1. Comer, Fundamentals of Abnormal Psychology, 7e Disorders of Trauma and Stress Chapter 5 Slides & Handouts by Karen Clay Rhines, Ph.D.

2. 2 Comer, Fundamentals of Abnormal Psychology, 7e Stress, Coping, and the Anxiety Response  The state of stress has two components:  Stressor – event that creates demands  Stress response – person’s reactions to the demands  Influenced by how we judge both the events and our capacity to react to them effectively  People who sense that they have the ability and resources to cope are more likely to take stressors in stride and respond well

3. 3 Comer, Fundamentals of Abnormal Psychology, 7e Stress, Coping, and the Anxiety Response  When we view a stressor as threatening, the natural reaction is arousal and fear  Fear is a “package” of responses that are physical, emotional, and cognitive  Stress reactions, and the fear they produce, are often at play in psychological disorders  People who experience a large number of stressful events are particularly vulnerable to the onset of anxiety and other psychological disorders

4. Stress, Coping, and the Anxiety Response  Extraordinary stress and trauma also play a more central role in certain psychological disorders, including:  Acute stress disorder  Posttraumatic stress disorder (PTSD)  …as well as the “dissociative disorders”:  Dissociative amnesia  Dissociative identity disorder  Depersonalization-derealization disorder 4 Comer, Fundamentals of Abnormal Psychology, 7e

5. 5 Stress and Arousal: The Fight-or-Flight Response  The features of arousal and fear are set in motion by the hypothalamus  Two important systems are activated:  Autonomic nervous system (ANS)  An extensive network of nerve fibers that connect the central nervous system (the brain and spinal cord) to all other organs of the body  Endocrine system  A network of glands throughout the body that release hormones

6. Stress and Arousal: The Fight-or-Flight Response  There are two pathways, or routes, by which the ANS and the endocrine system produce arousal and fear reactions:  Sympathetic nervous system pathway  Hypothalamic-pituitary-adrenal pathway 6 Comer, Fundamentals of Abnormal Psychology, 7e

7. 7 Stress and Arousal: The Fight-or-Flight Response  When we face a dangerous situation, the hypothalamus first excites the sympathetic nervous system, which stimulates key organs either directly or indirectly  When the perceived danger passes, the parasympathetic nervous system helps return body processes to normal

8. The Autonomic Nervous System 8 Comer, Fundamentals of Abnormal Psychology, 7e

9. 9 Stress and Arousal: The Fight-or- Flight Response  The second pathway is the hypothalamic- pituitary-adrenal (HPA) pathway  When we are faced by stressors, the hypothalamus signals the pituitary gland, which stimulates the adrenal cortex to release corticosteroids – stress hormones – into the bloodstream

10. The Endocrine System 10 Comer, Fundamentals of Abnormal Psychology, 7e

11. 11 Comer, Fundamentals of Abnormal Psychology, 7e Stress and Arousal: The Fight-or-Flight Response  The reactions on display in these two pathways are collectively referred to as the fight-or-flight response  Each person has a particular pattern of autonomic and endocrine functioning and so a particular way of experiencing arousal and fear…

12. 12 Comer, Fundamentals of Abnormal Psychology, 7e Stress and Arousal: The Fight-or-Flight Response  People differ in:  Their general level of arousal and anxiety  Called “trait anxiety”  Some people are usually somewhat tense; others are usually relaxed  Differences appear soon after birth  Their sense of which situations are threatening  Called “state anxiety”  Situation-based (example: fear of flying)

13. Acute and Posttraumatic Stress Disorders  During and immediately after trauma, we may temporarily experience high levels of arousal and upset  For some, symptoms persist well after the trauma  These people may be suffering from:  Acute stress disorder  Posttraumatic stress disorder (PTSD)  The precipitating event usually involves actual or threatened serious injury to self or others  The situations that cause these disorders would be traumatic to anyone (unlike the anxiety disorders) 13 Comer, Fundamentals of Abnormal Psychology, 7e

14. 14 Comer, Fundamentals of Abnormal Psychology, 7e Acute and Posttraumatic Stress Disorders  Acute stress disorder  Symptoms begin immediately or soon after the traumatic event and last for less than one month  Posttraumatic stress disorder (PTSD)  Symptoms may begin either shortly after the event, or months or years afterward  As many as 80% of all cases of acute stress disorder develop into PTSD

