Childhood Imaginary Companionship and Mental Health in Adolescence

Transcription

1 Childhood Imaginary Companionship and Mental Health in Adolescence Omer Bonne, MD Laura Canetti, MSc Eytan Bachar, PhD Atara Kaplan De-Nour, MD Arieh Shalev, MD Hadasssah University Hospital and Hadassah Hebrew University Medical School, Jerusalem, Israel ABSTRACT: An imaginary companion (IC) is a frequently encountered childhood fantasy, invisible to anyone but the child, who may be named, addressed or played with. Whether the presence of an IC is a normal developmental feature has not been determined. We examined psychometric measures and the presence/absence of childhood IC in a sample of 850 mentally healthy adolescents. 17.6% of our subjects, more often females, reported having had such a companion. Subjects who reported having had an IC in childhood exhibited higher levels of distress and emotional discontrol, displayed prolonged transitional object attachment and immature modes of coping with stress. Thus, although childhood imaginary companionship is not indicative of psychopathology, it may denote a vulnerability for adolescent perturbation and difficulty in coping with emotionally laden situations. KEY WORDS: Imaginary Companion; Transitional Object; Adolescence; Normal Population. Introduction A frequent, yet little studied, phenomenon encountered in the development of young children is the creation of an "imaginary companion" (IC). The companion is invisible to anyone but the child and may be named, addressed or played with directly.1 While seemingly similar to an hallucination, authors agree that children appear to be in control of the fantasy and possess intact reality testing.1,2 This phe- Received June 28, 1998; For Revision July 28, 1998; Accepted September 23, Address correspondence to Omer Bonne, MD, Director, Psychiatry Outpatient Clinic Department of Psychiatry, Hadassah University Hospital, P.O. Box 12000, Jerusalem 91120, Israel. Child Psychiatry and Human Development, Vol. 29(4), Summer 1999 & 1999 Human Sciences Press, Inc. 277

2 278 Child Psychiatry and Human Development nomenon may be found in children two to ten years of age. 3-5 Prevalence of imaginary companions ranges from 13% 1 to 31% 6 of the population. Since the recognition of this condition in the late 19th century, 7,8 opinion has been divergent as to whether the presence of such a companion is indicative of psychopathology 4,9 or is a normal developmental feature in certain individuals Most studies which have addressed this issue provide data based upon the examination of small subject groups and focus upon intrapsychic processes while only a few have attempted to correlate the presence or absence of an imaginary companion with mental, emotional and social/familial measures in such children Furthermore, we are not aware of any study, which examined the effect of the presence or absence of an imaginary companion in childhood upon mental health and function at later developmental stages. Myers, 14 based upon his and others' clinical observations and theoretical constructs, postulated that individuals who posses imaginary companions in childhood are more likely to express "creative" aptitudes as adults. This "capacity for vivid fantasy" has attracted considerable attention in the literature, and has been deemed indicative of a vulnerability toward dissociative phenomena and depesonalization. 15 These (and any other) associations between childhood imaginary companionship and adult properties and function remains to be proven. The present report draws from a larger study which examined diverse measures of mental health in a sample of Israeli high school students. The same subjects were then requested to report the presence or absence of earlier psychological constructs (e.g. transitional objects attachment, imaginary companionship, chumship). This study focuses upon the phenomenon of childhood imaginary companionship. The presence or absence of an IC in childhood is examined in relation to the presence or absence of other early developmental constructs as well as with multiple measures of adolescent well being. Subjects Subjects and Methods Eight hundred and seventy three Israeli high school students, th grade and th grade, 376 male and 597 female, participated in the study. Subjects were recruited from 8 different high schools, situated at 3

