What are imaginary friends?

One minute, you’re down on the floor playing with your child. The next, you’re asked to shove over to make room for “Candy,” an invisible friend that lives in the woods — oh, and would you mind leaving so she and Candy can play alone? What gives? “Children’s imaginations begin developing around 2½ to 3 years of age, marking the start of pretend play, and in 65% of children, that comes with the arrival of an imaginary friend or two,” says Susan Newman, Ph.D., social psychologist and author of The Case for the Only Child: Your Essential Guide. Pretend buddies are common, but the reasons for them vary, as does the length of time they stick around.

Why do children have imaginary friends?

Well, mostly, because they’re fun. “Children are naturally imaginative, and exercising their imaginations is good for their emotional and mental health,” says Laura Markham, Ph.D., author of Peaceful Parent, Happy Kids. “Kids who have imaginary friends enjoy them, so they always have someone to play with if they feel lonely or bored. My daughter at ages 3 and 4 used to say, ‘I’m going to play with Betsy now,’ and then yak away for half an hour in her bedroom.”

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Sometimes, the imaginary friends might also fill in a gap that other playmates don’t. “A child with few friends may create one,” says Samantha Rodman, Ph.D., author of How to Talk to Your Kids about Your Divorce. “A kid who never gets to choose what to play — being the youngest, let’s say — always can choose what to play with his imaginary friend. In childhood, a way to create your perfect friend is to conjure him up in your mind.”

Parents of only children, however, don’t have to worry that the arrival of a pretend playmate means their child is craving a brother or sister. “For forever, people have erroneously believed that only children have imaginary friends to compensate for the absence of siblings,” Dr. Newman says. “This is a myth, as two-thirds of all children — with or without siblings — have been found to have imaginary friends.”

Are imaginary friends real?

Of course, imaginary friends aren’t really real, but how real are they to your kids? “Most children are aware their pretend friends are not real,” Dr. Newman says. “In young children, pretend or fantasy friends are a sign of developing imagination.” So you don’t have to worry that you’ll be doing some kind of long-standing damage if you forget that Candy was sitting on a couch and plopped down on top of her.

How far you have to play along with your kid’s imaginary friend is really up to you and your child — but set limits.

If, suddenly, Candy starts requesting dinner, or breaking things when no one is looking, you have to figure out some ground rules. “For the most part, you can allow your child to decide how much you can engage in his or her fantasy,” Dr. Newman says. “Respect your child and let her take the lead. If the ‘friend’ often rides in the family car, don’t ask if she’s joining you today; wait to be told.

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Once given the okay by your child, it’s fine to talk to or about the imaginary friend, but it’s is important for children to remain in control of the fantasy. Interfering too much can cause friction, anger, or power struggles.”

When do imaginary friends become a problem?

If Candy’s demands start getting out of hand, you’re allowed to say no. “Indulging your child can be a nice way to bond and show respect and love,” Dr. Rodman says. “But doing anything that causes you or other family members more stress is not recommended. Don’t let your child’s imaginary friend turn into a way for your child to exert massive control over the family. Putting out an extra plate with imaginary food is fine, but serving a whole dinner sends the wrong message.”

And, at some point or another, children will experiment with acting out under the guise of or at the direction of the pretend buddy. “Imaginary friends usually only become problematic when a child blames their misbehavior on the imaginary friend,” she adds. “In this case, the child should be taught that they will be responsible for whatever they or their imaginary friend does.”

Another red flag to watch out for? Preferring the imaginary friend to real ones, which is uncommon and could be a signal something else is going on. “Kids who have imaginary friends usually tend to be more social than other children,” Dr. Markham says. “But if a parent notices that the child refuses opportunities to engage with other children and instead plays with the imaginary friend, I would want to understand how the child is experiencing their social world. Does the child have some social anxiety? Are they being bullied?”

Imaginary friends, sadly, are not associated with intelligence — but, thankfully, there’s no link to mental illness, either.

There is no evidence that shows the presence of a pretend friend can be linked to future IQ, but research does show some commonalities among children who have them. “Kids who have imaginary friends are more skilled in what we call perspective-taking — they can see things from another person’s point of view,” Dr. Markham says. “We don’t know, however, if this is chicken or egg. Do they develop this skill from having an imaginary friend, or do they already have this skill, which makes it easier to imagine the experience of the imaginary friend?”

Dr. Newman also points to The House of Make-Believe, written by Jerome Singer, Yale emeritus of psychology, and research assistant Dorothy Singer. “They studied preschoolers extensively,” Dr. Newman says. “They found that children who create make-believe friends tend to be more imaginative, have richer and fuller vocabularies, and are better able to entertain themselves. The Singers also discovered that children with imaginary friends get along better with classmates.”

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“There is no evidence that they have any issues with mental health,” Dr. Marhkam adds. “It’s not the same as Dissociative Identity Disorder or having multiple personalities, which is extremely rare in any case. Children who have imaginary friends grow up to be creative, imaginative, social adults.”

So, when do they leave? Is it normal to have an imaginary friend at 13?

Imaginary friends usually retreat by around age 9 — but some linger, and that’s okay.

Most of the time, imaginary friends tend to go away on their own as children become more invested with playing with their (real) peers. “My own daughter lost track of Betsy once we moved from Michigan to New York when she was four,” Dr. Markham says. “When I asked about Betsy, she said Betsy had stayed in Michigan. Most imaginary friends fade as childhood fades.”

In some cases, the friend doesn’t truly go away, but the child will stop talking about him for fear of being made fun of. If your kid holds on to her imaginary friend for longer, there isn’t reason to worry. “It’s completely fine,” Dr. Markham adds. “Again, I would intervene if there is something else worrisome going on, like a teen who can’t relate to peers. But if the teen is managing their life well, then an imaginary friend isn’t a problem.”

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In fact, some choose to keep their imaginary friends into adulthood. “Agatha Christie famously said in her autobiography that she had imaginary friends as an adult,” she notes. “I also know one adult woman who says she has an imaginary tiger who travels with her and keeps her safe. She knows the tiger isn’t real, but when she feels scared, the tiger reassures her and helps her feel less anxious. I thought that was brilliantly adaptive in helping her manage her anxiety!”

So your child’s imaginary friend may be a nuisance — asking you to make room for him on the couch, demanding plate after plate of pretend cookies — but he’s not problem. “Having an imaginary friend or friends will likely become part of family lore — to be rehashed and delight everyone in the family for decades to come,” Dr. Newman says.

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Marisa LaScala Parenting & Relationships Editor Marisa LaScala covers all things parenting, from the postpartum period through empty nests, for GoodHousekeeping.com; she previously wrote about motherhood for Parents and Working Mother.

What are imaginary friends?

Imaginary friends are pretend friends that your child makes up in his imagination.

Imaginary friends come in all shapes and sizes. They can be based on someone your child already knows, a storybook character or even a soft toy. Or they can come purely from your child’s imagination.

These friends might always be there, or they might come and go. They might exist only in certain spots like the cubby house or at the kitchen table. And they might appear and disappear for no apparent reason.

When do imaginary friends appear and how long do they last?

Children as young as 2½ years can have an imaginary friend.

Children usually stop playing with make-believe friends – whether they have one, several or even a whole family of them – when they’re ready to move on. Imaginary friends are most likely to be around for several months, but they could be a feature of your child’s life for up to three years.

Your child’s imaginary friend could be someone who:

  • listens to and supports your child
  • plays with your child
  • can do things that your child can’t do
  • is special and belongs only to your child
  • doesn’t judge or find fault with your child.

Your child is in charge of what the imaginary friend says, what the friend does and who this special friend can ‘play’ with. This could be part of the friend’s appeal too.

Imaginary friends allow children to explore a make-believe world that they create all by themselves. In fact, children with make-believe friends might be more imaginative and more likely to enjoy fantasy play and magical stories.

The way children play with or talk about their friends can tell you a lot about how they’re feeling. Make-believe friends give you insight into your child’s inner world, and her likes, dislikes and tastes.

Children with imaginary friends can be more social and less shy than other children, and they might show more empathy in their play with other children. They might also be more likely to grow up into adults who are more tuned in to the needs of others.

Handling issues with imaginary friends

Here are some ideas for times when your child’s imaginary friend has become hard to handle.

Doing things for imaginary friendsYou might find that you’re being asked to hold open doors, fix a snack or make up a bed for your child’s imaginary friend. Rather than doing it yourself, encourage your child to hold the door open, set a place for the friend at dinner or make up the bed. This way you’re accepting the imaginary friend but also taking the opportunity to develop your child’s skills.

Talking through imaginary friendsSome children insist on consulting with their imaginary friends all the time – for example, ‘I have to ask Sammy first’. They might also ask you to speak to their friend, rather than directly to them. If this is getting frustrating, try saying to your child, ‘I want to hear what you think – not what Sammy thinks’.

Blaming imaginary friends
Sometimes children will do or say something they shouldn’t have and blame their imaginary friends. You can handle this by clearly telling your child that the imaginary friend could not have done this. Then follow up with an appropriate consequence, like making your child clean up the mess.

