Outcome Measure
Dissociative Experiences Scale-II
What it measures?
- The DES-II is the most commonly used measure of dissociation. It measures various types of dissociation, including problematic dissociative states such as derealization, depersonalization, absorbtion and amnesia, as well as normmal dissociative experiences, such as daydreaming.
- The DES-II is also a screening tool for dissociative disorders, particularly Dissociative Identity Disorder (DID), and is also commonly used for screening in patients with psychotic disorders, such as schizophrenia.
Who is it for?
* Adults aged 18 years. * Adolescents should use a different version.
Instrument Quality
- The DES-II has demonstrated high internal consistency (Cronbach's alpha = .95), and strong evidence of convergent, discriminant, and criterion validity (Carlson & Putnam, 1993).
Structure
- 28 items
- 11-point Likert-type scale
- Respondents are asked what percentage of the time (0% = 'Never'; '100% = 'Always') in daily life they experience each symptom (e.g.' Some people have the experience of feeling that other people, objects, and the world around them are not real'
- Most factor-analytic research to-date supports a single-factor structure (Saggino et al., 2020)
Scoring instructions
- Sum the responses for all 28 items to form a total (the zero for each item should be dropped prior to this, such than 10% becomes 1, 20% becomes 2 etc.)
- Multiply the total by 10 and then divide the result by 28 (the number of items) to calculate the average score.
| Subscale | Item number |
|---|---|
Full-scale (DES-II) |
1,2,3,4,5,6,7,8,9,10,11,12,13,14,15,16,17,18,19,20,21,22,23,24,25,26,27,28 |
Score Interpretation
What higher scores mean?
- Higher levels of dissociation in daily life. Greater likelihood of meeting criteria for a dissociative disorde (including DID), a psychotic disorder, or Posttraumatic Stress Disorder (PTSD). A very high number of people who score above 30 have been shown to have PTSD or a dissociative disorder other than DID. The likely necessity for the assessing clinician to conduct a full clinical interview for dissociative disorder (it is recommended that a clinical interview should be undertaken if the respondent scores in the high range - i.e. above 30).
Identifying risk
A patient may be at risk if they endorse any of the following ‘red flag’ items. Further risk assessment should be undertaken.
| Item number | Item content |
|---|---|
| 27 | Some people sometimes find that they hear voices inside their head that tell them to do things or comment on things that they are doing. Circle the number to show what percentage of the time this happens to you. |
How to assess symptom severity & change?
| Description | Score Range | |
|---|---|---|
| Below normative mean | 0 | |
| Normative mean | 11.57 | |
| Dissociative Disorder | >=30 | Provisional Diagnosis |
| 1 SD above normative mean | 22.2 | |
| 2 SD above normative mean | 32.83 | |
| Dissociative Identity Disorder Mean | 44.64 | |
| Maximum | 100 |
Instrument developers
- Carlson, E. B., & Putnam, F. W. (1993). An update on the dissociative experiences scale. Dissociation: progress in the dissociative disorders.
Refrences
* Arzoumanian, M. A., Verbeck, E. G., Estrellado, J. E., Thompson, K. J., Dahlin, K., Hennrich, E. J., ... & Trauma Research Institute. (2023). Psychometrics of Three Dissociation Scales: Reliability and Validity Data on the DESR, DES-II, and DESC. Journal of Trauma & Dissociation, 24(2), 214-228. * Bernstein, E. M., & Putnam, F. W. (1986). Development, reliability and validity of a dissociation scale. The Journal of Nervous and Mental Disease, 174, 727–735 * Carlson, E. B., & Putnam, F. W. (1993). An update on the dissociative experiences scale. Dissociation: progress in the dissociative disorders * Van IJzendoorn, M. H., & Schuengel, C. (1996). The measurement of dissociation in normal and clinical populations: Meta-analytic validation of the Dissociative Experiences Scale (DES). Clinical psychology review, 16(5), 365-382 * Patihis, L., & Lynn, S. J. (2017). Psychometric comparison of Dissociative Experiences Scales II and C: A weak trauma‐dissociation link. Applied Cognitive Psychology, 31(4), 392-403. * Patihis, L., & Lynn, S. J. (2017). Psychometric comparison of Dissociative Experiences Scales II and C: A weak trauma‐dissociation link. Applied Cognitive Psychology, 31(4), 392-403 * Saggino, A., Molinengo, G., Rogier, G., Garofalo, C., Loera, B., Tommasi, M., & Velotti, P. (2020). Improving the psychometric properties of the dissociative experiences scale (DES-II): a Rasch validation study. BMC psychiatry, 20, 1-10.
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Severity ranges
*
Provisional diagnosis
* A very high number of people with scores above 30 have been shown to have Posttraumatic Disorder or a dissociative disorder. * Only around 1% of people with Dissociative Identity Disorder (DID) have been found to have a score below 30. * However, Leeds, Madere and Coy (2022) have raised serious concerns about over-reliance on DES-II mean scores to screen for dissociative disorders and determine whether it is safe to proceed with EMDR treatment. They also highlight comments by the scale developers (Bernstein & Putnam, 1986) that the DES-II is should not be used as a diagnostic instrument.
Reliable change and clinically significant improvement
Wampold et al (2001) conducted a meta analysis of psychotherapy outcome studies and noted that the average improvement was reflected in an effect size (ES) of .80. Because a change of 1 SD corresponds to an ES of 1.0, and .80 is considered to be a large ES, Wise (2004) concludes that a change of 1 SD is a defensible indicator of clinically significant change.
Mean
Standard Deviation
Reliability