International Journal of Psychiatry in Clinical Practice

ISSN: 1365-1501 (Print) 1471-1788 (Online) Journal homepage: https://www.tandfonline.com/loi/ijpc20

Pathological fantasy friend phenomenon

Anju Gupta & Nimesh G. Desai

To cite this article: Anju Gupta & Nimesh G. Desai (2006) Pathological fantasy friend
phenomenon, International Journal of Psychiatry in Clinical Practice, 10:2, 149-151, DOI:
10.1080/13651500600578961

To link to this article: https://doi.org/10.1080/13651500600578961

Published online: 12 Jul 2009.

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International Journal of Psychiatry in Clinical Practice, 2006; 10(2): 149
151

CASE REPORT

Pathological fantasy friend phenomenon

ANJU GUPTA & NIMESH G. DESAI

Department of Psychiatry, Institute of Human Behaviour & Allied Sciences (IHBAS), Delhi, India

Abstract
Fantasy friend or imaginary companions is usually regarded as normal phenomenon and commonly seen in children. The
index case is presented for highlighting the pathological nature of fantasy friend phenomenon, role of psychological, social
and cultural factors in its genesis and its course. Onset and persistence of this phenomenon throughout adolescence, its
longer duration and non-recognition of its imaginary component by the patient indicates its pathological nature. The patient
developed schizophrenia after experiencing this phenomenon for 12
13 years. It is concluded that pathological fantasy
friend phenomenon may carry risk of schizophrenia if continued without any intervention for longer duration. Hence, there
is a need to identify and intervene early in such kind of cases. The findings of this case report needs to be corroborated by
other case reports or studies.

Key Words: Fantasy, imaginary, phenomenon, friend

Introduction sies, creativity and changes in socio-emotional devel-

The phenomenon of fantasy friend or imaginary
companion is commonly seen in children with the
prevalence rate varying from 17 to 46% [1,2]. It is
usually regarded as normal in children, but if
encountered in adolescence, it indicates some under-
lying psychopathology. Due to limited research in
this area, the significance and functions of imaginary
companions remains poorly understood. Imaginary
companions or fantasy friends are experienced as
one or more invisible persons which may have a
conversation with the patient directly and mutually
over a period of time. They consist of vivid images
which may closely resemble the true perceptions.
The geographical position of these images is not
specified, and may be perceived internally and
externally by the patient. Adolescent patients sense
the reality of these images, and think of them as
other persons, but recognize them as unreal. These
above-mentioned characteristics indicate that this
phenomenon has a pathological structure, but some
characteristics, like the patient’s recognition of the
imaginary aspect of the companion and its benefits,
do not fall under the category of psychopathology
[3].
The fantasy friend phenomenon may be fulfilling
different functions of the child or adolescent, such
as: developmental changes in reality-testing, fanta-
opment and in friendship conceptions [4]. Imag-
inary companions supplement experiences with close
friends, but they do not compensate for the lack of
close friendships [5].
Here, a case is reported which describes the
pathological nature of the fantasy friend phenom-
enon.
Case report
Mr A, a 24-year-old Hindu male, high school
educated, working irregularly as an electrician,
attended the Psychiatric Outpatient Department of
our hospital with his mother. He was born as a full-
term normal delivery with uneventful antenatal,
natal and postnatal period as narrated by the
patient’s mother. He lost his father at the age of 3
years. He had a stepfather who had low frustration
tolerance and aggressive tendencies. His stepfather
was alcohol dependent. He had frequently abused
and assaulted the child physically and emotionally on
trivial issues. Mr A could not recall these incidences
afterwards. There was no difficulty in learning new
episodic information. He also did not get attention
and care from his mother as she remained preoccu-
pied with various marital and family problems, as
well as constant financial stress. She also worked as a
teacher. Since he grew up in these circumstances he

Correspondence: Dr Anju Gupta, Department of Psychiatry, Institute of Human Behavior & Allied Sciences, Dilshad Garden, Delhi 110 095, India. Tel: +11
22580862. Fax: +11 22999227. E-mail: anjusimran_2003@yahoo.co.in

(Received 3 October 2005; accepted 21 December 2005)