When there might be other issues

For a very few children, imaginary friends can be a symptom of other issues. If you’re worried about your child’s imaginary friend – for example, if your child has suffered a traumatic event or the imaginary friend is being malicious or nasty – consult your GP or another health professional.

· It promotes creativity

It takes a very creative mind to not only imagine a whole other person but to also imagine all the things a person says or does. So, if a child is having an imaginary friend, parents will most of the time simultaneously notice an increase in the creativity of the child, and this can be further nourished by encouraging the child (and their invisible buddy) to do a creative activity such as drawing or crafting.

· Better vocabulary

The best way to improve a child’s vocabulary is to start talking to them. Unfortunately, as much as parents would love to talk to their children all day long, they have errands and tasks to do, which leaves children are left to entertain themselves. By doing this, that means by imagining a friend, their constantly talking or, being talked to thereby they are always working on their vocabulary.

· It promotes abstract thinking

Now, while some children struggle with abstract thinking even when they get older, those who have imaginary friends tend to be way better at it. Again, it has to do with imagining something that isn’t actually there, visualizing it in a very unique way only known to the child. Abstract thinking is definitely a very important skill for children to learn and understand especially when they get older.

· Better social skills

Because those kids with an imaginary friend always have someone around, they also naturally tend to more easily develop better social skills and this helps them develop faster than other kids! Even though these interactions are a product of their imagination, they are still very much real to them, and they can even sometimes be slightly uncomfortable which means they learn to deal with all sorts of social situations very early on.

· Better understanding of other’s emotion

According to some studies, kids with imaginary friends tend to be more empathetic towards others and they usually accept and understand other people’s emotions much better. Besides that, better understanding other people’s emotions comes directly from understanding our own emotions first. And, who doesn’t want their child to grow into a person who understands, accepts and keep their emotions in check.

Developmental psychologist Marjorie Taylor still remembers when she was introduced to a female veterinarian named Elfi Welfi back in the late 1990s. Elfi was married to Sammy Whammy, and together they owned a few cats and dogs. Elfi lived in a completely tie-dyed world—hair, skin, furniture, bed sheets, everything. And she was about as tall as a pinky finger.

Elfi Welfi was the product of a 4-year-old girl’s imagination.

The child had come to see Taylor at her Imagination Lab at the University of Oregon, where she explores the relationship between imaginary companions and children’s social and cognitive development into adulthood. Her work has changed negative views of imaginary friends and has transformed how researchers approach studies on imagination.

Elfi Welfi is one of the most memorable pretend friends whom Taylor has come across in her research. “It was pretty elaborate and structured,” she recalls. “Imaginary companions and the worlds they live in can get really detailed.”

Marjorie Taylor. Photo by Luke Groskin

According to Taylor and her colleagues in the field of imagination research, an imaginary companion is a friend whom a child has created, talks about, or interacts with on a regular basis. Over the course of nearly 30 years, Taylor has heard of imaginary friends who can fly, live on the moon, become invisible, and breathe fire, and who can take the form of aliens, reptiles, and even real objects like stuffed animals.

“Every time you ask a child if they have an imaginary friend and they say yes, you have to prepare yourself not to laugh or give leading questions, because you don’t know what’s going to come next,” Taylor says. “I’m constantly entertained by what children come up with.”

Her daughter, Amber, first piqued Taylor’s curiosity in the idea of imaginary companions. When Amber was 3 years old, she started talking about a boy named Michael Rose. Taylor had assumed he was a kid at Amber’s daycare, but none of Amber’s teachers had heard of a Michael Rose. When her daughter later mentioned that he had a barn full of giraffes, Taylor put the pieces together: Michael Rose was a product of Amber’s imagination.

Taylor started professionally studying imaginary companions in the late 1980s, after attending a lecture by Harvard University psychologist Paul Harris. He discussed a study in which he had presented an empty box to children and asked them to imagine that there was a monster inside. Even though they had seen that the box was empty, some of the kids were still afraid to go near it. Harris’s study got Taylor wondering if kids with imaginary friends believed that their invisible pals were real.

“I’m constantly entertained by
what children come up with.”

In 1999, Taylor published a seminal book, Imaginary Companions and the Children Who Create Them. The work compiles everything scientists had learned about childhood imagination up to that point (and features the story of Amber and Michael Rose). It also details Taylor’s methodology in assessing imagination, as well as her meticulous interview process with children and their parents. (Children might make up a pretend friend on the spot—which doesn’t count as a true imaginary companion—or talk about their imaginary friends in detail for hours, so Taylor corroborates their stories with parents.)

“I think of as the imaginary companion bible,” says Tracy Gleason of Wellesley College in Massachusetts, who studies what role imaginary friends play in psychological and social development, and who met Taylor when she was finishing her book. Taylor has played an important part in countering stereotypes that are often attributed to children with imaginary friends, Gleason says.

Imaginary companions are much more common than people might think. Up to two-thirds of children have them, typically between the ages of 3 and 8 (although there are accounts of teenagers who retain them from childhood or who first develop them as teens).

Historically, many researchers and parents thought that imaginary companions were harmful or evil, and were a sign of a social deficit, demonic possession, or mental illness. For instance, at the University of Alabama’s Knowledge in Development (KID) Lab, lead psychologist Ansley Gilpin recently heard of a case where a parent thought her daughter might have schizophrenia. It turned out that the child just had an imaginary friend.

“Certainly, it scares many parents today when they have children who are talking to people who are not there,” Gilpin says. Kids who notice that concern might be afraid to admit that they have an imaginary friend, she says.

But some imaginary friends are hard to keep a secret from parents, because they manifest as mean, aggressive, and bossy. Children sometimes act subordinate to their creations, and their imaginary friends can cause kids to say and do things that would get them into trouble. The girl who created tie-dyed Elfi Welfi, for example, described her as being “kind of like a terrorist,” Taylor recalls.

“These relationships with imaginary friends really seem to mimic relationships with other kids in terms of their emotionality and autonomy,” explains Gilpin. Just like in real-life healthy peer relationships, a mixture of positive and negative emotions characterizes imaginary companionships, she says.

Perhaps surprisingly, the work of Taylor and others has shown that, despite the complexity of imaginary friendships and their similarities to real-world relationships, kids recognize that their imaginary friends are make-believe. “Many children at some point want to make sure you’re not confused,” says Taylor. “They’ll say, ‘You know it’s just a pretend little girl?’”

Imaginary companions are often thought to be an indication of superior intelligence, but the evidence for such an association isn’t compelling, Taylor notes in her book. “It is not true that all intelligent children create imaginary companions nor that only highly intelligent children create them,” she writes, adding that “the absence of an imaginary friend says nothing about the child’s intellectual abilities.”

Small, statistically significant differences between kids with and without imaginary companions do arise, however, and they tend to be positive, says Taylor. For example, children with these pretend pals tend to have a slightly larger vocabulary, are less shy, and are good at understanding the perspective of others.

“Imagination is not just a frivolous
thing you outgrow.”

Over the course of her research, Taylor has noticed that children who had imaginary friends as preschoolers sometimes move on to developing an entire imaginary world, or paracosm. These worlds are typically elaborate, entailing their own geography, transportation systems, governments, and holidays. In a study published last June in the Creativity Research Journal, Taylor interviewed four children about their paracosms and found that their worlds provided a creative outlet, as well as a platform for playing with friends and exploring the real world around them.

Recently, Taylor’s team completed an analysis (not yet published) revealing that 17 percent of approximately 200 children studied had created paracosms. It’s still unclear how often children with imaginary companions move on to these complex worlds or how the two phenomena are connected psychologically, but Taylor hopes that future investigations will reveal more insights.

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What Should I Do If My Child Has an Imaginary Friend?

Taylor and one of her graduate students, Naomi Aguiar, have also recently probed whether virtual characters can provide the same kind of companionship as imaginary friends, which is “important to understand, because children increasingly are dealing with characters on screens or virtual reality,” she says.

In the April 2015 issue of Cognitive Development, the pair published a study comparing children’s social interactions with a virtual dog and with a stuffed dog. They found that the kids regarded the virtual pup as entertaining, but felt protection and friendship from the plush one (children sometimes ascribe inanimate objects imaginary friend status, although Taylor says not all researchers agree that these items are true imaginary companions). The results hint at the idea that youngsters form deeper relationships with tangible objects than they do with technology, but more research is necessary to draw a more definitive conclusion.

“Often, it’s the parents who are the keepers of the memory.”

Despite how focused children might be on their imaginary friends, as they get older, many tend to forget that they even had one. It can happen within two years of outgrowing the companion. “ seem so special at the time, but we find that when you interview children later on, they’ve moved on,” Taylor says. “Often, it’s the parents who are the keepers of the memory. I remember Michael Rose, but actually, my daughter Amber does not.”

Yet, even if people forget their imaginary friends, the process they used to create them and the way they interacted with them could have a lasting impact. “Imagination is not just a frivolous thing you outgrow,” says Gleason. Being able to remove oneself from reality and visit different times and places in our minds is an ability even adults rely on, she says.

And kids are a good reminder of the mind’s limitless power to fantasize. “When you’re doing research on children’s imagination,” says Taylor, “you develop a very deep respect for their imaginations and what they’re able to create.”