15. Acute and Posttraumatic Stress Disorders  Aside from the differences in onset and duration, the symptoms of acute stress disorders and PTSD are almost identical:  Reexperiencing the traumatic event  Avoidance  Reduced responsiveness  Increased arousal, negative emotions, and guilt 15 Comer, Fundamentals of Abnormal Psychology, 7e

16. What Triggers Acute and Posttraumatic Stress Disorders?  Can occur at any age and affect all aspects of life  At least 3.5% of people in the U.S. are affected each year  7–9% of people in the U.S. are affected sometime during their lifetime  Around two-thirds seek treatment at some point 16 Comer, Fundamentals of Abnormal Psychology, 7e

17. What Triggers Acute and Posttraumatic Stress Disorders?  Ratio of women to men is 2:1  After trauma, around 20% of women and 8% of men develop disorders  In addition, people with low incomes are twice as likely as people with higher incomes to experience one of the stress disorders  Some events – including combat, disasters, abuse, and victimization – are more likely to cause disorders than others 17 Comer, Fundamentals of Abnormal Psychology, 7e

18. What Triggers Acute and Posttraumatic Stress Disorders?  Combat  For years clinicians have recognized that soldiers experience distress during combat  Called “shell shock” or “combat fatigue”  Post-Vietnam War clinicians discovered that soldiers also experienced psychological distress after combat 18 Comer, Fundamentals of Abnormal Psychology, 7e

19. What Triggers Acute and Posttraumatic Stress Disorders?  Combat  As many as 29% of Vietnam combat veterans suffered acute or posttraumatic stress disorders  An additional 22% had some stress symptoms  10% still experiencing problems  A similar pattern is currently unfolding among veterans of wars in Afghanistan and Iraq  Individuals who have served multiple deployments have a significantly heightened risk of developing PTSD 19 Comer, Fundamentals of Abnormal Psychology, 7e

20. What Triggers Acute and Posttraumatic Stress Disorders?  Disasters  Acute or posttraumatic stress disorders may also follow natural and accidental disasters  Types of disasters include earthquakes, floods, tornadoes, fires, airplane crashes, and serious car accidents  Because they occur more often, civilian traumas have been implicated in stress disorders at least 10 times as often as combat traumas 20 Comer, Fundamentals of Abnormal Psychology, 7e

21. What Triggers Acute and Posttraumatic Stress Disorders?  Victimization  People who have been abused or victimized often experience lingering stress symptoms  Research suggests that more than one-third of all victims of physical or sexual assault develop PTSD  Similarly, as many as half of all people who are directly exposed to terrorism or torture may develop this disorder 21 Comer, Fundamentals of Abnormal Psychology, 7e

22. What Triggers Acute and Posttraumatic Stress Disorders?  Victimization  A common form of victimization is sexual assault/rape  Around 1 in 6 women is raped at some time during her life  Psychological impact is immediate and may be long-lasting  One study found that 94% of rape survivors developed an acute stress disorder within 12 days after assault 22 Comer, Fundamentals of Abnormal Psychology, 7e

23. 23 Comer, Fundamentals of Abnormal Psychology, 7e What Triggers Acute and Posttraumatic Stress Disorders?  Victimization  Ongoing victimization and abuse in the family may also lead to stress disorders

24. 24 Comer, Fundamentals of Abnormal Psychology, 7e What Triggers Acute and Posttraumatic Stress Disorders?  Terrorism and torture  The experience of terrorism or the threat of terrorism often leads to posttraumatic stress symptoms, as does the experience of torture  Unfortunately, these sources of traumatic stress are on the rise in our society

25. Why Do People Develop Acute and Posttraumatic Stress Disorders?  Clearly, extraordinary trauma can cause a stress disorder  However, the event alone may not be the entire explanation  To understand the development of these disorders, researchers have looked to:  Survivors’ biological processes  Personalities  Childhood experiences  Social support systems  Cultural backgrounds  Severity of the traumas 25 Comer, Fundamentals of Abnormal Psychology, 7e

26. Why Do People Develop Acute and Posttraumatic Stress Disorders?  Biological and genetic factors  Traumatic events trigger physical changes in the brain and body that may lead to severe stress reactions and, in some cases, to stress disorders  Some research suggests abnormal neurotransmitter and hormone activity (especially norepinephrine and cortisol)  Evidence suggests that once a stress disorder sets in, further biochemical arousal and damage may also occur (especially in the hippocampus and amygdala)  There may be a biological/genetic predisposition to such reactions 26 Comer, Fundamentals of Abnormal Psychology, 7e

