All about maladaptive daydreaming (MD): causes, therapies and self-help strategies

Maladaptive daydreaming (MD) is an intense form of immersion in dream content accompanied by an exuberant imagination and the tendency to regularly escape from the present into inner images and imaginary worlds over long periods. This tendency is the fundamental characteristic of maladaptive daydreaming. It is not an everyday experience for most people. However, it is also not uncommon, as the increasing number of MD groups proves.

The result is excessive daydreaming that interferes with daily life. Maladaptive daydreaming can serve as a kind of dissociative “surge protection”, for example, in the case of PTSD or dissociative disorders. There is also an obvious connection to neuroatypical (autistic and attention-related) spectrum disorders. Although maladaptive daydreaming is not an official psychiatric diagnosis, it is currently the focus of psychological research, and this has even led to the development of specific tests such as the daydreaming self-test [see below].

Trending

Kindheitstrauma (cPTBS): ACE-Test kostenlos online

Understanding some differences is essential to recognizing the unique psychological dynamics and effects of maladaptive daydreaming compared to ordinary mind wandering.

Definitions

Mind Wandering (MW)

Definition

Mind wandering (MW) is a mental state in which one’s attention drifts away from a current task or the immediate environment. Instead, it becomes preoccupied with internal thoughts or fantasies.

Unconscious process

MW often occurs unconsciously or spontaneously. It is a natural and everyday process in which the mind wanders from one thought to another without necessarily being associated with deep emotional involvement.

Short-term and random

The episodes of MW are usually short and variable, without focussing on specific or detailed scenarios. They are often random and can be triggered by external stimuli or internal thoughts.

Maladaptive daydreaming (MD)

Definition

Maladaptive daydreaming is a much more intense and extensive form of daydreaming. It is characterized by extraordinarily vivid and detailed daydreams that involve a strong emotional connection and often also a complex plot.

Conscious and controlled process

In contrast to MW, maladaptive daydreaming is often a conscious and intentional process in which individuals actively immerse themselves in their daydream world and shape it. Maladaptive daydreaming can be used as an escape mechanism or to cope with emotional problems.

Long-term and thematically focussed

Maladaptive daydreams are more extended, more thematically focused and more structured. They can last for hours or even days and are often linked to personal wishes, goals, or scenarios deeply rooted in the psyche.

Comparison

Ordinariness vs. intensity

While MW is an everyday and ordinary part of mental life, maladaptive daydreaming is an extreme form of daydreaming that can interfere with daily life and well-being.

Spontaneity vs. structure

MW is spontaneous and unstructured, whereas maladaptive daydreaming is structured and often consciously controlled by the person.

Short-term distraction vs. long-term behaviour

MW serves as a short-term mental distraction, while maladaptive daydreaming serves as a long-term escape or coping mechanism.

Introduction

Maladaptive daydreaming, an often overlooked and poorly understood phenomenon, has received increasing attention recently. A link between maladaptive daydreaming and other mental illnesses is still being researched. Some studies indicate a link between maladaptive daydreaming and other disorders such as attention deficit hyperactivity disorder (ADHD), obsessive-compulsive disorder (OCD), depression, anxiety disorders, post-traumatic stress disorder (PTSD), bipolar disorder, borderline personality disorder, dissociative disorder and psychosis. Research has also shown that maladaptive daydreaming may share characteristics with behavioural addictions such as internet gaming. Of particular interest is the role childhood trauma may have in the onset and development of these disorders. However, it is unclear how these disorders specifically relate to maladaptive daydreaming. Further research is therefore essential to fully understand these relationships.

Maladaptive daydreaming and its connection to other disorders

There are both overlaps and distinguishing features between maladaptive daydreaming and other mental disorders. In all cases, attention must be paid to both maladaptive daydreaming and the underlying mental health problems.

Maladaptive daydreaming and addiction

Similarities in dynamics

Addictive behaviour and maladaptive daydreaming have similar behavioural dynamics. Both can act as a form of escape from reality or a means of coping with emotional difficulties. In addictive behaviour, individuals resort to substances or activities that provide short-term gratification or relief from negative feelings—similarly, individuals with maladaptive daydreaming use daydreaming as a mechanism to escape unpleasant realities or emotional states.