Meet the Writer

About Lauren J. Young

@laurenjyoung617

Lauren J. Young is Science Friday’s digital producer. When she’s not shelving books as a library assistant, she’s adding to her impressive Pez dispenser collection.

Hello, my (imaginary) friend

As a child, Kat Sandler loved to go to the park and play on the swings with her friend, a unicorn named Unicorn.

“The unicorn was white. It was a boy. It was always a full-grown horse. And it really liked to swing,” recalls Sandler, a 29-year-old Toronto-based playwright. “That’s when I would talk to him the most – when we were swinging. We would have these great conversations.”

In a previous generation, Sandler’s imaginary friend might have been cause for concern in her parents’ eyes. Instead, her mother and father happily indulged it. As it turns out, they are a part of a shift in thinking.

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The way researchers used to view imaginary friends has undergone a nearly complete reversal since the early 1990s. Until then, the consensus among child psychologists was that children with imaginary friends were troubled introverts who, the more they indulged their fantasies, were more likely to need professional help.

But, thanks to the pioneering work of developmental psychologist Marjorie Taylor and others who have followed in her footsteps, researchers now say, with a few exceptions, that the earlier view could not be more wrong.

Elfie Welfie is small enough to fit in your hand, has tie-dyed hair and works as a veterinarian.

As a result of this work, a new profile of children with imaginary companions has emerged: They are more socially skilled, they perform better on tests of verbal skills and, perhaps not surprisingly, they are more creative than children who do not have imaginary friends. What’s more, these benefits do not end in childhood.

Take all the most creative people you know, says Jonathan Plucker, a creativity researcher at the University of Connecticut who is researching how people, especially students, communicate their creativity to others. It doesn’t matter if they are artists or engineers or entrepreneurs. Now look for common denominators among them. What you are most likely to find if you do some digging is that they had an imaginary friend in childhood.

“It pops up almost whenever it’s asked. Creative people say, ‘Oh yeah, that was me,'” Plucker says.

Today, they can say it with pride, not fear of stigma.

It was not that long ago that parents were sent a much different message: “A little imagination is a good thing,” Dr. Benjamin Spock said. But if a child still had an imaginary friend at the age of four, he said, “a child psychiatrist, child psychologist or other mental-health counsellor should be able to find out what they are lacking.”

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Fake Rachel is an invisible version of the child’s real friend who can play with the child when Rachel isn’t around.

In 1962, Jean Piaget, a Swiss pioneer of developmental psychology, dismissed the idea that imaginary friends were signs of creativity. To him, they were a sign the child was failing. “The child has no imagination, and what we ascribe to him as such is no more than a lack of coherence,” he wrote.

Most psychologists shared this narrow view.

“They thought these children were weird,” says Taylor, head of the Imagination Research Lab at the University of Oregon. “Maybe smart, but socially troubled or shy or whatever. And all that is completely wrong.”

In was not until the 1990s that a new view emerged: that children with imaginary friends were actually exploring a form of play with a high degree of creativity.

In a study published in the Creativity Research Journal in 2005, researchers found that children who had imaginary companions were more creative than their imaginary-friendless peers.

And in 2010, Evan Kidd, a researcher at Australian National University, and colleagues found that adults who had imaginary friends as children scored higher on creativity tests than those who did not.

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Nutsy and Nutsy are two brightly coloured invisible birds that are about two feet tall, live in the tree outside the child’s bedroom window and like to argue.

While it is difficult to precisely quantify creativity – researchers employed a widely used test in which people say whether or not dozens of adjectives accurately describe them – the result was clear, Kidd says: “They’re reliably, consistently higher.”

What’s more, Kidd and colleagues also found that adults who had an imaginary companion in childhood scored higher on “absorption” tests: “They’re more likely to lose themselves in things like novels, and have a more imaginative life as adults,” he explains.

So why this link between imaginary friends and later creativity?

“I think it all comes back to play. Having an imaginary companion is really just a form of what developmental psychologists would call social dramatic play,” Kidd says.

Children with imaginary friends often adopt different roles with them and play out many different scenarios. That helps to explain having better social skills and the openness to new ideas that is essential to creativity, both when you’re a kid and in adulthood.

Dipper is an invisible flying dolphin who lives on a star, never sleeps and can fly very fast.

Sandra Russ, a clinical psychologist at Case Western Reserve University in Cleveland who researches play and creativity, points out that pretend play starts around the age of two and a half, becomes more complex, and then fades around ages nine or 10 – following the same arc as the typical lifespan of imaginary friends.

It could be that children with imaginary companions are learning how to work their creativity muscles harder than others, Kidd says.

Much of the research on children with imaginary friends has focused on verbal and social skills. After all, so much of having an imaginary friend is talking through issues, with imaginary friends frequently offering a different perspective than the child’s.

“It’s a good way of processing what’s going on around them,” says Karen Majors, a child psychologist at University College London’s Institute of Education.

Still, researchers agree that more studies are needed to better understand the phenomenon. And they note that the picture isn’t entirely rosy. At least two studies conducted in the 1990s found that sexually abused children who develop dissociative disorders are highly likely to have imaginary friends.

Baintor is a small boy who is snow-white all over and lives in the overhead light.

The demographics

Although they were once thought to be rare, separate studies by Taylor and researchers in Britain have estimated that between 46 and 65 per cent of school-age children have imaginary companions.

Girls are more likely than boys to have imaginary friends at the age of three and four, but by school age, the imbalance vanishes.

The peak age for having an imaginary friend is from ages three to five, Taylor says. And while imaginary companions usually taper off around the age of nine, in rare cases, they are friends for life. (Agatha Christie had imaginary friends into her 70s. She said she often preferred them to her characters because they weren’t as old.)

And that commonly held belief that girls create girl friends and boys imagine boy friends? It simply isn’t true. Often, the friends aren’t even human.

“There’s no typical one,” Taylor says. “It’s unbelievable what they come up with.”

Some of her favourites, from among her case studies, are Nutsy and Nutsy, two brightly coloured invisible birds that are about two feet tall, live in the tree outside the child’s bedroom window and like to argue; Elfie Welfie, a person small enough to fit in your hand, who has tie-dyed hair and works as a veterinarian; Fake Rachel, an invisible version of the child’s real friend who can play with the child when Rachel isn’t around; and Baintor, a small boy who is snow-white all over and lives in the overhead light.

“The list is endless,” Taylor says.

Today, with such a high premium placed on creativity, it should not be all that surprising that the imaginary-friend landscape has seen such a dramatic shift. “We’re getting much more interested in childhood imagination,” Majors says.

That interest has helped transform a once-stigmatized aspect of childhood into something that is increasingly celebrated. So much so, Taylor says, “now people worry if their child does not have an imaginary friend.”

Bob eats bugs, can read a 150-page book in a minute and likes to shape shift into animals or sometimes plants.

Parents: Find your own friends

Parents can (and should, according to the research) support a child’s imaginary friend, but they should be aware that meddling can have unforeseen consequences.

“Kids love to share their imaginary friends,” says Marjorie Taylor, the world’s foremost expert on imaginary friends. And nurturing parents can encourage their child by playing along, whether it’s setting a place for the friend at the dinner table or making room for it in the car on a drive.

But remember whose friend it is.

“Sometimes parents get so involved that they’re almost taking over the imaginary friend,” Taylor says.

And there have been case studies in which parents’ over-involvement proved disastrous.

In one, a parent used a remote control to close the family’s garage door, then told the child that the imaginary friend had done it. That didn’t compute with the confused child. The imaginary friend disappeared.

Another example: When Debbie Nolan was about to enter school, her grandparents decided that it was time for her imaginary friend, a boy named Jimmy, to disappear.

“I had a winter coat. It was this blue winter coat we were getting rid of because it didn’t fit me any more. My grandfather said, ‘We’re going to put Jimmy in the coat and then we’re going to give the coat away,'” Nolan says.

She pleaded, to no avail.

“I was thinking, ‘Just because you can’t see him doesn’t mean he’s not real,'” she recalls.

They took the coat away. Jimmy never came back. “I was devastated,” Nolan says.

Imaginary friends last into the school-age years

School-age children are as likely to play with imaginary friends as preschoolers are, according to a study in the November issue of Developmental Psychology (Vol. 40, No. 6).

The study, by University of Oregon psychologist Marjorie Taylor, PhD, and her colleagues, refutes the conventional wisdom that preschool is the peak time for all kinds of imaginative play, including playing with imaginary companions.

The study was a follow-up to a 1997 study in which the researchers interviewed 152 3- and 4-year-olds, and the children’s parents, and found that 28 percent of the children played with an imaginary friend. The goal of the current study, Taylor says, was to talk to those same children three years later to find out what had happened to those imaginary companions and learn whether the children had created new ones.

She and her colleagues expected to find that the overall number of imaginary friends had decreased. Instead, they found that of the 100 children who took part in the follow-up, 31 percent had an imaginary friend at age 6 or 7.

“We were definitely surprised,” Taylor says.

The researchers did, however, find some differences between the children at age 3 or 4 and at age 6 or 7. First, only three out of the 100 children were playing with the same imaginary friend that they had three years earlier.