3 O. Bonne, L. Canetti, E. Bachar, A. Kaplan De-Nour, and A. Shalev 279 major cities, and may be considered representative of the Israeli high school student population. Subjects were asked to answer the questionnaires during a regular week day. Questionnaires were administered anonymously in the student's home class-room in the presence of the class teacher. All students present in the class were invited to participate in the study. Only a negligible number of students refused. Instruments Family and sociodemographic data were collected from all participants in the study, and in addition the following instruments were employed: 1. Parental Bonding Instrument 16 (PBI) is a self rating scale in which participants rate their perception of their parents' attitudes towards them. Two dimensions of parenting are devised for each parent: "care" (12 items) and "overprotection-control" (13 items). Each item is rated on a 1-4 scale, with higher scores indicative of higher care and increased control. Cronbach Alpha for the internal reliability of the PBI subscales ranged from 0.75 (maternal care) to 0.83 (paternal control). 2. Brief Symptom Inventory 17 (BSI) is a brief psychological self-report inventory scale consisting of 53 items, which address 9 symptom areas: somatization, obsessivenes, interpersonal sensitivity, depression, anxiety, hostility, phobic anxiety, paranoid ideation and psychoticism. In addition, an overall global severity index (GSI) may also be obtained, which portrays the average symptom load for each case. Both test-retest and internal reliabilites are high for the primary symptom dimensions of the BSI and factor analytic studies of the internal structure of the scale contribute evidence of construct validity. 3. The General Well Being (GWB) Scale 18 is a self report instrument, designed to assess aspects of subjective well being and distress. It contains 33 items divided into 6 subscales: worry about health (i.e. somatization), energy level, satisfying-interesting life, depressed vs. cheerful mood, emotional behavioral control, and relaxed vs. tense anxious mood. Score may be presented separately for each scale or as a total score, the higher the score the more likely is the participant to report better psychological well being. 4. Perceived Social Support Scales 19 (PSS) were designed to measure the extent to which an individual perceives that his need for support, information and feedback are fulfilled by friends (PSS-Fr) and family (PSS-Fam). Each of the 20 items in the scale consists of declarative statements to which the individual answers "Yes", "No" or" Don't know". The higher the score, the higher the social support. 5. Items inquiring about the current or past existence of particular, emotionally laden figures, objects or activities: A. The Chestnut Lodge Transitional Object (TO) Instrument 20 consists of 6 items referring to a TO attachment. Three items refer to childhood TO attachment and three to TO attachment at the time of the questionnaire administration. While items inquiring into childhood TO attachment merely call for the existence of such object, items seeking adolescent TO attachment specify that it is an object used (only) under stressful condi-

4 280 Child Psychiatry and Human Development tions. No attempt has been made in the literature to assess reliability or validity of this questionnaire, although a previous report from our group 21 using this instrument demonstrated construct validity for the questionnaire items. B. An item asking about the existence of a "chum": 22 a special, enduring, very close friend). The participant was asked to rely on his/her memory regarding the period between the ages of 81/2 11. C. An item asking about the presence of a "soothing object" (i.e. Teddy bear, picture etc.). D. An item asking about the presence of a "charm" (amulet, talisman). E. An item asking about the presence of a "soothing animal". F. An item asking about any "soothing activities" (i.e. listening to music, going for a walk, etc.) 6. An item asking about the existence of an imaginary friend. The participant was asked to rely on his/her memory of his childhood, between the ages of 2-9, regarding the existence of "an imaginary friend, self invented, with whom you communicated, played and shared secrets". Each participant could affirm, deny or not remember the existence of such a friend. Data Analysis Categorical data were analyzed using chi-square while continuos and interval data were analyzed by two tailed Student's T-test. Since subscales of the rating scales (BSI, GWB) are presented in the Tables, and may be considered multiple comparisons, Bonferroni correction, with an alpha value of 0.05, is employed to protect against type I error. Results One hundred fifty four participants (17.6%) reported having had an imaginary companion (IC), 605 (69.3%), denied the existence of such a friend and 114 (13.1%) did not remember whether they had one or not. Having had an IC was significantly more common in female subjects than in males (23.5% and 16.5%, respectively, p<0.02), but no significant three way interactions were detected between sex, having had an IC and any of the other variables studied (association between sex and variables of mental health presented in a separate communication). Age of subjects, (i.e. 10th or 12th grade), socio-economic status, parental marital state, birth order and number of siblings were not related to the presence of an IC. The association between the having had an IC and childhood TO attachment (Table 1) was marginally significant (p=0.046), while the association between having had an IC and current TO attachment