Reinforcement and dependence

A cycle of reinforcement can be observed in both addictive and maladaptive daydreaming. In addictive behaviour, consuming the substance or engaging in the activity leads to a short-term reward or relief, which reinforces the desire for more. In maladaptive daydreaming, immersion in daydreams reinforces the need to continue daydreaming, especially if it is perceived as an effective method of emotional regulation.

Adverse effects on daily life

Both behaviours can have a negative impact on daily life. Addictive behaviour can lead to health problems, interpersonal difficulties and negative social consequences. Maladaptive daydreaming can also become problematic if it leads to neglect of real-life responsibilities, social isolation or a reduced ability to deal with the real world.

Coping mechanism

Both addiction and maladaptive daydreaming can be seen as dysfunctional coping mechanisms for deeper psychological problems such as anxiety, depression or trauma. They serve to distract from these problems in the short term, but this offers no long-term solution and often worsens the underlying issues.

Maladaptive daydreaming and dissociative disorders

The so-called “dissociative immersion” is a key component of maladaptive daydreaming and involves the internal (e.g. daydreaming) or external (e.g. reading a book or watching a film) absolute narrowing of attention. Dissociative immersion differs from attention deficit symptoms and mind wandering (MW).

Connection to maladaptive daydreaming

Maladaptive daydreaming can, in many ways, be considered a form of dissociation. Dissociation is a psychological process in which a person experiences a separation between their thoughts, feelings, memories or even their identity. In the case of maladaptive daydreaming, sufferers use daydreaming as a way of distancing themselves from their current reality or emotional states. This form of dissociation serves as a mechanism to cope with emotional dysregulation – a difficulty in experiencing, processing and responding to emotions appropriately.

Maladaptive daydreaming as a coping strategy

For people who experience maladaptive daydreaming, daydreaming often becomes a method of avoiding or controlling unpleasant or overwhelming emotions. Rather than dealing directly with these emotions or the underlying issues, maladaptive daydreaming allows them to immerse themselves in a world where they feel safe and in control. This escape into the world of daydreaming can provide temporary relief but often leads to a neglect of the real world and its challenges.

Dissociation and emotional dysregulation

As observed in maladaptive daydreaming, the tendency towards dissociative states is closely linked to emotional dysregulation. This dysregulation can arise for a variety of reasons, including trauma, mental disorders or developmental disorders. As a dissociative process, maladaptive daydreaming allows sufferers to dampen their emotional reactivity and distance themselves from the stressful aspects of their lives.

Long-term consequences

While maladaptive daydreaming can be an effective method of coping with emotional stress in the short term, it harbours the risk of increased alienation from reality in the long term. This continued dissociation can lead to further difficulties in emotional regulation and dealing with real-life situations.

Maladaptive daydreaming and obsessive-compulsive disorder (OCD)

While both maladaptive daydreaming and OCD can involve obsessive thoughts, maladaptive daydreaming is characterized by vivid and imaginative daydreams that alter the sense of agency and involve a motivation to turn attention inward. In contrast, obsessive-compulsive disorder is characterized by intrusive thoughts, worries or ruminations that occur involuntarily. Similarly, maladaptive daydreaming differs from OCD in its immersive and purposeful nature, whereas OCD is spontaneous, uncontrolled and fragmentary.

Similarities in behaviour patterns

Obsessive-compulsive disorder and maladaptive daydreaming share some characteristic behavioural patterns. In OCD, these patterns often manifest themselves in repetitive, unwanted thoughts (compulsions) and/or behaviours (rituals) that are intended to help the person reduce anxiety or discomfort. In maladaptive daydreaming, on the other hand, the pattern manifests itself in excessive, often deliberately induced daydreaming, which serves as an escape or coping mechanism for emotional stress.

Need for control and escape mechanism

A strong need for control can be observed in both obsessive-compulsive disorder and maladaptive daydreaming. People with obsessive-compulsive disorder try to gain a sense of control over their fears through rituals. In the case of maladaptive daydreaming, those affected use daydreaming to escape into a controllable, often idealized world in which they feel safe.

Emotional regulation

Emotional regulation difficulties play a role in both disorders. Compulsive behaviour often serves to reduce discomfort or anxiety. Similarly, maladaptive daydreaming serves as a means of coping with negative feelings or stress by immersing the person in their daydream world.