Also, in the first study there was a significant gender gap–girls were more likely to have imaginary friends than were boys. By the second study that gap disappeared. In the first study, the children were more likely to have an imaginary friend based on a physical object like a favorite stuffed animal, but by the second study they were more likely to have a purely imaginary companion. In the first study, parents were more likely to know that their child played with an imaginary companion than they were in the second study.

The researchers also investigated whether there were differences between the children who had imaginary friends and those who didn’t. They tested the children for various types of social understanding, emotional understanding and personality, and found very few differences.

Taylor says the new findings are consistent with her idea that fantasy and imaginary others play an important role throughout people’s lives–from childhood into adulthood. In fact, she and her colleagues are now talking to fiction writers about their relationships with the characters in their books, which Taylor believes may be analogous in some ways to children’s relationships with imaginary friends.

“Sometimes people believe that if children, particularly older children, have an imaginary friend then it means there’s something wrong–like the child is shy and doesn’t have any ‘real friends,'” Taylor says. “But really, it’s quite normative to have an imaginary friend.”

–L. WINERMAN

Talking to imaginary people caused by anxiety disorder

For 37 years I have had a sometimes uncontrollable compulsion to talk silently and often out loud to imaginary people. I have been to psychiatrists and have been diagnosed with multiple anxiety disorders — panic disorder with agoraphobia, obsessive worrying, social anxiety, OCD, as well as depression, for which I am medicated.
I now recognize this problem as caused by anxiety, not schizophrenia or psychosis:

  • There are no hallucinations;
  • I can control it at will for temporary periods;
  • It is caused by anxiety and relates entirely to social situations, particularly abusive ones;
  • Anxiety meds help; anti-psychotics (geodon) don’t;
  • I can control it somewhat by distracting myself, as with panic attacks and OCD;
  • It always involves potential future situations that could cause me worry, as with obsessive worrying
  • It is sometimes a way of dealing with anger, just ranting at some imaginary person, just as my father eventually learned to deal with abuse and anger by going into his room and shutting the door.

I have mentioned this problem to my psychiatrists over the years, but I have also been reluctant (partly due to anxiety, I’m sure) to describe it in detail for fear of being diagnosed as “crazy,” hospitalized, unemployed, etc. So I tend to downplay it or not even mention it.
I have also recognized there is no “cure” for it, although it seems to have lessened in intensity as I have gotten older (and gotten more anxiety medication).
It’s a bit lonely, although most of my psychiatrists over the decades seem to have understood it. Seeing that people talk to themselves for reasons other than schizophrenia, hearing some other anxiety sufferers say they have to do it and that it isn’t necessarily a sign of a mental illness that “needs to be cured” has made me feel better.
However, I can’t really live with other people for longer than a few days (before I have an uncontrollable angry talking spell). I have been fortunate to be able to work most of my life and be able to live alone in a house, but I worry about possibly having to live with other people in some other setting, should that happen in the future.
Any insights or support are appreciated.

Studies indicate that up to 60 percent of children will have an imaginary companion at some point between ages 3 and 8. These friends can be invisible beings or personalities embodied in objects like stuffed animals or dolls, and researchers believe they can teach us about children and their psychological development.

Tracy Gleason is a developmental psychologist and psychology professor at Wellesley College who’s been studying the relationships children have with both real and imagined characters.

Tracy Gleason. Photo by Luke Groskin

“I think imaginary companions can teach us quite a bit about how children think about relationships. One of the things that is very difficult to figure out is what children know and don’t know about relationships with other people,” Gleason says. “Especially preschool-aged children, are really just becoming involved in friendships and becoming friends themselves. And it takes a while to figure out what a friendship is and what you do and how it’s different than your relationships with, say, adults, or siblings, or other people in your life.”

Considering how common imaginary companions are, how should parents address the phenomenon? SciFri recently chatted with Gleason to learn more about what imaginary companions are and what parents should expect if their child has one.

What are the different kinds of imaginary companions?
I study two kinds. The first kind is invisible imaginary companions. They can be people, animals, monsters, mythical creatures, spirits, ghosts—you name it. I once met a child whose invisible friend was his shadow—not his real shadow, but a companion based on the idea of a shadow, because it had a life of its own (think Peter Pan). The second kind is so-called personified objects—objects that children animate and personify. These are often stuffed animals or dolls, but could include really any object, such as toy trains, blankets, action figures.

Sometimes when people talk about these phenomena, they will also talk about a third one: impersonation of characters. Not like, ‘I’m pretending to be a mommy today,’ but children who take on a role. Often that role has a different name; it might have a piece of clothing associated with it, like maybe you’re some sort of superhero and you have a cape that you wear everywhere. There are kids who will take on these roles and keep them for months on end, and only respond to the name of the character that they’re impersonating and that sort of thing.

With the invisible imaginary companion, you’re creating this ‘other’ that doesn’t have any physical instantiation. With the personified object, you’re creating this ‘other’ that is embodied in an object. And with the impersonated character, you’re creating this ‘other’ that you embody yourself.

What are some interesting findings from your research?
We found that there are some interesting differences between those first two types of imaginary companions. In particular, children often—not always—but they often create egalitarian-like relationships with invisible friends, but with personified objects, it tends to be more of a hierarchical relationship. So the child is in charge and more competent and kind of takes care of the object, whatever it happens to be.

You find some interesting differences in terms of how children think about their relationships in that the kids with the invisible imaginary companions, or the egalitarian relationships, they’re a little tiny bit ahead of their peers in terms of understanding what a friendship is and thinking about that relationship. They seem to have that figured out a little bit more. But we don’t know which direction it goes—do you create an invisible imaginary companion or an egalitarian relationship, and then that gives you a better understanding? Or do you already have a better understanding, and so you create that kind of relationship? It’s correlation.

What are some of the signs that a child has an imaginary companion?
When parents know, it’s typically because children tell them. In contrast to the stereotypical vision of an imaginary companion—there’s a child sitting around talking to the air—that really doesn’t happen all that much. Sometimes kids will talk to their objects. But much more often, the children will report on their imaginary companions to the parent. If the imaginary companion has an ordinary name, lots of parents will be like, ‘Oh who’s Steven?’ And then they’ll ask their kid’s teacher at school, ‘Is there a Steven in the class?’ and then they realize, no there isn’t, it’s an entirely made-up person. But if the made-up person has an ordinary name and does ordinary things, then it can take a while for a parent to figure out that this is actually an imaginary friend.

Why do you think children develop imaginary companions?
I’m sure there are as many different reasons as there are children. We don’t find that there is some particular thing that we can point to.

I think a lot of children create them because they’re fun. The kids who create them tend to be pretty sociable. They’re often less shy, for example, than other kids. And they also tend to be kids who are really into fantasy; they engage in a lot of pretend play, even independent of their imaginary companions. So that’s sort of the magical combination, is being somebody who loves people and who loves fantasy, and here you go—you’ve created somebody who you can always interact with, and also you have a basis for interacting with other real people in your life by talking about this imaginary companion.

I think it’s often a way for children to participate in adult-like conversation. Plus, they get to be the expert . When you’re 3 or 4, you’re not the expert on anything. To have this domain in which you get to be the one who has all the knowledge and information, that’s super fun. So I think that’s a lot of the appeal.

Related Article

The Truth About Imaginary Friends

What can parents do if they think their child has one?
I sort of see it the way I see any aspect of parenting: If you enjoy it, you foster and encourage it. You might ask questions about the imaginary companion. Some parents really feel like talking about something that doesn’t exist is not appropriate, that it’s like you’re making something up. For some parents, that’s a creative storytelling kind of activity, and for other parents, it’s lies. So depending on the culture of your family and how you feel about it, you will respond in different ways. And even for those who think it’s fantastic and really entertaining, there are limits. Most imaginary companions are not allowed to come to church, or if you end up talking about it at Grandma’s house and Grandma doesn’t understand what’s going on, then that can be complicated.

Perhaps there are formal occasions where your imaginary companion cannot have a seat at the table, but maybe every day at lunch time, your imaginary companion has their own plate. It’s the sort of thing, as with everything else, parents need to decide where they want to put the limits. You can easily say things like, ‘Well, imaginary companions get imaginary food,’ as opposed to serving a plate of food for the imaginary companion.

What if a child blames the imaginary companion for something he or she did?
Again, that’s a spot where you put a limit. Most kids will try that once, and parents will be like, no. I think in those sorts of situations, if the child says, ‘So-and-so did that,’ the parent can say, ‘Well you need to clean it up, because imaginary people can’t clean up real messes.’ You don’t have to accept imaginary companions as an excuse. You don’t necessarily have to say, ‘No, he or she did not make that mess; you did’—but you certainly could. You can make sure the consequences for the mess are borne by the child.

Would you say there’s a certain age when having an imaginary companion is unhealthy?
First of all, even the littlest children understand that their imaginary companions are not real. Many, many times I have been interviewing a 3-year-old about their imaginary companion, and they’re telling me in great detail all these things about their imaginary companion and what it says and it does and the things they do together and how it looks, and about halfway through, they kind of look at me and they say, ‘You know, he’s not real; he’s just a pretend friend.’ So they know.