27. Why Do People Develop Acute and Posttraumatic Stress Disorders?  Personality factors  Some studies suggest that people with certain personalities, attitudes, and coping styles are particularly likely to develop stress disorders  Risk factors include:  Preexisting high anxiety  Negative worldview  A set of positive attitudes (called resiliency or hardiness) is protective against developing stress disorders 27 Comer, Fundamentals of Abnormal Psychology, 7e

28. Why Do People Develop Acute and Posttraumatic Stress Disorders?  Childhood experiences  Researchers have found that certain childhood experiences increase risk for later stress disorders  Risk factors include:  An impoverished childhood  Psychological disorders in the family  The experience of assault, abuse, or catastrophe at an early age  Being younger than 10 years old when parents separated or divorced 28 Comer, Fundamentals of Abnormal Psychology, 7e

29. Why Do People Develop Acute and Posttraumatic Stress Disorders?  Social support  People whose social support systems are weak are more likely to develop a stress disorder after a traumatic event 29 Comer, Fundamentals of Abnormal Psychology, 7e

30. Why Do People Develop Acute and Posttraumatic Stress Disorders?  Multicultural factors  There is a growing suspicion among clinical researchers that the rates of PTSD may differ among ethnic groups in the US  It seems that Hispanic Americans might be more vulnerable to PTSD than other cultural groups  Possible explanations include cultural belief systems about trauma and the cultural emphasis on social relationships and social support 30 Comer, Fundamentals of Abnormal Psychology, 7e

31. Why Do People Develop Acute and Posttraumatic Stress Disorders?  Severity of the trauma  Generally, the more severe the trauma and the more direct one’s exposure to it, the greater the likelihood of developing a stress disorder  Especially risky: Mutilation and severe injury; witnessing the injury or death of others 31 Comer, Fundamentals of Abnormal Psychology, 7e

32. How Do Clinicians Treat Acute and Posttraumatic Stress Disorders?  About half of all cases of PTSD improve within 6 months; the remainder may persist for years  Treatment procedures vary depending on type of trauma  General goals:  End lingering stress reactions  Gain perspective on painful experiences  Return to constructive living 32 Comer, Fundamentals of Abnormal Psychology, 7e

33. How Do Clinicians Treat Acute and Posttraumatic Stress Disorders?  Treatment for combat veterans  Drug therapy  Antianxiety and antidepressant medications are most common  Behavioral exposure techniques  Reduce specific symptoms, increase overall adjustment  Use flooding and relaxation training  Use eye movement desensitization and reprocessing (EMDR)  Insight therapy  Bring out deep-seated feelings, create acceptance, lessen guilt  Often use couple, family, or group therapy formats; rap groups 33 Comer, Fundamentals of Abnormal Psychology, 7e

34. How Do Clinicians Treat Acute and Posttraumatic Stress Disorders?  Psychological debriefing  A form of crisis intervention that has victims of trauma talk extensively about their feelings and reactions within days of the critical incident  Major components include:  Normalizing responses to the disaster  Encouraging expressions of anxiety, anger, and frustration  Teaching self-help skills  Providing referrals 34 Comer, Fundamentals of Abnormal Psychology, 7e

35. How Do Clinicians Treat Acute and Posttraumatic Stress Disorders?  Psychological debriefing  The approach has come under careful scrutiny  While many health professionals continue to believe in the approach despite unsupportive research findings, the current climate is moving away from outright acceptance  It’s possible that certain high-risk individuals may profit from debriefing programs but that others shouldn’t receive such interventions 35 Comer, Fundamentals of Abnormal Psychology, 7e

36. Dissociative Disorders  Although their conditions are also triggered by traumatic events, individuals with dissociative disorders do not typically experience the significant arousal, negative emotions and other symptoms associated with the stress disorders  Instead, their symptoms are characterized by patterns of memory loss and identity change 36 Comer, Fundamentals of Abnormal Psychology, 7e

37. Dissociative Disorders  The key to our identity – the sense of who we are and where we fit in our environment – is memory  In dissociative disorders, one part of the person’s memory typically seems to be dissociated, or separated, from the rest 37 Comer, Fundamentals of Abnormal Psychology, 7e

38. Dissociative Disorders  There are several kinds of dissociative disorders, including:  Dissociative amnesia  Dissociative identity disorder (multiple personality disorder)  Depersonalization-derealization disorder  These disorders are often memorably portrayed in books, movies, and television programs 38 Comer, Fundamentals of Abnormal Psychology, 7e