5 O. Bonne, L. Canetti, E. Bachar, A. Kaplan De-Nour, and A. Shalev 281 Table 1 Comparison Between Having and Not Having Had an Imaginary Companion (IC), Transitional Object (TO) Attachment, and Transitional Phenomena Mature and Immature. (Whole sample distribution of having/not having had an IC presented for reference. Values marked by an asterisk (*) represent Bonferroni correction survived significance levels.) Attachment Had IC No IC Chi Sq Value (df=l) p Value Whole Sample TO-Childhood TO Now Soothing Object Magic Object Soothing Animal Soothing Activities * 0.006* 0.000* highly significant (p<0.0005). A highly significant association (p< ) was also found between the use of a "magic object" (charm, amulet, talisman), a soothing object and having had an IC. Use of a specific activity or pet in times of hardship was not significantly associated with having an IC in childhood. No association was found between the presence of a "chum" and that of an IC. Subjects who reported having had an IC scored higher on the BSI, on most measures as well as on the global score (Table 2). No difference was observed in subject assessment of perceived social support (PSS) and parental attitude. In the scale measuring general well being (GWB), subjects who reported having had an IC described significantly higher levels of emotional behavior control, but scored similar to subjects who did not have an IC in all other subscales as well as on the global well being measure (Table 3). Discussion The prevalence of childhood imaginary companion found in our study (17.6%) is well within the range reported in the literature, although available data can not be considered robust. This value may be an underestimation, since it regards all subjects who "did not remember" whether or not they had an IC as if they did not have one. Although our sample is representative of Israeli high school students in their respective age groups, it may differ somewhat from the gen-

6 282 Child Psychiatry and Human Development Table 2 Comparison Between Adolescents Who Reported Having Had an Imaginary Companion (IC; n= 154) and Those Who Reported Not Having Had One (n=605) on the Subscales of Mental Health of the Brief Symptom Inventory (BSD as Well as the Global Score (GSI) of This Instrument. (Analysis performed by two tailed Student's T-test. Values marked by an asterik (*) represent Bonferroni correction survived significance levels.) Had IC(±SD) No IC(±SD) T. Value DF p Value Somatization Obsessions Sensitivity Depression Anxiety Hostility Phobia Paranoia Psychoticism GSI 51.2 ± ± ± ± ± ± ± ± ± ± ± ± ± ± ± ± * * * 0.000* 0.001* eral population, possibly over-representing subjects from a higher educational (and socio-demographic) background. In addition, although particulars of the IC were not investigated in our study, phrasing of the question implies an that the "imaginary being" sought is human, rather than animal or object. Although the human IC is the most common manifestation of an IC, 10,12,23 animal or personified object ICs Table 3 Comparison Between Adolescents Who Reported Having Had an Imaginary Companion (IC; n = 154) and Those Who Reported Not Having Had One (n = 605) on the Subscales of the General Well Being (GWB) Rating Scale as Well as the Global Score of This Instrument. (Analysis performed by two tailed Student's T-test. Values marked by an asterik (*) represent Bonferroni correction survived significance levels.) Had IC (±SD) No IC (±SD) T. Value DF p Value Health Worry Energy Satisfaction Cheerfulness Tension Emotion Total Score ± ± ± ± ± ± ± *