We study preschoolers a lot, because they talk about their imaginary companions. There’s a fair amount of evidence in the literature that children much older than preschool have imaginary companions, but they’re internal. They don’t talk about them as much. They might be a little more hesitant to tell you about it, but they do have them. And there’s evidence that kids in adolescence have them as well. I wouldn’t say that there’s a point at which it’s unhealthy. There are stories of adults in the literature who have them. The key is that they know that they’re not real.

I would worry about it if the child did not to seem to understand that it was not real, because most children are very clear on that. But if that’s the situation, then usually you’re talking about a child who has many other problems that you already know about. It’s very rare for an imaginary companion to be a signal of psychopathology.

This article has been edited for space and clarity.

About Chau Tu

@chaubtu

Chau Tu is an associate editor at Slate Plus. She was formerly Science Friday’s story producer/reporter.

The Simple Way to Stop Negative Self-Talk

My daughter Emily talks to her imaginary friends. We think that’s weird.

Meanwhile, we talk to our imaginary enemies – and those conversations are often full of negative self-talk. That’s not weird?

On a drive back from the Duchess County carnival, Emily took out her phone, tapped in a contact number and after a brief pause began talking.

“Hi Ray, it’s Emily, how are you?” Pause. “Uh-huh, that’s good, I’m glad you went to see a movie …Yes, I’m good. My family spent the morning at the carnival.” Pause. “Yeah, it was really fun. My sister and brother went on the water fall ride and got soaked! (She starts giggling). I loved the carousel ride and the cotton candy…yes, they’re still soaked. No, I’m dry. Dad played the cup game and won me a bear…”

All this would have been normal chatter on a car ride home with a family of four kids. Except my daughter was 12-years-old and talking to her imaginary friend on a toy phone.

Emily capitalizes on the happy-making activity of being social and lingering over a good experience.

She has imaginary conversations with her friends all the time. She calls them when she has good news to share or when she’s bored. And she’s also eager to hear how they’re doing. My daughter really savors her good times, from a day at the carnival to sharing a funny story with a (real) friend.

Most people are in such a hurry to control the future, that they miss out on lingering over the fun they just experienced. Talking on toy phones is obviously not something normal people do (although I now recommend it), but there’s a lesson to be learned from Emily’s activity.

The next time you’re distracted or can’t fall asleep, notice whether you’re having an internal phone call with an imaginary enemy. And be on the look out for any negative self-talk. Are you re-hashing an old conflict, or mentally arguing over something that’s already happened or has yet to happen? Is your imaginary conversation building from a slow burn to a self-imposed seething?

Take Emily’s advice and hang up now!

Breathe, re-set and re-dial. Call a person you love, and if that’s not convenient, call an imaginary friend. Tell them about your day, share your hard time, ask advice and express gratitude.

You’ll feel better about yourself. And feel happier too (read this post for more happiness tips). I know this from personal experience because Emily reminds me that enjoying the good stuff is so much better than sweating the small stuff.

But you don’t have to take my word for it. Stop talking to your imaginary enemies and try talking to your imaginary friends instead. Then let me know how you feel in the comment section below.

Heartfelt wishes,
Amy

Schizophrenia | Symptoms & Causes

Schizophrenia is a major psychiatric illness that—while it is more common in adults—also affects children and adolescents. The disease is called “early-onset” schizophrenia when it occurs before the age of 18.

Schizophrenia can cause:

  • visual hallucinations of people and objects that are not actually there
  • auditory hallucinations of voices, music or other sounds that are not real
  • delusions of threats that have no basis in reality
  • severe difficulty making friends and maintaining relationships
  • impaired speech and other communication skills
  • inappropriate and damaging behavior

Though we are still learning the specifics of how schizophrenia affects the brain, it is believed that the disease may be linked to:

  • a below-normal amount of gray matter—cell material that transmits sensory and movement messages throughout the central nervous system–in the brain’s temporal lobe (the part of the brain’s cerebral cortex that is responsible for hearing) and frontal lobe (the front portion of the brain’s cerebral hemisphere, responsible for processing emotions, retaining memories, making decisions and measuring social responses)

  • related loss of gray matter in the parietal lobe (part of the brain that processes information from the senses, makes mathematical calculations and controls how we handle objects)

In summary, schizophrenia:

  • has no known, exact cause

  • often appears to be inherited, passing down from generation to generation

  • affects boys slightly more often than girls when it develops in childhood

  • affects men and women equally when it develops in adolescence and adulthood

  • has no known cure, but can be managed well when caught early and treated with effective therapy, medications and support

Causes

What causes schizophrenia?

There is no known, exact cause for schizophrenia, but the disease is believed to be linked to the following factors:

Genetics

While there is no single known cause for schizophrenia, experts believe that the disease has a strong genetic component—specifically, an inherited chemical imbalance in the brain.
A combination of genes passed down by both parents can lead to schizophrenia: If a parent has the disorder, a child has an estimated 10 to 15 percent chance of developing it; if a sibling is schizophrenic, a child has an estimated 7 to 8 percent chance of developing the disease. The risk significantly increases if more than one family member has the disease.

Environmental stresses during pregnancy

Though data is not conclusive, some experts believe a child’s schizophrenia may be linked to certain environmental factors that affect the mother during pregnancy, such as:

  • drug or alcohol use
  • exposure to particular hormonal or chemical agents
  • exposure to certain viruses or infections
  • extreme stress
  • poor nutritional health

Signs and symptoms

What are the early warning signs of schizophrenia?

The behavioral changes caused by schizophrenia can be difficult to identify in the earliest stages of the disease. Symptoms may emerge slowly, develop over time or occur suddenly, as though “out of the blue.”

The following list of possible warning signs for schizophrenia is not definitive. Many of these symptoms may be caused by a condition other than schizophrenia; some will occur in children who do not have any disorder. However, it’s important to take note of any of these behaviors in your child as soon as they arise—especially if you have a family history of schizophrenia—and, if the behaviors persist, to contact a mental health professional as soon as possible.

Possible early warning signs in infants

  • abnormal listlessness or extensive periods of inactivity
  • overly relaxed or “floppy” arms or legs
  • unnaturally still, flat posture when lying down
  • unusual sensitivity to bright lights or rapid movements

Possible early warning signs in toddlers

  • chronic high fevers

  • fixation on repeating behaviors, even play, according to a specific regimen

  • persistent state of distraction, anxiety or distress

  • pronounced and sustained fear of certain events, situations or objects (note: while nearly all children experience specific fears as a normal developmental stage, children with early-onset schizophrenia tend to experience an extreme degree of fear that does not subside)

  • weak and slumping posture

Possible early warning signs in school-aged children

  • auditory hallucinations (the perception of sounds that others do not hear); most often, these hallucinations manifest as loud noises, whispers or collective murmuring

  • claims that someone or something is “in my head” or “telling me to do things”

  • extreme sensitivity to sounds and lights

  • frequent self-talk (note: while many children will go through phases of having an “imaginary friend” or occasionally talking to themselves, children with possible early-onset schizophrenia spend the majority of their time conversing and laughing with themselves while shutting out real people and surroundings)

  • tendency to be very “closed off” from others

  • visual hallucinations (seeing things that are not actually there); common examples include streaks or swirls of light or flashing patches of darkness

Possible early warning signs in adolescents and teens

  • a persistently vacant facial expression (known as “blank affect”)

  • awkward, contorted or unusual movements of the face, limbs or body

  • complaints and suspicions of threats, plots or conspiracies (for example, “someone has been sent to spy on me”)

  • dwelling excessively on perceived slights, failures or past disappointments

  • extreme irritability or angry outbursts that are unprovoked or disproportionate to the situation

  • extreme or unwarranted resentment and accusations against others (“I know my parents have been stealing from me”)

  • inability to follow a single train of thought

  • inability to read nonverbal “cues” (failing to understand and respond appropriately to other people’s tone of voice, facial expressions or body language)

  • inappropriate behavior and responses to social situations (for example, laughing out loud during a sad moment)

  • incoherent speech

  • irrational thinking, including:

    • assignment of “special meaning” to events and objects with no personal significance (for example, watching a famous person on television and believing they are conveying a secret message with their words or gestures)

    • assumption of extravagant religious, political or other authority (“I am God”)

    • belief that another person or entity is controlling one’s body, thoughts or movements

    • belief that an evil force, spirit or entity has “possessed” the body or mind

  • lapses in personal hygiene practices

  • long periods of staring without blinking or difficulty focusing on objects

  • rapidly fluctuating moods

  • seeing or hearing things that others do not

  • sudden, painful sensitivity to light and noise

  • sudden, significant changes in sleep patterns—either inability to fall or stay asleep (insomnia), or excessive sleepiness and listlessness (called catatonia)

  • talking aloud to oneself, often repeating or rehearsing conversations with others (real or imaginary)

  • tendency to rapidly shift topics during a single conversation

  • use of “nonsense” or made-up words

  • withdrawal from friendships and activities

It is important to note that, in the case of all of the above warning signs, a child or adolescent with schizophrenia is not aware that these behaviors pose a problem. A schizophrenic child does not have a sense of becoming ill or that something is wrong. The gravity of the situation is only apparent to outside observers.
What symptoms do people with schizophrenia develop as the disease progresses?

