connecting children who have been abused with professional mental health help. some trauma specialists suggest increasing inquiry into information about children's trauma history and exposure to violence, since the majority of people (about 80%) responsible for child maltreatment are the child's own parents. trauma-specific intervention for children may be useful in preventing future symptoms. another way to help prevent symptoms is by using "grounding techniques". grounding techniques involve identifying objects, entities etc... using your five senses. for example, some psychologists recommend identifying five things you can see, four things you can touch, three things you can hear, two things you can smell, and one thing you can taste. doing this brings the patient 'back to reality' as it helps relieve the anxiety that comes from the 'unknowingness' of one's dpdr. treatment treatment of dpdr is often difficult and refractory. some clinicians speculate that this could be due to a delay in diagnosis by which point symptoms tend to be constant and less responsive to treatment. additionally, symptoms tend to overlap with other diagnoses. some results have been promising, but are hard to evaluate with confidence due to the small size of trials. however, recognizing and diagnosing the condition may in itself have therapeutic benefits, considering many patients express their problems as baffling and unique to them, but are in fact: one, recognized and described by psychiatry; and two, those affected by it are not the only individuals to be affected from the condition. however, symptoms are often transient and can remit on their own without treatment. treatment is primarily non-pharmacological and can include paradoxical intention, record keeping, positive reward, flooding, psychotherapy, cognitive-behavioral therapy, psychoeducation, self-hypnosis, and meditation. meditation with the focus on the body has been used to achieve self awareness as it allows feelings, which otherwise are put aside or neutralized by the dpdr condition. self-hypnosis training can be helpful and entails training patients to induce dissociative symptoms and respond in an alternative manner. psychoeducation involves counseling regarding the disorder, reassurance, and emphasis on dpdr as a perceptual disturbance rather than a true physical experience. clinical pharmacotherapy research continues to explore a number of possible options, including selective serotonin reuptake inhibitors (ssri), benzodiazepines, stimulants and opioid antagonists (ex: naltrexone). cognitive behavioral therapy an open study of cognitive behavioral therapy has aimed to help patients reinterpret their symptoms in a nonthreatening way, leading to an improvement on several standardized measures. a standardized treatment for dpdr based on cognitive behavioral principles was published in the netherlands in 2011. medications neither antidepressants nor antipsychotics have been found to be useful; additionally, antipsychotics can worsen symptoms of depersonalisation. tentative evidence supports use of naloxone and naltrexone. a combination of an ssri and a benzodiazepine has been proposed to be useful for dpdr patients with anxiety. modafinil used alone has been reported to be effective in a subgroup of individuals with depersonalization disorder (those who have attentional impairments, under-arousal and hypersomnia). however, clinical trials have not been conducted. repetitive transcranial magnetic stimulation (rtms) some studies have found repetitive transcranial magnetic stimulation (rtms) to be helpful. one study examined 12 patients with dpdr that were treated with right temporoparietal junction (tpj) rtms and found that 50% showed improvement after three weeks of treatment. five of the participants received an additional three weeks of treatment and reported overall a 68% improvement in their symptoms. treating patients with rtms specifically at the tpj may be an alternative treatment. prognosis dpdr is typically chronic and continuous though some individuals report experiencing periods of remission. exacerbations can be caused by psychologically stressful situations. michal et al. (2016) analyzed a 223 case series on patients with dpdr and agreed that the condition tended to be chronic. epidemiology men and women are diagnosed in equal numbers with depersonalization disorder. a 1991 study on a sample from winnipeg, manitoba estimated the prevalence of depersonalization disorder at 2.4% of the population. a 2008 review of several studies estimated the prevalence between 0.8% and 1.9%. this disorder is episodic in about one-third of individuals, with each episode lasting from hours to months at a time. depersonalization can begin episodically, and later become continuous at constant or varying intensity. onset is typically during the teenage years or early 20s, although some report being depersonalized as long as they can remember, and others report a later onset. the onset can be acute or insidious. with acute onset, some individuals remember the exact time and place of their first experience of depersonalization. this may follow a prolonged period of severe stress, a traumatic event, an episode of another mental illness, or drug use. insidious onset may reach back as far as can be remembered, or it may begin with