39. Dissociative Amnesia  People with dissociative amnesia are unable to recall important information, usually of a stressful nature, about their lives  The loss of memory is much more extensive than normal forgetting and is not caused by physical factors  Often an episode of amnesia is directly triggered by a specific upsetting event 39 Comer, Fundamentals of Abnormal Psychology, 7e

40. Dissociative Amnesia  Dissociative amnesia may be:  Localized – most common type; loss of all memory of events occurring within a limited period  Selective – loss of memory for some, but not all, events occurring within a period  Generalized – loss of memory beginning with an event, but extending back in time; may lose sense of identity; may fail to recognize family and friends  Continuous – forgetting continues into the future; quite rare in cases of dissociative amnesia 40 Comer, Fundamentals of Abnormal Psychology, 7e

41. Dissociative Amnesia  All forms of the disorder are similar in that the amnesia interferes mostly with a person’s memory for personal material  Memory for abstract or encyclopedic information – usually remains intact  Clinicians do not known how common dissociative amnesia is, but many cases seem to begin serious threats to health and safety 41 Comer, Fundamentals of Abnormal Psychology, 7e

42. Dissociative Amnesia  An extreme version of dissociative amnesia is called dissociative fugue  Here persons not only forget their personal identities and details of their past, but also flee to an entirely different location  For some, the fugue is brief – a matter of hours or days – and ends suddenly  For others, the fugue is more severe: people may travel far from home, take a new name and establish new relationships, and even a new line of work; some display new personality characteristics 42 Comer, Fundamentals of Abnormal Psychology, 7e

43. Dissociative Amnesia  Fugues tend to end abruptly  When people are found before their fugue has ended, therapists may find it necessary to continually remind them of their own identity  The majority of people regain most or all of their memories and never have a recurrence 43 Comer, Fundamentals of Abnormal Psychology, 7e

44. Dissociative Identity Disorder (Multiple Personality Disorder)  A person with dissociative identity disorder (DID, or multiple personality disorder) develops two or more distinct personalities, called “subpersonalities”, each with a unique set of memories, behaviors, thoughts, and emotions 44 Comer, Fundamentals of Abnormal Psychology, 7e

45. Dissociative Identity Disorder (Multiple Personality Disorder)  At any given time, one of the subpersonalities dominates the person’s functioning  Usually one of these subpersonalities – called the primary, or host, personality – appears more often than the others  The transition from one subpersonality to the next (“switching”) is usually sudden and may be dramatic 45 Comer, Fundamentals of Abnormal Psychology, 7e

46. Dissociative Identity Disorder (Multiple Personality Disorder)  Cases of this disorder were first reported almost three centuries ago  Many clinicians consider the disorder to be rare, but some reports suggest that it may be more common than once thought 46 Comer, Fundamentals of Abnormal Psychology, 7e

47. Dissociative Identity Disorder (Multiple Personality Disorder)  Most cases are first diagnosed in late adolescence or early adulthood  Symptoms generally begin in childhood after episodes of abuse  Women receive the diagnosis three times as often as men 47 Comer, Fundamentals of Abnormal Psychology, 7e

48. Dissociative Identity Disorder (Multiple Personality Disorder)  How do subpersonalities interact?  The relationship between or among subpersonalities varies from case to case  Generally there are three kinds of relationships:  Mutually amnesic relationships – subpersonalities have no awareness of one another  Mutually cognizant patterns – each subpersonality is well aware of the rest  One-way amnesic relationships – most common pattern; some personalities are aware of others, but the awareness is not mutual  Those who are aware (“co-conscious subpersonalities”) are “quiet observers” 48 Comer, Fundamentals of Abnormal Psychology, 7e

49. Dissociative Identity Disorder (Multiple Personality Disorder)  How do subpersonalities interact?  Investigators used to believe that most cases of the disorder involved two or three subpersonalities  Studies now suggest that the average number is much higher – 15 for women, 8 for men  There have been cases of more than 100! 49 Comer, Fundamentals of Abnormal Psychology, 7e

50. Dissociative Identity Disorder (Multiple Personality Disorder)  How do subpersonalities differ?  Subpersonalities often display dramatically different characteristics, including:  Identifying features  Subpersonalities may differ in features as basic as age, sex, race, and family history  Abilities and preferences  Although encyclopedic information is not usually affected by dissociative amnesia, in DID it is often disturbed  It is not uncommon for different subpersonalities to have different abilities, including being able to drive, speak a foreign language, or play an instrument 50 Comer, Fundamentals of Abnormal Psychology, 7e