As the disease progresses, people with schizophrenia display symptoms that are grouped into four categories: positive symptoms, negative symptoms, disorganized speech and disorganized or catatonic behavior.

Positive symptoms

Positive symptoms of schizophrenia involve the onset and acquisition of certain feelings, traits, and behaviors. These can include:

  • beliefs that someone, or something, poses a threat or is causing some type of harm (for example, a sense of being followed by a person or group)

  • confused thinking (for example, confusing what is happening on television with what is occurring in reality)

  • hallucinations (seeing, hearing or feeling things that are not real; for example, hearing voices giving commands or seeing people, animals or objects that are not really there)

  • delusions (ideas, situations or threats that seem real but are not actually based in reality; for example, believing a surveillance device has been installed in the body, home or car). Children with schizophrenia tend to experience hallucinations, but not delusions, until they reach early adulthood.

  • problems distinguishing dreams from reality

  • regressive behavior (for example, an older child suddenly acting like a much younger child and clinging to parents)

  • severe anxiety

  • severe changes in behavior (for example, becoming noticeably withdrawn)

  • suddenly struggling with schoolwork; inability to comprehend material that was previously familiar

  • vivid, detailed and bizarre thoughts and ideas

Negative symptoms

Negative symptoms of schizophrenia involve the lack or loss of certain capabilities and traits, such as:

  • failure to demonstrate appropriate emotional responses (for example, laughing during a somber event or an upsetting conversation)

  • inability to sustain existing friendships and relationships

  • lack of emotional expression when speaking or interacting with others (having what is known as a “blank affect” on the face or failing to make eye contact)

  • severe difficulty making friends

Disorganized speech

Schizophrenia often causes spoken and written communication that is garbled, nonsensical or otherwise impossible for others to follow. Examples of this disorganized speech may include:

  • using words and sentences that do not fit together
  • inventing words or terms that make no sense to others
  • inability to stay “on track” in a conversation

Disorganized or catatonic behavior

Schizophrenia may lead to impaired behaviors that have a drastic impact on daily functions and activities. These disorganized or catatonic behaviors include:

  • engaging in inappropriate activities or speech (for example, making obscene gestures or comments in public)

  • extreme moodiness and irritability

  • failure to dress in accordance with the weather (for example, wearing layers of heavy clothing on a sweltering summer day)

  • failure to practice personal hygiene (for example, not bathing or brushing teeth)

  • suddenly becoming confused or agitated, followed by sitting and staring in place as though “frozen” (this is called a catatonic state)

Your child may be diagnosed with schizophrenia if these symptoms are present for a period of at least one month.

FAQ

Q: Is schizophrenia common in adults? In children?
A: According to the Society for Neuroscience, about one in 100 adults has schizophrenia. The disease is considerably rarer in children; roughly one in 40,000 people under the age of 18 are diagnosed with the disease.

Q: What are the major similarities and differences between schizophrenia in adults and childhood-onset schizophrenia?
A: As is the case for adults with schizophrenia, children who are schizophrenic are also likely to:

  • display limited or impaired emotional responses
  • fail to practice adequate personal hygiene or other aspects of self-care (such as dressing weather-appropriately)
  • have great difficulty in day-to-day functioning
  • “live in their heads,” closing themselves off from other people and their surroundings
  • suffer from hallucinations (both visual and auditory) or delusions (impressions or perceptions of situations that are not real)
  • struggle to make and maintain friendships

Unlike adults with schizophrenia, children with the disease tend to:

  • experience a gradual appearance and progression of symptoms, as opposed to a sudden and severe onset
  • display difficulty meeting age-appropriate developmental milestones in motor skills, memory and reasoning and speech and language before developing symptoms of schizophrenia

Q: Can I prevent my child from developing schizophrenia?
A: While there is no way to prevent schizophrenia, a close look at your family history and careful observation of your child’s behavior can help predict the likelihood of him developing the disease. The earlier you seek treatment, the better chance you have to improve your child’s quality of life.
If you suspect your child is displaying symptoms of schizophrenia, the most important step you can take is scheduling an immediate professional evaluation. Request an appointment at Children’s today.

Q: Do people with schizophrenia really have multiple personalities?
A: Although this is a common misconception about schizophrenia, it’s not true. What many peoplerefer to as “multiple personality disorder” is altogether different and is now known as dissociative identity disorder.
A schizophrenic person does not experience memory “blackouts” and alternate identities. Instead, an individual with schizophrenia experiences a separation from reality that is characterized by:

  • visual and auditory hallucinations
  • false and irrational ideas and perceptions
  • impaired or incoherent thinking and speech
  • problems initiating and maintaining relationships
  • difficulty processing social cues and non-verbal communication
  • inability to recognize and adhere to appropriate social behaviors or personal hygiene practices
  • oversensitivity to external stimulation, such as sounds and lights
  • withdrawal from the outside world

Q: Is it possible my child has bipolar disorder, not schizophrenia?
A: There are certain similarities between early-onset schizophrenia and pediatric bipolar disorder, particularly in the shared tendency to erupt in sudden and often unpredictable emotional outbursts.
The differentiating factor is what triggers these episodes: A child with bipolar disorder will become angry or inconsolable in response to a specific event or action). A child with early schizophrenia, by contrast, will have outbursts seemingly “out of nowhere,” with no obvious cause. In these cases, schizophrenic children are usually reacting to an overwhelming onslaught of sensation, such as sudden, unbearable sensitivity to noise in a room. They may also be frustrated by a sudden inability to communicate, think clearly or even stand or walk properly.

Q: What is the “black label warning” I keep hearing about when it comes to certain psychiatric medications?
A: Since 2004, the U.S. Food and Drug Administration has placed a black warning label on antidepressant medications. The warning label states, in part:
“Antidepressants increased the risk of suicidal thinking and behavior (suicidality) in short-term studies in children and adolescents with Major Depressive Disorder (MDD) and other psychiatric disorders. Anyone considering the use of or any other antidepressant in a child or adolescent must balance this risk with the clinical need. Patients who are started on therapy should be observed closely for clinical worsening, suicidality, or unusual changes in behavior.”
Your clinician will carefully go over the specifics of any medication prescribed for your child’s schizophrenia, as well as any potential side effects you should watch for. Our team has years of experience in managing the use of psychiatric medications in children of all ages and with a wide variety of conditions. We will closely monitor your child for any sign of a negative response to the medication, and are always here to answer your questions and address any concerns you may have.

Q: What is the long-term outlook for my child?
A: If schizophrenia is detected and treated early, and if medications and therapies are successful, the disease has an excellent treatment rate. Lifelong monitoring by a qualified health professional is a must for anyone diagnosed with schizophrenia.
While there is no cure, children and adolescents with the disease can achieve normal—and even extraordinary—milestones at school, at work and in their personal lives. With proper treatment, many children with schizophrenia are able to go to college, hold jobs and have families as adults.

The following factors are critical in successfully treating schizophrenia:

  • building a foundation of family and school awareness and support
  • remaining under a clinician’s care for therapeutic treatment and regular monitoring
  • seeking professional treatment as soon as symptoms emerge
  • taking prescribed medications exactly as directed and for as long as directed (often long-term or throughout the lifetime)

Your treating clinician can give you specific information about your child’s condition, symptoms and recommended treatment plan.

I Have Had an Imaginary Friend my Entire Life

To preface this, I have eidetic memory and therefore can remember large chunks of my early childhood. I grew up in a fairly normal middle-class home, with two parents, a roof over my head and a great education. However, ever since I was young, my parents have been so busy working and taking care of my two younger sisters who have autism and bipolar disorder, that I have been emotionally and psychologically neglected. To this day, I crave attention and have abandonment and attachment issues.

This is going to sound strange, so please stay with me. My parents have always been huge Queen fans, and I grew up surrounded by their music and pictures of the band members. When I was 5 months old, I saw for the first time, Freddie Mercury smiling at me over my crib. He has been my constant companion and best friend all my life. No one else can see him, and I know he isn’t real. Freddie Mercury died in 1991, and I was born years later. My imaginary friend Freddie has never said any negative things to me and has never tempted me towards negative or suicidal behavior. He has been nothing but a great friend and confidante. I have lots of other social relationships and am doing well academically. Having had this “imaginary friend” for 17 and 1/2 years now, he’s never caused me any problems. I’m not paranoid, I don’t hear disturbing voices, and I don’t believe I’m the anti-Christ or anything. But I do see Freddie, clear as day, flesh and blood, around me all the time. He’s the only hallucination I’ve ever experienced.

I would like to know if I have schizophrenia, and if I should be worried. I have honestly felt no negative repercussions from the relationship at all. I have lots of friends, and am on good terms with my family. I have never used drugs or alcohol and have only suffered a brief period of depression in middle school.

Tell me, should I be worried?

I Have Had an Imaginary Friend my Entire Life

Illustration, Noma Bar.