Cyclical nature and reinforcement

Another common element is the cyclical nature of both disorders. In OCD, giving in to a compulsion can bring short-term relief but often leads to an intensification of the compulsion in the long term. Similarly, in maladaptive daydreaming, immersing oneself in daydreams can have a temporary calming effect, but in the long term, it increases the need for and dependence on daydreaming.

Maladaptive daydreaming and depression

Connection

Maladaptive daydreaming can occur in depression both as a symptom and as a coping mechanism. Depression tempts people to escape into maladaptive daydreaming to escape the real world, but this can increase isolation and other symptoms of depression.

Reinforcement of negative emotions

Persistent maladaptive daydreaming can lead to an increased focus on negative thoughts and feelings. That exacerbates the depressive symptoms.

Maladaptive daydreaming and anxiety disorders

Escape from fear

Maladaptive daydreaming can serve as an escape from anxiety and stress-inducing situations. Those affected can use maladaptive daydreaming to retreat into a safer, more controllable world.

Avoidance behaviour

However, this leads to avoidance in the long term and undermines the ability to develop effective coping strategies for anxiety.

Maladaptive daydreaming and bipolar disorder

Fluctuations in daydreaming

In bipolar disorder, the intensity and frequency of maladaptive daydreaming may vary with mood swings. In manic phases, daydreams may be more intense and grandiose, while in depressive phases, they may become more sombre.

Influencing the reference to reality

The boundary between reality and fantasy can become blurred during extreme mood phases, which can complicate the symptoms of bipolar disorder.

Maladaptive daydreaming and borderline personality disorder (BPD)

Emotional regulation

For people with BPD, who often have difficulties with emotional regulation, maladaptive daydreaming can be a method of tolerating or regulating intense emotions.

Intensification of the symptoms

At the same time, maladaptive daydreaming can lead to an increase in symptoms such as impulsivity, identity conflicts and interpersonal problems that are characteristic of BPD.

Maladaptive daydreaming and psychosis

Distinguishing between reality and fantasy

While maladaptive daydreaming is not a psychosis in itself, in people who are prone to psychotic episodes, intense daydreaming can impair the ability to distinguish between reality and fantasy.

Risk of amplification

In rare cases, intense maladaptive daydreaming may exacerbate symptoms or trigger psychotic episodes.

Maladaptive daydreaming and attention-deficit/hyperactivity disorder (ADHD)

Maladaptive daydreaming and attention deficit hyperactivity disorder (ADHD) have some interesting overlaps but also striking differences, particularly concerning concentration difficulties and attention processes.

One of the main characteristics of ADHD is the difficulty in maintaining a chosen direction of attention, resulting in a lack of concentration and easy distractibility. The problem is not the lack of focus of attention but its “seductiveness” to (and adherence to) originally unintended objects of attention. This fundamental problem leads to challenges in various areas of life, from school to professional life. In contrast, maladaptive daydreaming is characterized by deliberately triggered, intense and often excessive daydreaming, which can be understood as a deliberate escape from reality. While ADHD patients have difficulties focusing their attention, maladaptive daydreaming patients deliberately direct daydreams away from the present.

The commonality between maladaptive daydreaming and ADHD is the tendency to hyperfocus with intense emotional and cognitive involvement. In ADHD, those affected lose themselves in some regions of interest or activities and then wholly ignore their surroundings. In maladaptive daydreaming, on the other hand, this hyperfocus is directed exclusively towards the inner world of daydreams, so while ADHD is often associated with external sources of stimulation, which can manifest itself in impulsive behaviour and hyperactivity, maladaptive daydreaming is more associated with an internal escape into one’s world of thoughts. While ADHD manifests itself in an inability to regulate and sustain attention, maladaptive daydreaming offers a refuge into an inner world as a defence reaction to external stimuli or emotional stress.

Maladaptive daydreaming and autism

Maladaptive daydreaming in individuals with autism spectrum disorders provides an interesting perspective on the functioning of maladaptive daydreaming as a means of self-regulation or as a response to socialization difficulties. Autism is characterized by a wide range of behaviour and communication patterns, and for many individuals, social interaction can be challenging. Maladaptive daydreaming can occur in this context as a form of coping, allowing individuals to retreat into an inner world where social interactions are controllable and less stressful. Returning to the world of daydreaming is a self-regulatory mechanism against overstimulation or emotional overload. The intense world of maladaptive daydreaming offers a safe space where emotions and thoughts can be processed in a way that may not be accessible in the real world. That can be particularly relevant for people with autism who have difficulty understanding and expressing their emotions.

