychiatry, 9, 377254.

Somer, E. (2002). Maladaptive daydreaming: A qualitative inquiry. Journal of Contemporary Psychotherapy, 32(2), 197-212.

Somer, E., & Herscu, O. (2017). Childhood trauma, social anxiety, absorption and fantasy dependence: Two potential mediated pathways to maladaptive daydreaming. Journal of Addictive  Behaviour and Therapeutic Rehabilitation, 6(3), 252-260.

Somer, E. (2018). Maladaptive daydreaming: Ontological analysis, treatment rationale; a pilot case report. Frontiers in the Psychotherapy of Trauma and Dissociation, 1(2), 1-22.

Somer, E., Abu-Rayya, H. M., & Brenner, R. (2020). Childhood trauma and maladaptive daydreaming: Fantasy functions and themes in a multi-country sample. Journal of Trauma & Dissociation, 22(3), 288-303.

Somer, E., Lehrfeld, J., Bigelsen, J., & Jopp, D. S. (2017). Development and validation of the Maladaptive Daydreaming Scale (MDS). Consciousness and Cognition, 39(1), 77-91.

Somer, E., Lowell, S. (2016). Maladaptive daydreaming: Evidence for an under-researched mental health disorder. Consciousness and Cognition, 42(2), 254-266.

Van Loon, L. M. A., Van De Ven, M. O. M., Van Doesum, K. T. M., Hosman, C. M. H., & Witteman, C. L. M. (2015). Child & Youth Care Forum. Boston, USA: Springer.

West, M., & Somer, E. (2019). A daily diary study on maladaptive daydreaming, mind wandering, and sleep disturbances: Examining within-person and between-persons relations. PloS one, 14(11), e0225529.

Widom, C. S. (1989). Child abuse, neglect, and adult behavior: Research design and findings on criminality, violence, and child abuse. American Journal of Orthopsychiatry, 59(3), 355-367.

Widom, C. S., & White, H. R. (1997). Problem behaviors in abused and neglected children grown up: Prevalence and co-occurrence of substance abuse, crime and violence. Criminal Behavior and Mental Health, 7(4), 287-310.

Received 16 September 2022
Revision received 17 August 2023