Every spring and fall, Jenna Walker* battled depression  —  a rhythmic, debilitating expression of her type 2 bipolar disorder. She was irritable and unwilling to be around other people, making her job as an administrative assistant untenable. She’d snap if her son touched her shoulder at the wrong moment. Medication didn’t always work. There were a lot of mornings she just stayed in bed, unable to overcome the emotional and physical exhaustion of her illness. She felt trapped by the competing needs for affection and solitude, a conflict that was hard for her family to navigate.

In 2014, after five years of suffering, she sought out a friend named Jensen. She shared everything with him. They became so close, they could communicate without words. He’s pragmatic, confident and focused — complements to Walker’s sometimes scattered personality. He tells her that she’s strong, that she can fight her depression, and when he says it, she believes it. He doesn’t treat her with kid gloves; he can be blunt, even harsh, but ultimately he’s one of her greatest supports. He also doesn’t exist.

Jensen is Walker’s imaginary friend, a construct she uses to help keep her negative emotions at bay. She doesn’t see him — he’s more like a presence — but she does hear and converse with him, and she pictures him as tall, with brown hair, a goatee and sharp features. When he’s around, he sits just at her periphery, to her left, she says. She likens him to a “giant steel beam” that props up a roof, providing shelter and protection to everything underneath. “He’s unmovable, indestructible. I built him to be that way.”

Related: I spent 20 years hiding my depression — now I’m ready to talk

Having burned through all the coping mechanisms suggested by her doctors, she decided she needed a mental barrier between herself and the pain — something to protect her from depressive thoughts. “I believed if I sell myself on this so hard… it will protect me.” She gave this barrier the shape of a man, modelled after a character in a video game she had been playing, and gave him a name.

As she dealt with day-to-day situations, she imagined Jensen’s responses and reactions to her actions, supplying both sides of the conversation. After about a month, she says, he developed sentience. She describes that moment as feeling a strange pressure in her head — like a dog, shaking off water — and then having the distinct sensation that someone was looking at her. It was after that, she says, that she first heard thoughts that weren’t her own.

Auditory hallucinations are a symptom of a number of mental illnesses: bipolar disorder, borderline personality disorder, obsessive-compulsive disorder and, most notably, schizophrenia. Between 5 and 15 percent of the general population will experience them at some point; and, according to a recent study from Harvard and the University of Queensland in Australia, auditory hallucinations are more common in women, though the reasons for this are unclear.

They are stereotypically associated with the decline of someone’s mental health, but some experts are beginning to view the experience as one that sits on a spectrum, similar to how we view autism; they argue that not all voices are unhealthy or destructive, and that some — like Jensen’s — can even help people cope with stress and illness. Discussions in online groups such as the Hearing Voices Movement have been shedding light on the issue, and this fall, the topic will truly hit the mainstream with the expected debut on ABC of Imaginary Mary, a dramatic comedy starring Jenna Elfman, in which Elfman’s childhood imaginary friend (a small, furry monster voiced by Saturday Night Live alum Rachel Dratch) re-enters her life, triggered by a stressful event.

Related: Serena Ryder opens up about her battle with depression

When Jensen first took on a life of his own, there was plenty about him that Walker didn’t like: He could be critical and would make snide comments about people around her, for instance. But he encouraged her to deal with difficult situations rather than avoid them and said he would always be there for her. The two developed a camaraderie. His primary job now is to push her through the pain —  to help her through one more day, and then another.

Beyond telling her therapist (who has signed off on Jensen as a healthy coping mechanism) and her best friend, Walker, 35, has kept him a secret. She’s never mentioned him to her kids or her husband. “I feel like if my husband knew about Jensen, it would really stress him out that I had somebody riding shotgun in my head, and that I put him there.”

Walker’s concern isn’t misplaced: The illnesses that are accompanied by auditory hallucinations are among the most stigmatized disorders in society, says Dr. Sean Kidd, chief of psychology at the Centre for Addiction and Mental Health in Toronto, who specializes in schizophrenia. But there is a lot of research that suggests having an imaginary friend can be extremely helpful for children dealing with loneliness, abrupt life changes and bullying, and can lead to improved social skills and increased creativity. Can the same be true for adults?

When Jensen broke out on his own, Walker panicked. She was sitting alone on a bus, staring out the window. The next moment, she had the unmistakable feeling that he was looking at her. He didn’t say anything — but she knew things had changed. “It was terrifying,” she says. “I didn’t know what to do. I thought I was losing my mind.”

Soon, the pair started to have what she describes as an unfiltered exchange of ideas. There was no barrier — he could hear all her thoughts, and she could hear his, an experience that left her feeling vulnerable and scared. After a week, she told her best friend. He was supportive and encouraged her to see if other people were talking about similar experiences online. She found a Reddit community populated with seemingly reasonable people discussing “beings” in their heads. All of a sudden, she wasn’t alone, and she had another name for what Jensen could be: a tulpa.

Tulpamancy — the act of meditating a mental being into existence — was first thought to be practised by Tibetan monks, says Samuel Veissière, an anthropology and psychiatry professor at McGill University and one of the few academics to have studied the subject, but its transition to a modern phenomenon happened largely online.

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Conversations around tulpas and imaginary friends first appeared on the message board 4chan in 2009, Veissière says, and then migrated to Reddit. After that, other online groups started popping up. Today, tulpas are thought of as a more defined version of the voices people might hear in their heads. They tend to have shapes and are considered to have consciousness independent of their hosts, who are called tulpamancers.

The subreddit, started in 2012, has more than 10,000 subscribers; however, only a small percentage are active in the discussions, says Veissière. He says people create tulpas for a wide variety of reasons: to help with coping day to day, like Walker, or for companionship. “There is a big concern among the community that they’ll be presented as ‘crazy,’ ” he says. “But nothing is ever cut and dried.”

Tulpamancers often (but not always) choose to create their tulpas, he says, training their brain to think with two independent streams of consciousness. Many will practise conversations in their head, focusing on creating a separate personality. (Walker unknowingly followed these steps in creating Jensen.) Eventually, it breaks off. Veissière likens the experience to learning to drive: Creating a tulpa takes practice, and eventually muscle memory takes over and does most of the work. “There’s a giant array of things the mind can do,” he says.

The notion that there is a spectrum of auditory hallucinations, from healthy to unhealthy, has become largely accepted in the medical community, but the concept has yet to make the leap into the mainstream. Some of the stigma people associate with hearing voices is cultural: North Americans, for example, are more likely to associate hearing voices with mental illness than those in other parts of the world, Kidd says, partly because of how it’s portrayed in media and film.

Stanford anthropology professor Tanya Luhrmann studied auditory hallucinations in North America and in India and Africa. She found that in the East, hearing voices is considered a largely positive, almost spiritual experience, while in the West, it is a source of distress. In the West, she notes, people value individual autonomy over collectivism, and so voices are seen as an intrusion.

Not surprisingly, people experiencing auditory hallucinations often hide it, afraid they’ll be labelled as “crazy,” says Ben Alderson-Day, a research fellow at Durham University in the U.K. and a member of the Hearing the Voice research group. As a result, the community remains understudied, and people in distress aren’t likely to seek help in time, he says.

One study in the Scandinavian Journal of Psychology found that only 16 percent of people who hear voices seek medical attention. When people stay silent, it can “lend itself to self-stigmatization,” says Kidd. “They take on these negative messages about what it might mean, as opposed to talking to a physician or friend and hashing out what it means, which can be quite therapeutic.”

Walker feels this pressure every day. “It’s a huge stressor,” she says. There’s not much she keeps from her husband, but she thinks telling him about Jensen would irreparably damage their relationship. So far, he has no idea — she sometimes zones out when she’s interacting with Jensen, but not to the point where her husband has ever noticed. And Jensen will usually stay quiet if she tells him to, so he rarely interrupts their conversations. She’s set some clear boundaries  — and Jensen rarely breaks the rules.

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Up until 10 years ago, says Kidd, the thinking was that any kind of auditory hallucination needed to be eradicated with medication and therapy. But that thinking has evolved: The most recent edition of the Diagnostic and Statistical Manual of Mental Disorders places many mental illnesses associated with auditory hallucinations (including schizophrenia) on a spectrum. On one end, there is a percentage of people who are severely affected by their psychoses, in need of serious medical attention and unable to go about their daily routines. But on the other, there are people who hear voices and can still lead healthy and productive lives, he says.

Dr. Roger McIntyre, head of the mood disorders and psychopharmacology unit at the University Health Network in Toronto, says anyone who hears any kind of voice, even if it’s friendly and useful, should consider talking to a doctor, so the voices can be monitored and properly managed. But it’s when people lose control over the voices that they need to be seriously concerned.

For example, if Jensen were to break the “rules” that Walker has set out (such as not interrupting real-life conversations, or not coming into certain rooms of the house, like the bedroom), spew hateful or dangerous comments, or refuse to stay silent when told, it would be cause for concern, and a doctor should be informed, he says. “In other words, when have a life of their own and intrude when they wish, that can be very distressing to people.”

If the voices start to interfere with a person’s ability to function, or if that person becomes lost in a fantasy world and loses touch with reality, it should be a big warning flag, he says. People should also seek help if the quantity of time spent with the voices is increasing, if the complexity of the phenomenon is increasing or if the patient starts to feel a weakening sense of control.