7 O. Bonne, L. Canetti, E. Bachar, A. Kaplan De-Nour, and A. Shalev 283 may also be encountered in children who show this phenomenon (Klein; 5 17% non-human IC in Meyer and Tuber 12 ). Furthermore, in contrast with most previous studies, which examined subjects at an age corresponding to the advent of the IC, ours is a retrospective study, and subjects may have become oblivious to the existence of an IC in their lives. IC was significantly more prevalent among females (23.5%) than among males (16.5%), in keeping with previous reports. 1,10,23 In contrast to previous publications, 10,12 order of birth, or being an only child was not associated with the existence of an IC. Subjects who report having had an IC display higher levels of psychological distress than those who do not recall having had such a companion, although levels of distress are well below those encountered in the psychiatrically ill. This can be primarily seen from the highly significant elevation in current symptomatology (Table 2), particularly in items addressing sensitivity, hostility, paranoia and psychoticism. Although the general well being of subjects reporting an IC is not significantly different from that of the rest of the sample, emotional behavior control was significantly poorer in these subjects (Table 3). It should be noted that symptomatology in the subjects who report having had an IC was not detected in all domains examined (i.e. parental bonding, social support), but rather focused mainly upon difficulties in handling emotional content. All authors who have studied imaginary companionship are unanimous in the opinion that this construct does not disrupt mentally healthy thought processes, and is not detrimental to normal daily function. 4,9,10,14,24 In fact, some theorists have even postulated the existence of a transitional "zone", 5 "phenomena' 25 or of "narcissistic guardians" 23,26 which accompany a child through development and represent age-related stages of object relation capabilities. These theorists follow the concept of "transitional object", conceived by Winnicot 27 and referring to the attachment between an infant and an object, which he regards as neither wholly internal or external, and to which he ascribes many animate attributes. Our study offered us a means to actually examine this assumption, i.e. to assess whether subjects who report having had a TO in childhood would also report the existence of an IC. We then thought to extend this assumption, and hypothesized that a subsequent developmental object relation stage would be the formation of a "chumship", as described by Sullivan, 22 thus forming a continuum of age related transitional object relation phenomena. Having had an IC was marginally associated with childhood TO attachment but not with having had a chum. Given the relatively

8 284 Child Psychiatry and Human Development large group of participants in our study and number of comparisons performed, such a significance level can not be considered conclusive. Therefore, based upon an empirical observation rather than upon a theoretical surmise, we conclude that our "continuum hypothesis" was not validated, although further research in this issue may be warranted. Both TO attachment and chumship are considered normative developmental stages. Several authors have suggested that the evolution of an IC is a means to confront inner tension, conflict, loneliness or perceived harassment. 4,9,14,24 Thus, in what may be the only quantitative study assessing psychodynamic and behavioral attributes of children with an IC and without overt symptomatology, Meyer & Tuber 12 found excess movement scores and poorer form level on the Rorschach Test, but no evidence for behavioral impairment on the Child Behavior Check List (CBCL). This Rorschach pattern indicates ego strengths and resourcefulness, but also internal conflict and poorer reality testing, although no evidence for disturbed performance was detected. While presence of childhood IC is not considered indicative of psychopathology, its persistence into adolescence is deemed highly pathological. 28 Since our sample consisted of mentally healthy adolescents, we assumed it unlikely that subjects would retain a bona fida IC. Therefore, the possibility of persistence of the IC into adolescence was not examined. We looked into other modes that may be used by healthy adolescents to alleviate tension, such as animate or inanimate object attachments or specific soothing activities. We found that among subjects who reported having had an IC, significantly more employed TO attachment and relied upon "magical" (charms, amulets), or other "soothing" objects for tension relief. In a separate exposition from our group, 21 we found that normal adolescents who employ a TO show higher levels of mental distress. Among the various modes of tension relief and stress reduction examined in our cohort, Winnicot 27 regards the use of TO attachment or of a magic object in adolescence as an immature process, compared with more mature stratagems, termed (by him) transitional phenomena, such as the use of particular activities (listening to music, reading a book, going for a walk) to achieve the same aim. In our study we found no difference in the use of the more mature modes of tension relief between subjects who had and did not have an IC. This is in keeping with the normality of our sample, and is demonstrative in that the subgroup of