When looking at maladaptive daydreaming, ADHD and autism, it is noticeable that although intense daydreaming is a standard feature, it manifests itself in different contexts. In maladaptive daydreaming, intense daydreaming is central and often plays a dominant role in the lives of those affected. In ADHD, intense daydreaming can occur as a by-product of difficulties with attention regulation. At the same time, with autism, it can serve as a mechanism for coping with social and emotional challenges. In all three cases, daydreaming provides a way to cope with internal or external stressors. Although the specific triggers and functions of daydreaming may vary, the tendency to withdraw into an inner world is a common link. This commonality emphasizes the importance of understanding the individual experiences and backgrounds of those affected to develop appropriate therapeutic strategies.

Maladaptive daydreaming and trauma

The link between childhood trauma and maladaptive daydreaming is a fascinating and complex aspect of psychological research. Childhood trauma, which includes violence and other traumatic experiences, leaves deep psychological scars that strongly influence an individual’s later life. Those who have experienced violence and other forms of childhood trauma in their childhood will have difficulty recognizing their own history. That can lead to various coping strategies, including maladaptive daydreaming.

Maladaptive daydreaming, characterized by intense and frequent daydreaming that interferes with everyday living, can be a form of escape or processing of these unprocessed traumas. In this world of daydreaming, individuals often find a refuge that allows them to gain control over the experiences and emotions that they find overwhelming in the real world. Maladaptive daydreaming will enable people to process feelings and experiences in a way that may not be accessible or safe in their real-life environment.

These observations suggest that maladaptive daydreaming is more than a simple escape into fantasy; it is a complex psychological reaction to unprocessed inner states.

 Therapeutic approaches and coping strategies

Various therapeutic approaches are used to treat maladaptive daydreaming in the context of mental disorders and self-management techniques. The effectiveness of these therapeutic approaches and techniques varies from individual to individual, and sometimes, a combination of different methods is required to meet the specific needs and challenges of those affected. Therefore, the treatment of maladaptive daydreaming requires a holistic and interdisciplinary approach. While psychotherapeutic methods address the underlying emotional and cognitive aspects of maladaptive daydreaming, medication may be needed to treat co-occurring mental disorders such as anxiety, depression or ADHD.

Maladaptive daydreaming is often a long-term problem that requires ongoing care and regular adjustments to the treatment plan.

In addition, the focus should be on reducing maladaptive daydreaming symptoms and promoting general mental and physical health. That includes exercise, a balanced diet, sufficient sleep and social contact.

Cognitive behavioural therapy (CBT) for maladaptive daydreaming

Cognitive Behavioural Therapy (CBT) is a practical approach to treating a variety of mental disorders, including maladaptive daydreaming. CBT focuses on identifying and changing unhealthy thought patterns and behaviours.

Psychodynamic therapy

Handling of underlying conflicts

This form of therapy uncovers unconscious conflicts and traumas that trigger or intensify maladaptive daydreaming and helps to overcome them.

Understanding the function of maladaptive daydreaming

The therapy supports the understanding of maladaptive daydreaming as a coping strategy for unresolved emotional problems.

Mentalization-Based Therapy (MBT)

Focus on understanding mental states

MBT helps individuals better understand their thoughts and feelings and those of others. In the case of maladaptive daydreaming, this helps to sharpen the distinction between reality and the daydream world.

Improvement of emotional regulation

MBT also helps to better recognize and regulate inner states, such as emotional reactions and needs. Escaping into fantasy becomes superfluous.

Narrative therapy

Redefining one’s own history

Through narrative therapy, people with maladaptive daydreams can re-evaluate and rewrite their life story because they see themselves in a different light.

Separation of person and problem

This method helps to see maladaptive daydreaming as a “problem” you have, not one you are.

 Self-management techniques for maladaptive daydreaming

1. Identifying and challenging thought patterns

   How to:

Identifying negative or irrational thought patterns that lead to maladaptive daydreaming. That includes recognizing and challenging the distortions of reality or self-criticism associated with maladaptive daydreaming.

   Exercise:

Thought logs – Keep a log in which you write down the thoughts that occur before, during and after daydreaming. Then, assess these thoughts for their rationality and look for more realistic and healthier alternatives.