smaller episodes of lesser severity that become gradually stronger. patients with drug-induced depersonalization do not appear to be a clinically separate group from those with a non-drug precipitant. relation to other psychiatric disorders depersonalization exists as both a primary and secondary phenomenon, although making a clinical distinction appears easy, it is not absolute. the most common comorbid disorders are depression and anxiety, although cases of depersonalization disorder without symptoms of either do exist. comorbid obsessive and compulsive behaviours may exist as attempts to deal with depersonalization, such as checking whether symptoms have changed and avoiding behavioural and cognitive factors that exacerbate symptoms. many people with personality disorders such as schizoid personality disorder, schizotypal personality disorder, and borderline personality disorder will have high chances of having depersonalization disorder. history the word depersonalization itself was first used by henri frédéric amiel in the journal intime. the 8 july 1880 entry reads: i find myself regarding existence as though from beyond the tomb, from another world; all is strange to me; i am, as it were, outside my own body and individuality; i am depersonalized, detached, cut adrift. is this madness? depersonalization was first used as a clinical term by ludovic dugas in 1898 to refer to "a state in which there is the feeling or sensation that thoughts and acts elude the self and become strange; there is an alienation of personality – in other words a depersonalization". this description refers to personalization as a psychical synthesis of attribution of states to the self. early theories of the cause of depersonalization focused on sensory impairment. maurice krishaber proposed depersonalization was the result of pathological changes to the body's sensory modalities which lead to experiences of "self-strangeness" and the description of one patient who "feels that he is no longer himself". one of carl wernicke's students suggested all sensations were composed of a sensory component and a related muscular sensation that came from the movement itself and served to guide the sensory apparatus to the stimulus. in depersonalized patients, these two components were not synchronized, and the myogenic sensation failed to reach consciousness. the sensory hypothesis was challenged by others who suggested that patient complaints were being taken too literally and that some descriptions were metaphors – attempts to describe experiences that are difficult to articulate in words. pierre janet approached the theory by pointing out his patients with clear sensory pathology did not complain of symptoms of unreality, and that those who have depersonalization were normal from a sensory viewpoint. psychodynamic theory formed the basis for the conceptualization of dissociation as a defense mechanism. within this framework, depersonalization is understood as a defense against a variety of negative feelings, conflicts, or experiences. sigmund freud himself experienced fleeting derealization when visiting the acropolis in person; having read about it for years and knowing it existed, seeing the real thing was overwhelming and proved difficult for him to perceive it as real. freudian theory is the basis for the description of depersonalization as a dissociative reaction, placed within the category of psychoneurotic disorders, in the first two editions of the diagnostic and statistical manual of mental disorders. some argue that because depersonalization and derealization are both impairments to one's ability to perceive reality, they are merely two facets of the same disorder. depersonalization also differs from delusion in the sense that the patient is able to differentiate between reality and the symptoms they may experience. the ability to sense that something is unreal is maintained when experiencing symptoms of the disorder. the problem with properly defining depersonalization also lies within the understanding of what reality actually is. in order to comprehend the nature of reality we must incorporate all the subjective experiences throughout and thus the problem of obtaining an objective definition is brought about again. society and culture depersonalization disorder has appeared in a variety of media. the director of the autobiographical documentary tarnation, jonathan caouette, had depersonalization disorder. the screenwriter for the 2007 film numb had depersonalization disorder, as does the film's protagonist played by matthew perry. norwegian painter edvard munch's famous masterpiece the scream may have been inspired by depersonalization disorder. in glen hirshberg's novel the snowman's children, main female plot characters throughout the book had a condition that is revealed to be depersonalization disorder. suzanne segal had an episode in her 20s that was diagnosed by several psychologists as depersonalization disorder, though segal herself interpreted it through the lens of buddhism as a spiritual experience, commonly known as "satori" or "samadhi". the song "is happiness just a word?" by hip hop artist vinnie paz describes his struggle with depersonalization disorder. adam duritz, of the band counting crows, has often spoken about his diagnosis of depersonalization disorder.