9 O. Bonne, L. Canetti. E. Bachar, A. Kaplan De-Nour, and A. Shalev 285 adolescents who had an IC use immature modes of tension relief in addition to their usage of more mature modes of stress alleviation Summary The present study, although retrospective, renders data gathered from the largest normal subject cohort to date, showing that a childhood imaginary companion was present in a substantial subgroup of mentally healthy adolescents. The present study also confirms previous reports in ascertaining a relatively high prevalence of an IC in childhood. Mentally healthy adolescents who report having had an IC show higher levels of psychological distress, particularly regarding social interaction and emotional discontrol/vulnerability. Subjects who report having had an IC in childhood may be more inclined to employ immature modes of stress alleviation as adolescents. It is suggested that further study be undertaken to substantiate findings presented in this study. In addition, prospective development studies could determine the intrapsychic and environmental circumstances which promote the appearance and later on disappearance of this intriguing phenomenon. References 1. Svendsen M: Childrens' imaginary companions. Arch Neurol Psychiatry 12: , Schaeffer CE: Imaginary companions and creative adolescents. Dev Psychol 1: , Sperling OE: An imaginary companion representing a pre-stage of the superego. Psychoanal Study Child 9: , Nagera, H: The imaginary companion: Its significance for ego development and conflict resolution. Psychoanal Study Child 24: , Klein BR: A child's imaginary companion: A transitional self. Clin Soc Work J 13(3): , Hurlock EB & Burnstein M: The imaginary playmate: A questionnaire study. J Genet Psychol, 41: , Munroe JP: Report at NEA meeting. Pediater Sem 3: , Vostrovsky C: A study of imaginary companions. Education 15: , Pines M: Invisible playmates. Psychol Today, 106: 38-42, Manosevitz M, Prentice NM, Wilson F: Individual and family correlates of imaginary companions in preschool children. Dev Psychol 8:72-79, Somers JU, Yawkey TD: Imaginary play companions: Contributions of creative and intellectual abilities of young children. J Creat Behav 18(2):77-89, Meyer JR, Tuber SB: Intrapsychic and behavioral correlates of the phenomenon of imaginary companions in young children. Psychoanal Psychol 6(2): , 1989.

10 286 Child Psychiatry and Human Development 13. Singer JL: The Child's World of Make Belief. New York: Academic Press, Myers WA: Imaginary companions in childhood and adult creativity. Pychoanal Q 48(2): , Myers WA: Imaginary companions, fantasy twins, mirror dreams and depersonalization. Pychoanal Q 45(4): , Parker G, Tupling H, Brown LB: A Parental Bonding Instrument. Br J Med Psychol 52:1-10, Derogatis LR, Spencer PM: The Brief Symptom Inventory: Administration, scoring and procedures, Manual I. Baltimore, MD: Clinical Psychometric Research, Dupuy DF: Utility of the National Center for Health Statistics' General Well Being Schedule in the assessment of self representations of subjective well being and distress. Paper presented at the National Conference on the Evaluation of Drug, Alcohol and Mental Health Programs, Prociadno MF, Heller K: Measures of perceived social support from friends and from family. Three validation studies. Am J Comm Psychol 11(1): 1-23, Free K, Goodrich W: Transitional object attachment in normal and in chronically disturbed adolescent population. Child Psychiat Hum Develpm 16(1): 30-44, Bachar E, Canetti L, Galili-Weisstub E, Kaplan-DeNour A, Shalev AY: Childhood Vs. adolescence transitional object attachment, and its relation to mental health and parental bonding. Child Psychiat Hum Develpm 28(3): , Sullivan HS: The Interpersonal Theory of Psychiatry. New York, Norton, Ames LB, Learned J: Imaginary companions and related phenomena. J Genet Psychol 69: , Benson RM: Narcissistic guardians: developmental apexes of transitional objects, imaginary companions, and career fantasies. Adolesc Psychiatry 8: , Deri S: Transitional phenomena: Vicissitudes of symbolization and creativity. In: Between Reality and Fantasy: Transitional Objects and Phenomena, eds. S.A. Grolnick and L. Borkin, in collaboration with W. Muensterberger. New York: Jason Aronson, Lasker M: Imaginary companions and transitional objects: Narcissistic guardians of children. Northampton: Smith College Studies in Social Work, Winnicot DW: Transitional objects and transitional phenomena. Int J Psychoanal 34: 89-97, Freud A: The Writings of Anna Freud: The ego and Mechanisms of Defense. Vol. 2, New York: International Universities Press, Inc., 1966.

11 Reproduced with permission of the copyright owner. Further reproduction prohibited without permission.