2. Developing coping strategies

   How to:

Learning techniques for coping with stress, anxiety or other emotions that could trigger maladaptive daydreaming.

   Exercise:

Relaxation techniques – Learn grounding and relaxation techniques such as 4×4 breathing, progressive muscle relaxation (PMR) or guided meditation to reduce anxiety and stress.

3. Changing behaviour

   How to:

Changing the behaviours associated with maladaptive daydreaming and promoting healthier activities.

   Exercise:

Activity planning – Schedule daily activities you enjoy, such as sports, art, music or social interactions, to reduce dependence on daydreaming.

4. Strengthening ties with reality

   How to:

Strengthen your connection to the real world to reduce daydreaming. Take regular, conscious breaks during the day to become aware of your surroundings and reassure yourself of what is real and what is daydreaming.

   Exercise:

Walk in nature – Go for a walk for at least 20 minutes every day. Concentrate on the things you see, hear and feel. Try to immerse yourself in the experience of walking fully.

5. Mindfulness

   How to:

The practice of mindfulness focuses on staying in the present moment and consciously perceiving your surroundings, thoughts and feelings without making judgements.

   Exercise:

Simple breathing exercise – Sit or lie down in a comfortable position. Concentrate on your breath. Observe how the air flows in and out. If your thoughts wander, gently bring your attention back to your breath. Do this for 5-10 minutes.

6. Self-reflection

   How to:

Self-understanding to create awareness of the frequency and content of daydreams. Creative activities such as painting, writing or music are other ways of expressing emotions and thoughts.

   Exercise:

Daydream log – Every time you catch yourself daydreaming, write down the daydream’s date, time, duration and content. At the end of the day, reflect on patterns and triggers.

7. Structured daily schedules

   How to:

Create a structured daily schedule to encourage productive activities and limit time for daydreaming.

   Exercise:

Plan your day in advance with set times for work, meals, relaxation and hobbies. Try to stick to this plan and evaluate at the end of the day how well you followed it and how it influenced your daydreams.

Be patient with yourself and give yourself time to change.

Summary

1. Maladaptive daydreaming as a form of dissociation: Maladaptive daydreaming can be understood as a form of dissociation that often occurs as a reaction to emotional dysregulation. Maladaptive daydreaming frees individuals from stressful emotions or experiences and offers a temporary escape into a controllable fantasy world.

2. Link to mental disorders: Maladaptive daydreaming shows significant overlap with several mental disorders, including depression, anxiety disorders, bipolar disorder, borderline personality disorder, and, in some cases, even tendencies towards psychotic episodes. These connections emphasize the complexity of maladaptive daydreaming as a psychological phenomenon.

3. Therapeutic approaches and self-management: Treating maladaptive daydreaming requires a holistic approach that considers both psychological and medical aspects. Therapy options such as Cognitive Behavioural Therapy, Mentalization-Based Therapy, Psychodynamic Therapy and Narrative Therapy are effective. In addition, self-management techniques such as mindfulness, creative expression, structured daily schedules, and self-reflection support the management of maladaptive daydreaming.

4. Importance of a comprehensive approach: An effective treatment plan for maladaptive daydreaming should include the integration of various therapeutic disciplines to address the disorder’s psychological and physical aspects. That includes an individualized approach and long-term adaptation of therapy to the specific needs and changes in the individual’s life.

5 Importance of understanding maladaptive daydreaming: A thorough understanding of maladaptive daydreaming and its relationship to other mental disorders is crucial to developing effective treatment strategies. This understanding helps to consider maladaptive daydreaming not just as an isolated phenomenon but in the context of overall emotional and mental health.

Understanding maladaptive daydreaming and its role in the spectrum of mental disorders is a growing field that requires further research.