ISSN 1365-1501 print/ISSN 1471-1788 online # 2006 Taylor & Francis
DOI: 10.1080/13651500600578961
150 A. Gupta & N.G. Desai
remained lonely most of the time. He had just one or
two casual friends.
The patient reported that when he was 11 years
old, he witnessed supernatural rituals performed by
an ojha (the equivalent to a faith healer in India) at
his home. In this ritual, the ojha would bring
supernatural powers into a person. After this event,
he started copying him. He often sat alone in his
room, closed his eyes and called a friendly ghost. He
started calling him almost daily whenever he re-
quired him. He could visualize him clearly and
internally. He could hear his voice coming from
within. The ghost helped him in solving problems
and completing his tasks. When one ghost was not
able to help him, he would change over to another
ghost. He also gave them different names.
As he grew, his interest changed from supernatural
powers to scientific themes and extra-planetary
powers, accordingly the earlier visits of the ghosts
were replaced by aliens from different planets. This
practice continued for another 2
3 years. Then he
ceased to believe in extra-planetary powers and
replaced the extra alien friend with an adolescent
named Dil (heart). This was his best friend. This
friend helped him to win games (cricket), do
electrical work, other household work and also
advised him in times of need. He described this
friend as an ideal, powerful, confident, and dom-
ineering person with special abilities to do all
difficult work and found himself different from him
as he himself was mild, low in confidence and of
submissive type. This continued for another 4 or 5
years.
One day while he was talking to the imaginary
friend in the park, a passerby objected. At that time
he realized that something was wrong with him and
told all these things to his mother. He did not accept
that his friend ‘Dil’ was not real when his mother
tried to convince him. Subsequently he was brought
to Psychiatric Outpatient Department for interven-
tion. There was no history of abnormal behavior,
delusion, hallucination, first-rank symptoms of schi-
zophrenia or symptoms suggestive of affective dis-
order. There was no history of any medical,
neurological or substance use disorders. Physical
examination was found to be normal. Mental status
examination revealed no psychotic symptoms. Var-
ious psychological tests (Rorschach test, Thematic
Apperception Test (TAT), Multiphasic Personality
Questionnaire (MPQ), Draw a Person Test and
Wechsler Adult Performance Intelligence Scale (WA-
PIS)) were administered by a clinical psychologist.
The findings of these tests were high sensitivity, high
creativity, conflict with father and fantasy thinking.
Routine investigations were found to be normal.
Various sessions (reality-oriented psychotherapy)
were conducted, focusing on the unreal nature of
this imaginary friend. After a few sessions he
accepted the reality, but could not control it as he
felt very tense and helpless without this imaginary
friend and dropped out of treatment.
After 6 months he was brought back by his mother
because of increased disturbances. He was suspi-
cious, behaving and talking abnormally, not doing
any work and neglecting self care. Interviewing of the
patient revealed systematized delusion of persecu-
tion, thought broadcast, thought echo and third-
person auditory hallucinations, and a diagnosis of
schizophrenia was made and treatment started
accordingly.
Discussion
Fantasy friend phenomenon is considered normal in
children, but if encountered in adolescence it sug-
gests a psychopathological condition.
Here, the patient could visualize vivid images of
invisible persons internally without specifying the
exact location, and could call them according to his
willpower. This differentiates the phenomenon from
a true perceptual disorder. Normally the fantasy
friend is recognized as unreal. In this case, imaginary
companions were perceived as real by the patient
without sensing the imaginary component, indicat-
ing a pathological nature. In the present case, the
‘imaginary companions’ phenomenon was experi-
enced at the age of 11 years for the first time, and it
persisted throughout adolescence, further indicating
its pathological nature.
Imaginary companions are reported more often by
girls [3], the first-born and only child [6], and by the
very imaginative. These subjects have a predisposi-
tion to engage in fantasy [7]. This patient is also a
first-born child, and is the only child of his parents
with a high creativity and high sensitivity. Psychoso-
cial factors, such as verbal and physical abuse by his
stepfather, lack of emotional support, loneliness and
marital discord of parents may be predisposing
factors for the patient’s illness. Socially withdrawn
adolescents [8] and adolescents with a higher level of
distress [1] are at high risk of creating fantasy
friends. The cultural belief that supernatural power
can be brought into human beings is quite prevalent
in India. It became a learning model for the client
and helped in initiating this phenomenon.
Similarly, Sobel has described a patient with
multiple childhood stressors who developed an
imaginary friend phenomenon during early child-
hood [9]. The stressors in this case were: separation
from the father, loneliness and the dangerous and
poor urban neighborhood. He also had only a few
friends. In that case, the imaginary friend disap-
peared after early childhood, and the patient devel-
oped schizophrenia at the age of 23 years, long after
the disappearance of the phenomenon. There ap-
pears to be no relation between the imaginary friend
phenomenon and schizophrenia in that case, unlike
our case report.

In the present case, the patient is aware of fantasy
friends and can control their visits according to his
willpower. This differentiates it from multiple per-
sonality disorder (MPD). In MPD, an altered state
arises in order to compartmentalize stress-related
memory and the patient remains unaware of it.
Schizoid fantasy can be differentiated from this
phenomenon, as its contents and motivation are
determined by microsomal environmental influ-
ences.
The patient developed schizophrenia after 12
13
years of experiencing this phenomenon which sug-
gests its course.
It is concluded that features like onset of this
phenomenon during adolescence, its longer duration
and persistence throughout adolescence and non-
recognition of the imaginary component of it by the
patient, indicate the pathological nature of the
symptoms. As is evident from this case, the patho-
logical nature of this phenomena suggests its course
(developing schizophrenia); however, this requires
further research evidence.
Key points
. Loneliness, lack of emotional support and
physical assault by stepfather during childhood
. Could conjure imaginary friend at 11 years of
age after witnessing a supernatural ritual by ojha
. This imaginary friend was an ideal person and
helped him in day-to-day functioning
. patient developed schizophrenia 12
13 years
after experiencing this phenomenon
Fantasy friend phenomenon 151
Statement of interest
The authors have no conflict of interest with any
commercial or other associations in connection with
the submitted article.
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