ABSTRACT
Derek, a shy 17-year-old, reported that for several months he had been almost unable to function. Everyday events such as an airplane ¯ying overhead, a ®re engine's siren or his mother picking him up two minutes late, brought panic. Derek's father, an accountant, had died a year earlier from a heart attack. Derek had few school friends. His social contact consisted of playing Dungeons and Dragons weekly with older men. He said he was neither sad nor depressed and yet he presented with strikingly ¯at affect and an odd way of thinking that was creative yet mechanical. In his second year of treatment, Derek reported a dream:
I was taking a Latin exam but it wasn't on Latin ± it was on Dungeons and Dragons. There were 8 questions and we had to answer 3 of them. The ®rst question was numbered 23 and the second 28. The third one didn't have a number, and after I'd ®nished it I realized I'd done the wrong question and didn't have time to go back and do the correct 3rd question. At one point I looked at my watch and it was 12:41. As I was doing the test I looked at the time at 12:52, 12:54, and 12:58. I woke up depressed because I had done the test wrong and it was something that I knew ± I could have gotten it right.