Outlook

1. In-depth research into the causes: More detail is needed to understand the exact causes and mechanisms of maladaptive daydreaming. In particular, the role of trauma, emotional dysregulation and their connection to maladaptive daydreaming need to be further researched.
2. Development of specific treatment approaches: Treatment methods from related psychological fields are currently being adapted for maladaptive daydreaming. There is a need for specific, evidence-based treatment approaches that directly target maladaptive daydreaming.
3. Long-term studies on the effectiveness of therapies: Long-term studies are needed to assess and compare the efficacy of different therapeutic approaches in treating maladaptive daydreaming.
4. Integration into diagnostic manuals: Including maladaptive daydreaming in official diagnostic manuals such as the DSM or ICD could facilitate and standardize the research, diagnosis and treatment of maladaptive daydreaming.
5. Promoting acceptance and support: People with maladaptive daydreaming need a supportive environment and acceptance. Raising society’s awareness of this disorder can help to reduce stigmatization and make it easier for those affected to access help and support.
6. Interdisciplinary research: Promoting interdisciplinary research that integrates different aspects of maladaptive daydreaming, such as psychology, neurology and social sciences, could lead to a more comprehensive understanding of maladaptive daydreaming.

Increasing recognition and research into maladaptive daydreaming must help identify any pathological changes in maladaptive daydreaming, develop more effective treatment strategies and improve the lives of those living with this challenge.

Are you affected? Take the test

The 16-item Maladaptive Daydreaming Scale by Eli Somer, Jayne Bigelsen, Jonathan Lehrfeld and Daniela Jopp (2016) consists of 16 questions. These questions were developed to assess the degree of maladaptive daydreaming in adolescents or adults. Score each set from 0 to 100.

1. Is your daydreaming triggered by music? (0 Never, 100 Very often)
2. If an event in the real world interrupted one of your daydreams, how strong was your need to return to that daydream as soon as possible? (0 zero, 100 extreme)
3. How often are your current daydreams accompanied by vocal sounds or facial expressions (e.g. laughing, talking or mouth movements)? (0 Never, 100 Very often)
4. How much does it bother you when you are unable to dream as much as usual due to real-world commitments? (0 Not at all, 100 Extremely stressful)
5. How much does your daydreaming affect your ability to complete important tasks? (0 Not at all impaired, 100 Extremely impaired)
6. How concerned are you currently about the time you spend daydreaming? (0 Not at all worried, 100 Extremely worried)
7. If you know you had something important or difficult to do, how difficult was it for you to stay on task and achieve the goal without daydreaming? (0 No difficulty at all, 100 Extreme difficulty)
8. Do you feel that your daydreaming hinders you from achieving your general life goals? (0 Not at all impaired, 100 Extremely impaired)
9. How difficult was it for you to keep your daydreaming under control? (0 No difficulty at all, 100 Extreme difficulty)
10. How annoyed do you usually feel when the real world interrupts one of your daydreams? (0 Not at all annoyed, 100 Extremely annoyed)
11. How much does your daydreaming affect your academic/professional success? (0 Not affected at all, 100 Extremely affected)
12. Would you rather daydream than socialize or pursue hobbies? (0 Not at all, 100 To the full extent)
13. When you wake up in the morning, how strong is your urge to start daydreaming immediately? (0 No urge at all, 100 Extreme urge)
14. How often are your current daydreams accompanied by physical activities such as walking up and down, swinging, or shaking hands? (0 Never, 100 Very often)
15. Do you find dreaming calming and/or pleasant? (0 Not at all calming/pleasant, 100 Very calming/pleasant)
16. Is your daydreaming dependent on continued listening to music? (0 Not dependent, 100 Completely dependent)

At the end, the average of all answers between the minimum score of 0 and the maximum score of 100 is calculated i.e. the sum of the individual scores divided by 16.

Interpretation of the scores

• 0 to 39 normal range; maladaptive daydreaming is unlikely.
• 40 or more maladaptive daydreaming likely.

These scores apply to adolescents and adults aged 13 years and older; children may have higher or lower scores. A clinical assessment is required for diagnosis. Try the Maladaptive Daydreaming Scale online http//traumadissociation.com/mds#languages

Sources

Psychology Today: Do You Suffer From Maladaptive Daydreaming?

PubMed: Maladaptive daydreaming: Evidence for an under-researched mental health disorder

Maladaptive Daydreaming Center – Reddit Community: Reddit – Maladaptive Daydreaming Center

ISSTD – Self Care Resources: Self Care Resources for the Public – ISSTD

Deutschlandfunk Nova Maladaptives Tagträumen: Wenn Träumen zur Sucht wird

Related posts:

Toxic shame: understanding and overcoming its effects Childhood Trauma: understanding and overcoming rage in cPTSD Childhood trauma: understanding and overcoming toxic shame and cPTSD. Childhood trauma – forms: These are the most important cPTSD symptoms