Dissociative Experiences Scale – II (DES-II)

The Dissociative Experiences Scale-II (DES-II) is a 28-item self-report measure used to assess dissociation in adults (ages 18+). The DES-II was developed by Carlson and Putnam (1993) as a revision of the original DES (Bernstein & Putnam, 1986) to measure dissociative experiences in clinical settings. Dissociation is defined in the DSM-5 as “a disruption of and/or discontinuity in the normal integration of consciousness, memory, identity, emotion, perception, body representation, motor control, and behaviour” (American Psychiatric Association, 2013, p. 291).The DES-II is a widely used scale, measuring the frequency of various dissociative experiences (Kate et al., 2020). 

The DES-II assesses three main domains of dissociative experiences: 

• Amnesia: assesses gaps in memory and awareness, with examples including not knowing how you got somewhere, being dressed in clothes you don’t remember putting on, finding new things among belongings you don’t remember buying, not recognising friends or family members, finding evidence of having done things you don’t remember doing.
• Depersonalisation/derealisation: measures feelings of unreality or detachment regarding oneself or the environment. Examples include feeling that you are standing next to yourself or watching yourself do something and seeing yourself as if you were looking at another person, or feeling your body does not belong to you.
• Absorption/imaginative involvement: measures high engagement in an activity with reduced awareness of surroundings, related primarily to one’s traumatic experiences. Examples include realising that you did not hear part or all of what was said by another, remembering a past event so vividly that you feel as if you are reliving the event, or becoming so involved in a fantasy or daydream that it feels as though it were really happening to you. 

Research has consistently found the DES-II to be associated with traumatic experiences, particularly childhood trauma (Dalenberg et al., 2012). Studies have demonstrated significant correlations between dissociative symptoms and trauma history, post-traumatic stress symptoms, and alexithymia (Frewen et al., 2008; Schimmenti, 2016). Higher DES-II scores have been found across various psychiatric disorders, with the highest scores typically seen in dissociative disorders, followed by posttraumatic stress disorder and conversion disorder (Lyssenko et al., 2018).

The DES-II can be used to identify individuals who may require further assessment for dissociative disorders. For example, when a client presents with treatment-resistant depression, anxiety, or PTSD, elevated dissociation scores may indicate a need to address dissociative symptoms that could be interfering with treatment progress. The scale also serves as a screening tool, particularly as many individuals with dissociative symptoms may not spontaneously report such experiences due to shame, trouble remembering, or lack of awareness that such experiences are abnormal (Loewenstein, 2018).

In a clinical context, the DES-II can be used to guide formulation and treatment planning. For instance, a client with high scores on items related to depersonalisation may benefit from grounding techniques and mindfulness interventions to increase present-moment awareness. In addition to tracking changes in dissociative symptoms over time, the DES-II can also serve as a screening tool for EMDR therapists to identify clients who may require enhanced stabilisation and additional resourcing during the preparation phase of EMDR therapy.  

High scores on the DES-II may be indicative of trauma history. Research demonstrates that dissociative symptoms often develop as protective psychological mechanisms in response to overwhelming experiences (Dalenberg et al., 2012). The relationship between dissociation and trauma has treatment implications, as trauma-focused therapies may need modification when dissociation is present. Phase-based approaches that address dissociative symptoms before processing traumatic memories may be necessary. Additionally, elevated dissociation scores in trauma survivors may signal the need for additional stabilisation work before engaging in exposure-based interventions (Brand et al., 2012; Cloitre et al., 2011).

The DES-II is scored by calculating the mean of all 28 items, resulting in an overall score and subscale scores ranging from 0 to 100. Higher scores indicate greater frequency and severity of dissociative experiences. 

Three subscale scores can also be calculated: 

1. Amnesia (items 3, 4, 5, 8, 25, 26): assesses gaps in memory and awareness, with examples including not knowing how you got somewhere, being dressed in clothes you don’t remember putting on, finding new things among belongings you don’t remember buying, not recognising friends or family members, finding evidence of having done things you don’t remember doing.
2. Depersonalisation/derealisation (items 7, 11, 12, 13, 27, 28): measures feelings of unreality or detachment regarding oneself or the environment. Examples include feeling that you are standing next to yourself or watching yourself do something and seeing yourself as if you were looking at another person, or feeling your body does not belong to you.
3. Absorption (items 2, 14, 15, 17, 18, 20): measures high engagement in an activity with reduced awareness of surroundings, related primarily to one’s traumatic experiences. Examples include realising that you did not hear part or all of what was said by another, remembering a past event so vividly that you feel as if you are reliving the event, or becoming so involved in a fantasy or daydream that it feels as though it were really happening to you.

Descriptors based upon the score are also provided:

• Low (0-11): Typical in the general population, reflective of normal variations in attention and awareness. 
• Mild (12-19): Above community averages but generally remaining within normal limits. 
• Moderate (20-29): Notable dissociative experiences. 
• High (30-45): Substantial dissociative symptoms consistent with possible dissociative disorders 
• Very High (46+): Extreme dissociative experiences, most commonly observed in dissociative identity disorders. 

