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  
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
Sample Mean Comments
Clinical 32.01 Ijzendoorn and Schuengel (1996) used meta-analytics methods to derived pooled mean scores on the DES-11, based on over 100 uniques studies across various diagnosistic groups. Whe have chosen to report the pooled mean (M = 32.01, SD = 19.18) reported for studies that examined patients with PTSD (4 studies, N = 121)—given that many clinicians will be using the DES-II with patients presenting for trauma treatment.
Normative 11.57 Ijzendoorn and Schuengel (1996) used meta-analytics methods to derived pooled mean scores on the DES-11, based on over 100 uniques studies across various diagnosistic groups. Based on 7 studies (N = 1458) they reported a pooled mean of 11.57 (SD = 10.63) across 7 studies examining healthy samples. *Studies examining student samples have tended to report higher mean scores on the DES-II. For example, Patihis and colleagues (2017) reported a mean of 18.5 (SD = 12.9) in sample of undergraduate university students,
Standard Deviation
Sample Mean Comments
Clinical 19.18 Ijzendoorn and Schuengel (1996) used meta-analytics methods to derived pooled mean scores on the DES-11, based on over 100 uniques studies across various diagnosistic groups. Whe have chosen to report the pooled mean (M = 32.01, SD = 19.18) reported for studies that examined patients with PTSD (4 studies, N = 121)—given that many clinicians will be using the DES-II with patients presenting for trauma treatment.
Normative 10.63 Ijzendoorn and Schuengel (1996) used meta-analytics methods to derived pooled mean scores on the DES-11, based on over 100 uniques studies across various diagnosistic groups. Based on 7 studies (N = 1458) they reported a pooled mean of 11.57 (SD = 10.63) across 7 studies examining healthy samples. *Studies examining student samples have tended to report higher mean scores on the DES-II. For example, Patihis and colleagues (2017) reported a mean of 18.5 (SD = 12.9) in sample of undergraduate university students,
Reliability
Value Comments
0.89 * Arzoumanian and colleagues (2022) reported test-retest reliability of 0.89 over a two-week period, in an ethnically diverse sample of American college students (N = 300). * Another study (Patihis & Lynn, 2017) reported test-retest reliability of 0.80 in a diverse sample of American undergraduate students at a public university (N = 161). * The original scale developers reported test-retest reliability of 0.84 over a 4-8 week retest interval (Bernstein & Putnam, 1986).

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.

Related Outcome Measures

ACE-Q

The Adverse Childhood Experiences Questionnaire

The Adverse Childhood Experiences Questionnaire (ACE-Q) is a widely used tool for assessing childho...

Know more

MDRS-22

Male Depression Risk Scale

The Male Depression Risk Scale (MDRS) measures the risk of depression in men by assessing externali...

Know more

DES-II

Dissociative Experiences Scale-II

The DES-II is the most commonly used measure of dissociation. It measures various types of dissocia...

Know more

PCL-5

PTSD Checklist for DSM-5

The 20 symptoms of Post-Traumatic Stress Disorder, as outlined in the Diagnostic & Statistical Manua...

Know more

PDSS-SR

Panic Disorder Severity Scale – Self-Report

The severity of Panic Disorder symptoms during the past week. Specifically, the instrument assesses...

Know more

SCAS-P

Spence Children’s Anxiety Scale – Parent

The SCAS-P measures anxiety symptoms in children in the general population through parent report. T...

Know more

PSEQ

Pain Self-Efficacy Questionnaire

The beliefs held by people experiencing chronic pain that they can carry out certain activities even...

Know more

PHQ-9

Patient Health Questionnaire 9-Item

Symptoms of Depression over the previous 2 weeks.

Know more

RIS

Regensburg Insomnia Scale

Psychological symptoms of insomnia assessing cognitive, emotional and behavioural aspects. The RIS m...

Know more

PSWQ

Penn State Worry Questionnaire

The PSWQ assesses pervasive and uncontrollable worry.

Know more

GAD-7

Generalised Anxiety 7-Item

The symptoms of Generalized Anxiety Disorder, as outlined in the Diagnostic and Statistical Manual ...

Know more

CIA

Clinical Impairment Assessment Questionnaire

The severity of psychosocial impairment due to eating disorder pathology.

Know more

AUDIT

Alcohol Use Disorder Identification Test

The AUDIT identifies risky or harmful alcohol consumption, as well as alcohol dependence or abuse. ...

Know more

AAI

Appearance Anxiety Inventory

Cognitive and behavioural symptoms of body image anxiety and body dysmorphic disorder (BDD). In part...

Know more

K10

Kessler Psychological Distress Scale

Non-specific psychological distress in the past 2 weeks.

Know more

SWLS

The Satisfaction With Life Scale

The Satisfaction With Life Scale (SWLS) examines the extent to which a person is satisfied with thei...

Know more

DASS-21

Depression Anxiety Stress Scales – 21-Item

Three self-report subscales assess the emotional states of depression, anxiety and stress.

Know more

CORE-OM

Clinical Outcomes in Routine Evaluation

The CORE-OM aims to capture the ‘core’ of client distress and provide a global index of distres...

Know more

ASRS

Adult ADHD Self-Report Scale

The ASRS aims to examine Attention Deficit Hyperactivity Disorder (ADHD) symptoms in adults consiste...

Know more