51. Dissociative Identity Disorder (Multiple Personality Disorder)  How do subpersonalities differ?  Subpersonalities often display dramatically different characteristics, including:  Physiological responses  Researchers have discovered that subpersonalities may have physiological differences, such as differences in autonomic nervous system activity, blood pressure levels, and allergies 51 Comer, Fundamentals of Abnormal Psychology, 7e

52. Dissociative Identity Disorder (Multiple Personality Disorder)  How common is DID?  Traditionally, DID was believed to be rare  Some researchers even argue that many or all cases are iatrogenic; that is, unintentionally produced by practitioners  These arguments are supported by the fact that many cases of DID first come to attention only after a person is already in treatment  Not true of all cases 52 Comer, Fundamentals of Abnormal Psychology, 7e

53. Dissociative Identity Disorder (Multiple Personality Disorder)  How common is DID?  The number of people diagnosed with the disorder has been increasing  Although the disorder is still uncommon, thousands of cases have been documented in the U.S. and Canada alone  Two factors may account for this increase:  A growing number of clinicians believe that the disorder does exist and are willing to diagnose it  Diagnostic procedures have become more accurate  Despite changes, many clinicians continue to question the legitimacy of this category 53 Comer, Fundamentals of Abnormal Psychology, 7e

54. How Do Theorists Explain Dissociative Amnesia and DID?  A variety of theories have been proposed to explain these disorders  Older explanations have not received much investigation  Newer viewpoints, which combine cognitive, behavioral, and biological principles, have captured the interest of clinical scientists 54 Comer, Fundamentals of Abnormal Psychology, 7e

55. How Do Theorists Explain Dissociative Amnesia and DID?  The psychodynamic view  Psychodynamic theorists believe that dissociative disorders are caused by repression, the most basic ego defense mechanism  People fight off anxiety by unconsciously preventing painful memories, thoughts, or impulses from reaching awareness 55 Comer, Fundamentals of Abnormal Psychology, 7e

56. 56 Comer, Fundamentals of Abnormal Psychology, 7e How Do Theorists Explain Dissociative Amnesia and DID?  The psychodynamic view  In this view, dissociative amnesia is a single episode of massive repression  DID is thought to result from a lifetime of excessive repression, motivated by very traumatic childhood events

57. How Do Theorists Explain Dissociative Amnesia and DID?  The psychodynamic view  Most of the support for this model is drawn from case histories, which report brutal childhood experiences, yet:  Some individuals with DID do not seem to have these experiences of abuse 57 Comer, Fundamentals of Abnormal Psychology, 7e

58. How Do Theorists Explain Dissociative Amnesia and DID?  The behavioral view  Behaviorists believe that dissociation grows from normal memory processes and is a response learned through operant conditioning:  Momentary forgetting of trauma leads to a drop in anxiety, which increases the likelihood of future forgetting  Like psychodynamic theorists, behaviorists see dissociation as escape behavior  Also like psychodynamic theorists, behaviorists rely largely on case histories to support their view of dissociative disorders  Moreover, these explanations fail to explain all aspects of these disorders 58 Comer, Fundamentals of Abnormal Psychology, 7e

59. How Do Theorists Explain Dissociative Amnesia and DID?  State-dependent learning  If people learn something when they are in a particular state of mind, they are likely to remember it best when they are in the same condition  This link between state and recall is called state- dependent learning  This model has been demonstrated with substances and mood and may be linked to arousal levels 59 Comer, Fundamentals of Abnormal Psychology, 7e

60. How Do Theorists Explain Dissociative Amnesia and DID?  State-dependent learning  Perhaps people who are prone to develop dissociative disorders may have state-to- memory links that are unusually rigid and narrow; each thought, memory, and skill may be tied exclusively to a particular state of arousal, so that they recall a given event only when they experience an arousal state almost identical to the state in which the memory was first acquired 60 Comer, Fundamentals of Abnormal Psychology, 7e

61. How Do Theorists Explain Dissociative Amnesia and DID?  Self-hypnosis  Although hypnosis can help people remember events that occurred and were forgotten years ago, it can also help people forget facts, events, and their personal identity  Called “hypnotic amnesia,” this phenomenon has been demonstrated in research studies with word lists  The parallels between hypnotic amnesia and dissociative disorders are striking and have led researchers to conclude that dissociative disorders may be a form of self-hypnosis 61 Comer, Fundamentals of Abnormal Psychology, 7e