The total score is also expressed as a percentile rank, based on normative data from van Ijzendoorn & Schuengel’s (1996) meta-analysis of community samples. This percentile contextualises the client’s score relative to the general population, indicating the percentage of individuals who scored lower than the client. For example, a score at the 85th percentile means that 85% of people in the community sample scored lower than the client, placing them in the upper range of dissociative experiences.

When the DES-II score exceeds 30, further assessment for a dissociative disorder is recommended, potentially including structured clinical interviews such as the Structured Clinical Interview for DSM-5 Dissociative Disorders (SCID-D) (Steinberg, 1994). It should be noted that a threshold of 30 has been observed to miss 46% of positive diagnoses of dissociative disorders later identified via diagnostic interview, so considering a reduced cut off of 20 (Moderate range or above) will yield higher sensitivity (Leed et al., 2022). 

For tracking clinical progress, a reliable change index quantifies a clinically meaningful change (11 average score points), following guidelines Jacobson and Truax (1991). Monitoring scores over time allows clinicians to assess treatment effectiveness and adjust interventions as needed.

On first administration a bar graph showing total and subscale average scores is displayed, along with two comparison graphs illustrating the client’s scores relative to different reference groups.

When the assessment is administered multiple times, longitudinal line graphs are generated to track changes in both total average scores and subscale average scores over time.

The DES-II demonstrates strong construct validity across various studies. Convergent validity studies have shown moderate to high correlations with other measures of dissociation, such as the Multidimensional Inventory of Dissociation (MID; r = .90) and the Somatoform Dissociation Questionnaire (SDQ-20; r = .61) (Schimmenti, 2016; Nijenhuis et al., 1996). Discriminant validity is supported by its ability to distinguish between individuals with dissociative disorders and those with other psychiatric conditions, as well as non-clinical samples (van Ijzendoorn & Schuengel, 1996).

The DES-II shows excellent internal consistency, with Cronbach’s alpha values ranging from .93 to .95 across multiple studies (Carlson & Putnam, 1993; Frischholz et al., 1990; Lyssenko et al., 2018). Test-retest reliability over periods of 4-8 weeks has consistently been found to be good, with correlation coefficients ranging from .79 to .84 (Bernstein & Putnam, 1986; Carlson & Putnam, 1993). The split-half reliability has been reported as r = .83 to .93 (Carlson & Putnam, 1993; Schimmenti, 2016).

Regarding dimensionality, the factor structure of the DES-II has been extensively examined. The most commonly reported factor structure is a three-factor solution consisting of amnesia, depersonalisation/derealisation, and absorption (Carlson et al., 1991; Ross et al., 1991); a two-factor model involving absorption and amnesia/depersonalisation (Olsen et al., 2013); and a single-factor solution for the DES-T items representing pathological dissociation (Waller et al., 1996). Although there are competing factor models, the three-factor structure is most widely used and accepted (Carlson et al., 1991; Ross et al., 1995; Ruiz et al., 2008; Stockdale et al., 2002; Sanders & Green, 1994).

Normative data for the DES-II have been compiled from numerous studies across various populations. In non-clinical samples, mean scores typically range from 4.4 to 14.3, with standard deviations between 6.2 and 11.6 (van Ijzendoorn & Schuengel, 1996; Lyssenko et al., 2018). Clinical samples generally show higher means, particularly for dissociative disorders (mean = 38.9-48.7), PTSD (mean = 26.0-31.5), and borderline personality disorder (mean = 25.3-30.6) (Lyssenko et al., 2018; Ross et al., 1992). These normative data provide valuable reference points for interpreting individual scores within clinical contexts.

A cut-off score of 30 or higher is recommended by the original authors (Carlson & Putnam, 1993) as indicating potential dissociative psychopathology requiring further diagnostic assessment. In addition to this, NovoPsych has drawn on a review by Leeds et al. (2022) and cluster analysis by Schimmenti et al. (2016) to add further severity guidelines to aid interpretation. Leeds et al. (2022) suggested lower thresholds of 12 or 20 to increase sensitivity in identifying cases that might be missed using the traditional cutoff, noting that a score threshold under 30 missed 46% of positive diagnoses of dissociative disorders later identified via diagnostic interview. 

To develop descriptive categories for DES-II scores, NovoPsych  incorporated the suggestions of Leeds et al. (2022),  by adding three lower (below a score of 30) interpretive categories. Further, the results of a cluster analysis by Schimmenti et al. (2016) revealed three distinct groups: non-dissociative (M = 8.27), mildly/moderately dissociative (M = 23.45) and highly dissociative (M = 45.53), allowing for NovoPsych to add a Very High category for scores 45 and above. In light of these findings, NovoPsych’s adjusted guidelines are as follows:

• Low (0-11): Typical in the general population, reflective of normal variations in attention and awareness. 
• Mild (12-19): Above community averages but generally remaining within normal limits. 
• Moderate (20-29): Notable dissociative experiences. 
• High (30-44): Substantial dissociative symptoms consistent with possible dissociative disorders. 
• Very High (45+): Extreme dissociative experiences, most commonly observed in dissociative identity disorders.

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