But Veissière says there are many circumstances in which hearing voices can be helpful. In his research, he found that the presence of a tulpa helped some patients with Asperger’s syndrome, attention deficit disorder and general anxiety. More than half of respondents on the Asperger’s or autistic spectrum, for example, said their ability to read other people improves with the help of the voice in their head.

People in the online tulpa community are also speaking out about how their voices have helped them. Joanna Bennett,* a Montreal-based engineering student who has a tulpa named Melissa, says the voice helps her cope with the anxiety she feels around decision making. She runs her ideas and plans by Melissa, and Melissa gives her two cents back. California-based Katie Chester,* who suffers from depression, says her tulpa, KT, helped talk her through a time when she was having suicidal thoughts.

When Walker told her therapist about Jensen, she was surprised by the reaction. “She didn’t think I was crazy,” she says. “She thought it was a creative and healthy way to be dealing with . All this time, I’d been carrying this stress that if I told anyone, my doctor was going to send me straight to a hospital. I could have gotten up and hugged her.”

Walker sees Jensen as her safety net — someone she can talk to at any time, in any place. “Depression is lonely,” she says. “You feel isolated, so lost by yourself, and nobody seems to be able to bridge that gap. Having support that’s internal like not only do I have someone who is there with me, but because he is a part of me, and aware of what my needs actually are, he gets it. It’s the happiest I’ve been in years.”

*Names have been changed

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Lifetime Review: ‘Imaginary Friend’

WARNING: SPOILERS AHEAD

With a beautiful home and a doting husband, artist Emma Turner (Lacey Chabert) appears to have it all. But despite her lavish lifestyle, Emma is trapped in the prison of her own mind, having been left with deep scars from a childhood marred by her abusive father, who ultimately committed suicide after murdering her mother. The only comfort Emma had in her youth was her imaginary friend Lily, who she confided to when her home life became too much to bear.

Just as Emma tries to break free from her reclusive shell, however, she begins having apparent visions of a now adult Lily (Amanda Schull), leaving Emma’s husband Brad (Ethan Embry) convinced Emma is still unwell. But as the visions of her old imaginary friend persist and Emma finds herself questioning her sanity, it becomes clear that not all is as it appears to be—and Emma is caught in a web of deceit that threatens to destroy her unless she can fight her way out.

Among things that can taken away from Imaginary Friend, two things stand out: It delves more into the realm of atmosphere than most Lifetime-ian dramas do and is far more slow boiling than most films of the same genre. So for those looking for the drama that appeals many to Lifetime, this film might not fill that niche. But for what it does accomplish, Imaginary Friend is a different sort of Lifetime flick that can at the very least be respected for going in its own direction—even if it won’t fulfill every Lifetime viewer’s taste and, at moments, goes a little overboard (the moments where the action goes into slow motion were odd and didn’t really match up with the rest of the movie).

In addition to developing its atmosphere through its music and cinematography that makes good use of the beautiful mansion where much of the story takes place, Imaginary Friend plays its story out for the emotional weight it carries rather than going for blown-out drama. While this again might not suit everyone who is attracted towards Lifetime movies, this change of pace suits the movie well and is carried by its strong cast. Lacey Chabert is an excellent choice for Emma, making the viewer sympathize with Emma’s struggles to recover from an abusive childhood and root for her as her story arc has her pushed to a point where she won’t allow herself to be manipulated anymore. For all her mental anguish, Emma never truly allows it to consume her, with Chabert playing out Emma’s arc with aching emotion and sincerity.

Ethan Embry tackles his role with an equal amount of drive, making Brad a truly detestable and threatening villain that the audience will be cheering to see be brought down. Embry also takes the wise route in playing Brad as a subdued antagonist to fit with the more understated nature of Imaginary Friend’s drama; making him a chillingly true-to-life example of a psychologically abusive husband, becoming truly frightening when the tables are turned on him in the film’s suspenseful third act. Amanda Schull, meanwhile, has an arc which serves as a parallel to Chabert’s, as Brittany (“Lily’s” real name) goes from a willing conspirator in Brad’s plot to get his hands on Emma’s trust fund to an unlikely ally of Emma’s solely due to forming a genuine friendship with the woman she was enlisted to help destroy. The bond that forms between Emma and Brittany is heartwarming to watch develop, with Chabert and Schull sharing excellent chemistry that allows this bond to flourish.

Other solid performances exist in the form of Paul Sorvino and Jacob Young as Emma’s benefactor Jonathan and therapist Dr. Kent respectively, with their roles (along with Ted McGinley’s minor role as Officer Cameron) serving as satisfying parallels to the manipulative and self-centered Brad, and Sam Page brings vigor to his role as Emma’s abusive father, starting the movie and Emma’s emotion-driven character arc off with a bang. Imaginary Friend is a deliberately paced movie, but this different approach works to the film’s benefit and contains strong characters and an expertly built climax and conclusion that make it easy to say you should give it a chance, even if the toned down nature sounds like a deal breaker to you.

Score: 8 out of 10 pinky promises.

“Dear friend,” writes Charlie, at the beginning of Stephen Chbosky’s much-beloved coming-of-age novel The Perks of Being a Wallflower (1999), “I am writing to you because she said you listen and understand.” Charlie, Chbosky’s troubled teenage “wallflower”, pours out his heart to this friend in a series of letters trying to make sense of his life, but we learn nothing more about him or her.

Two decades on, the friend in Chbosky’s follow-up is even more mysterious. Seven-year-old Christopher Reese and his single mother, Kate, arrive in the small town of Mill Grove, Pennsylvania, running from their past. “Deep down, Christopher thought maybe she picked it because it seemed tucked away from the rest of the world. One highway in. One highway out. Surrounded by trees.”

Christopher is a good kid, but he’s dyslexic and struggles at school; Kate is on the brink financially, piling up bills and living in a motel. Then, bullied and miserable at school, Christopher notices a collection of clouds that look like a face. He follows the face, and finds himself lost in the woods. Six days later, he emerges – suddenly top of his class, and talking about the “nice man” who led him out. It turns out there’s a whole other world lying behind Mill Grove, “an imaginary world filled with hissing ladies and mailbox people with mouths sewn shut and eyes closed with zippers”, one Christopher has found his way to, and where his new friend, the nice man whom nobody else can see but who keeps on whispering to him, needs his help.

There are elements of Imaginary Friend that are genuinely frightening: as the nice man talks Christopher into building a tree house – which, incidentally, he and his gang of friends pull off with amazing skill for a group of seven-year-olds – the real and imaginary worlds of Mill Grove begin to overlap, and the bad things that lurk around this town are gradually revealed. There’s the hissing lady: “she turned to teeth and a hissing mouth. Worse than the Wicked Witch. Worse than anything. Four legs like a dog. Or a long neck like a giraffe. Hssss.” The man who lies inside the hollow log. The couple who can’t stop kissing, blood running from their mouths. The children with mouths sewn shut. Christopher battles with sleep, which would take him into the arms of the hissing lady, and the residents of the real town start to get sicker, and angrier.

Reading this book alone in the house, late at night, I will admit to a thud of fear at a bump downstairs, and a rush to switch all the lights on. But there are only so many carnivorous children and menacing deer a reader can take before becoming inured to their terrors, and after a while Imaginary Friend drifts into repetition. Christopher and his friends – and the adults in the story – are well drawn, but Chbosky is stage-managing a lot of characters, and as he moves through the gradual disintegration of each of their realities, over 720 pages, his story slows … and slows. That’s not to diss the blockbuster horror novel – my shelves are lined with Stephen King, and there are elements of King here (small town, group of young boys, evil lurking beneath). But if you’re going to pay homage to the master, you’re going to have to do it better.

Chbosky also stumbles when it comes to his register. Writing mostly from the perspective of a seven-year-old, he’s clearly tried to simplify, to imply the worldview of a child. Over the course of the novel, this starts to grate. “It felt like there was a monster in there. Or something else. Something that hissed. The hiss reminded him of a baby rattle. But not from a baby. From a rattlesnake.” Or: “That’s when the snake jumped out. It was a rattler. Coiled. Hissing. Hissss. Hissss. The sheriff backed away. The snake slithered toward him. Hissing like a baby’s rattle. The sheriff stumbled on a log and fell. The rattler came at him. Its fangs out. Ready to strike. The sheriff pulled out his revolver just as the snake jumped for his face. Bang. The snake’s head exploded with the bullet.” This overabundance of full stops becomes infuriating, as does the regular use of the line-break to create menace (or not, as the case may be):

He reached to unlock the doorknob.

Until it began to turn from the other side.

Chbosky, who in the years since his debut was published has been in Hollywood, screenwriting the live-action Beauty and the Beast and directing the film adaptation of Wonder by RJ Palacio, is ambitious, to say the least, increasingly tingeing his story with Christian symbolism as the population of his small town goes into meltdown. All the elements are here to create something truly scary: it just needs to be boiled down, fine-tuned – cut, basically.

• Imaginary Friend is published by Orion (£20). To order a copy go to guardianbookshop.com or call 020-3176 3837. Free UK p&p over £15, online orders only. Phone orders min p&p of £1.99.