62. How Are Dissociative Amnesia and DID Treated?  People with dissociative amnesia often recover on their own  Only sometimes do their memory problems linger and require treatment  In contrast, people with DID usually require treatment to regain their lost memories and develop an integrated personality  Treatment for dissociative amnesia tends to be more successful than treatment for DID 62 Comer, Fundamentals of Abnormal Psychology, 7e

63. How Are Dissociative Amnesia and DID Treated?  How do therapists help people with dissociative amnesia?  The leading treatments for these disorders are psychodynamic therapy, hypnotic therapy, and drug therapy  Psychodynamic therapists guide patients to search their unconscious and bring forgotten experiences into consciousness  In hypnotic therapy, patients are hypnotized and guided to recall forgotten events  Sometimes intravenous injections of barbiturates are used to help patients regain lost memories  Often called “truth serums,” the key to the drugs’ success is their ability to calm people and free their inhibitions 63 Comer, Fundamentals of Abnormal Psychology, 7e

64. How Are Dissociative Amnesia and DID Treated?  How do therapists help individuals with DID?  Unlike victims of dissociative amnesia, people with DID do not typically recover without treatment  Treatment for this pattern, like the disorder itself, is complex and difficult 64 Comer, Fundamentals of Abnormal Psychology, 7e

65. How Are Dissociative Amnesia and DID Treated?  How do therapists help individuals with DID?  Therapists usually try to help the client by:  Recognizing the disorder  Once a diagnosis of DID has been made, therapists try to bond with the primary personality and with each of the subpersonalities  As bonds are forged, therapists try to educate the patients and help them recognize the nature of the disorder  Some use hypnosis or video as a means of presenting other subpersonalities  Many therapists recommend group or family therapy 65 Comer, Fundamentals of Abnormal Psychology, 7e

66. How Are Dissociative Amnesia and DID Treated?  How do therapists help individuals with DID?  Therapists usually try to help the client by:  Recovering memories  To help patients recover missing memories, therapists use many of the approaches applied in other dissociative disorders, including psychodynamic therapy, hypnotherapy, and drug treatment  These techniques tend to work slowly in cases of DID 66 Comer, Fundamentals of Abnormal Psychology, 7e

67. How Are Dissociative Amnesia and DID Treated?  How do therapists help individuals with DID?  Therapists usually try to help the client by:  Integrating the subpersonalities  The final goal of therapy is to merge the different subpersonalities into a single, integrated identity  Integration is a continuous process; fusion is the final merging  Many patients distrust this final treatment goal and their subpersonalities see integration as a form of death  Once the subpersonalities are integrated, further therapy is typically needed to maintain the complete personality and to teach social and coping skills to prevent later dissociations 67 Comer, Fundamentals of Abnormal Psychology, 7e

68. Depersonalization-Derealization Disorder  DSM-5 categorizes depersonalization- derealization disorder as a dissociative disorder, even though it is not characterized by memory difficulties  The central symptom is persistent and recurrent episodes of depersonalization, which is the sense that one’s own mental functioning or body are unreal or detached, and/or derealization, which is the sense that one’s surroundings are unreal or detached 68 Comer, Fundamentals of Abnormal Psychology, 7e

69. Depersonalization-Derealization Disorder  People with depersonalization- derealization disorder feel as though they have become separated from their body and are observing themselves from outside  This sense of unreality can extend to other sensory experiences and behavior  Depersonalization is often accompanied by derealization – the feeling that the external world, too, is unreal and strange 69 Comer, Fundamentals of Abnormal Psychology, 7e

70. Depersonalization-Derealization Disorder  Depersonalization and derealization experiences by themselves do not indicate a depersonalization disorder  Transient depersonalization reactions are fairly common  The symptoms of a depersonalization- derealization disorder are persistent or recurrent, cause considerable distress, and interfere with social relationships and job performance 70 Comer, Fundamentals of Abnormal Psychology, 7e

71. Depersonalization-Derealization Disorder  The disorder occurs most frequently in adolescents and young adults, hardly ever in people older than 40  The disorder comes on suddenly and tends to be long-lasting  Few theories have been offered to explain this disorder 71 Comer, Fundamentals of Abnormal Psychology, 7e