The impact of pathological and non-pathological fantasizing on the adaptation of adolescents with intellectual disability and schizotypal disorder

Background. Fantasizing is an integral component of cognitive and emotional development, yet in adolescents with intellectual disability (ID) and schizotypal disorder (STD), this process can take maladaptive forms. Maladaptive Daydreaming (MD), although not an official diagnostic category, is associated with significant functional impairment. Understanding the differential features of pathological and non-pathological fantasizing in these clinical groups is crucial for developing adequate diagnostic and therapeutic approaches. Insufficient study of the MD phenomenon in adolescents with ID and the specifics of fantasizing in STD necessitates further research. Purpose – to conduct a comparative analysis of pathological and non-pathological fantasizing syndromes in adolescents with intellectual disability and schizotypal disorder to develop differential diagnostic criteria and justify therapeutic strategies. Materials and Methods. A systematic review of scientific publications in Scopus, Web of Science, PubMed, PsycINFO, and Google Scholar databases was conducted for the period from 2019 to 2024. The search utilized Keywords: «maladaptive daydreaming», «pathological fantasizing», «intellectual disability», «schizotypal disorder», «adolescents», «adaptive fantasizing», «fantasy proneness», «daydreaming». Source analysis was performed according to PRISMA and PICO guidelines (Population – adolescents with ID and STD; Intervention – assessment of fantasizing; Comparator – pathological vs. non-pathological fantasizing; Outcome – impact on adaptation). A total of 68 relevant articles were analyzed, including original research, reviews, and clinical case reports. Results. Pathological fantasizing in adolescents with ID often manifests as stereotypical, perseverative behavior that significantly hinders the formation of adaptive skills and social integration. In adolescents with STD, MD can acquire features bordering on psychotic experiences, including magical thinking, ideas of reference, and increased social isolation. Non-pathological fantasizing in both groups, although with its own specificities, performs important adaptive functions, contributing to emotional regulation and creativity. The main differential criteria are the level of control over fantasies, their impact on daily functioning, the awareness of the distinction between fantasy and reality, and the presence of associated distress. Conclusions. Pathological fantasizing syndrome is a significant clinical phenomenon in adolescents with ID and STD that requires specific diagnosis and correction. Understanding the functional differences between adaptive and maladaptive fantasizing is the basis for developing targeted therapeutic interventions aimed at supporting adaptive forms of imagination and minimizing the negative impact of pathological fantasizing.