A fixed fantasy is a belief that cannot be confirmed, seen most commonly in patients with personality disorders. This is also referred to as a dysfunctional schema, and can involve patterns established very early in childhood. For example, a patient may be convinced that she is a horrible person and everyone around her hates her, even though there is ample evidence to the contrary. Treating patients with fixed fantasies can be complex, involving an exploration of the events that led to the formation of the dysfunctional schema as well as attacking the belief or interconnected beliefs directly.
People with anxiety and depression can also develop fixed fantasies. Some are very fatalistic in nature; the patient may feel worthless or undervalued by friends or family. Such beliefs can also play a role in self-harming and suicidal behavior, where patients may feel like they need to punish themselves or think their deaths would spare the people around them pain and suffering. A patient who feels evil and irredeemable, for example, may believe that suicide would be an appropriate action.
Early childhood may lay the groundwork for a fixed fantasy; children who have experienced abuse, neglect, and molestation, for example, may develop beliefs with no grounding in reality as a coping mechanism. A child who was abused, for instance, might have a fixed fantasy that he is bad and was simply being punished for his unacceptable behavior. As the child develops, the fixed fantasy can trigger repetitive behaviors which reinforce it and convince the patient that the belief is correct.
In other cases, fixed fantasies develop without a clear cause. Patients with personality disorders, for example, can be convinced that other people dislike them and are conspiring against them, but may not have a specific history of experiences that might have sown the seeds for this belief. This can become a fixation which interferes with daily living; a patient who thinks everyone is conspiring, for example, assumes that people whispering in the office are plotting something and has trouble focusing at work.
Schema therapy is one method of addressing a fixed fantasy. In this approach to psychotherapy, patient and therapist work together to explore the origins of a schema, dismantle it, and cultivate more healthy beliefs. Some patients find it helpful to take medication to address psychological symptoms like anxiety while they are in therapy, because these symptoms can distract from the sessions and make it hard to focus.