The Multidimensional Inventory of Dissociation 60-item version (MID-60) is a screening tool for adults (18 years +) that assesses dissociative symptoms and experiences consistent with DSM-5-TR dissociative disorders. It also captures dissociative experiences, PTSD and somatic symptoms, and phenomena closely related to dissociation such as trance and self-confusion. There is also an adolescent version for use with adolescents ages 16 to 19 years of age – the MID-60-A.
Dissociation is an adaptive defence in response to high stress or trauma that is characterised by amnesia or memory problems, depersonalisation, derealisation, identity confusion, and identity alteration. Around 10% of the population will meet criteria for a dissociative disorder during their lifetime (Kate et al, 2020).
Example MID-60 Item
The MID-60 has 12 subscales, which are presented here according to the diagnostic category the subscale is most aligned to:
– Dissociative identity disorder
1. Amnesia (for recent events): Assesses episodes of “losing time,” finding oneself in unexpected locations, discovering unexplained changes to appearance, and regaining awareness with objects in hand with no memory of how they got there
– Dissociative identity disorder (DID) and its subclinical variant, other specified dissociative disorder – 1 (OSDD-1).
2. Subjective Awareness of Alter Personalities and Self-States: Evaluates awareness of distinct personality states or “parts” with their own identities, voices, and perspectives, including hearing child voices internally and sensing other people inside who can speak or take control
3. Angry Intrusions: Measures intrusions of anger that feel outside one’s control, including words or actions not remembered after calming down
4. Persecutory Intrusions: Assesses critical, hostile, or self-destructive internal voices that demean, command self-harm, or wish the individual dead
– Depersonalisation/derealisation disorder
5. Derealisation/Depersonalisation: Evaluates experiences of unreality about oneself, others, or surroundings, including feeling detached from one’s body or emotions and perceiving the world as foggy or distant
– Dissociative amnesia
6. Distress about Severe Memory Problems: Measures subjective distress related to pervasive memory difficulties affecting daily functioning
7. Loss of Autobiographical Memory: Assesses substantial gaps in personal history, including missing periods from childhood or feeling that important life events cannot be recalled
– Posttraumatic stress disorder
8. Flashbacks: Evaluates intrusive re-experiencing of traumatic memories with vivid sensory detail
– Functional Neurological Symptom Disorder (Conversion disorder):
9. Body Symptoms: Measures episodes of neurological symptoms without medical explanation, including temporary blindness, deafness, paralysis, or difficulty swallowing
10. Psychogenic Non-Epileptic Seizures: Assesses seizure-like episodes that are not epileptic in origin
– General subscales
11. Trance: Evaluates prolonged trance states characterised by staring, reduced awareness, and disconnection from present reality
12. Self-Confusion: Measures profound uncertainty about identity, including confusion about who one is and struggling to maintain a coherent sense of self
The MID-60 mean score represents the percentage of time the individual self-reports experiencing dissociative symptoms, providing an intuitive metric for both clinicians and clients. Subscale scores enable clinicians to form impressions about likely diagnoses. For example, elevated flashbacks and depersonalisation/derealisation subscales may indicate the dissociative subtype of PTSD, whilst elevated amnesia for recent events combined with identity-related subscales (i.e., Alter Personalities, Angry Intrusions, Persecutory Intrusions) suggests dissociative identity disorder.
The instrument is particularly valuable in identifying individuals who warrant comprehensive assessment using structured diagnostic interviews such as the Structured Clinical Interview for DSM-5 Dissociative Disorders (SCID-D) or the Dissociative Disorders Interview Schedule (DDIS). Given that dissociative symptoms are frequently misattributed to other conditions such as bipolar disorder or psychosis, the MID-60 can help clinicians recognise dissociative presentations that might otherwise be overlooked.
Clients who are completing the MID-60 at home may benefit from further instructions available here.
A total mean score (range 0 to 100) is calculated by averaging all 60 responses and multiplying by 10. The mean score represents the total level of dissociative experiences, also interpreted as the percentage of time the person self-reports having dissociative symptoms and experiences.
The MID-60 employs a 16-category diagnostic profile classification system based on a priori rules (Kate et al., 2026). Respondents are assigned to the first category for which criteria are met, evaluated hierarchically in descending order of clinical severity. The algorithm considers total MID-60 severity, specific subscale elevations at clinical cutoff, and symptom co-occurrence patterns.
Classifications are organised into four diagnostic families:
Complete classification criteria, including MID-60 thresholds and required subscale combinations for each profile, are provided in the Supporting Information section of the MID-60 Review (Kate & Hegarty, 2026).
Two percentiles are presented for the total mean score, indicating how the respondent scored in comparison to community and clinical populations. The community percentile provides a comparison against a sample of typical individuals (Kate et al., 2021). A percentile of 50 represents average (and healthy) levels of dissociative experiences. In contrast, a percentile of 90 indicates the respondent scored above 90 percent of typical individuals and is of clinical significance. The clinical percentile compares the respondent’s score against clients with a diagnosed dissociative disorder, comprising predominantly females with DID (Kate, Jamieson & Middleton, 2023). A clinical percentile of 50 represents pathological levels of dissociation that is typical among those with a complex dissociative disorder, particularly DID.
Interpretation for the MID-60 mean scores is as follows:
The MID-60 provides information on subscales relevant to different diagnoses. This enables the clinician to form an impression about the likely diagnosis. For example, a score of 27 is clinically significant, but does not indicate the most likely diagnosis. If the subscales of PTSD and depersonalisation/derealisation are both above the clinical threshold, this can indicate the person has the dissociative subtype of PTSD, whereas if the memory-related subscales are above the clinical threshold this can indicate dissociative amnesia. Another example is a person who has a total mean score of 45, which would seem to indicate dissociative identity disorder. Yet, if the subscale score for amnesia (for recent events) is not elevated, this points towards a more severe case of other specified dissociative disorder.
The subscales are:
The MID-60 is a screening instrument only. It is not designed to be the sole basis for diagnosis and should always be interpreted alongside clinical judgment. Clinicians are encouraged to follow up clinically significant elevations by asking targeted questions to clarify whether the nature and severity of the symptom truly match the item content. Where indicated, further evaluation can be undertaken using validated structured clinical interviews, such as the Structured Clinical Interview for DSM-5 Dissociative Disorders (SCID-D; Marlene Steinberg, MD), the Dissociative Disorders Interview Schedule (DDIS; Colin Ross, MD), or the Trauma and Dissociative Symptoms Interview (TADS-I; Suzette Boon).
On first administration of the MID-60, three visualisations are presented. The Total Score Bar Chart displays the client’s Total Mean Score as a vertical bar against colour-coded severity descriptor bands ranging from “None” through to “Extremely Severe”, providing an immediate visual indication of overall dissociative symptom severity. The Horizontal Distribution Chart positions the client’s score in comparison to two reference populations: a community (non-clinical) sample shown in green and a clinical sample of individuals with complex dissociative disorders shown in blue. Interquartile ranges (25th–75th percentiles) and median markers are displayed for both populations, enabling clinicians to determine whether the client’s score is more consistent with typical dissociative experiences or with pathological dissociation. Severity descriptor bands appear along the bottom axis for additional interpretive context. The Subscale Bar Chart presents all 12 subscale mean scores as horizontal bars, with shaded regions indicating scores within the clinical range for each subscale. This allows clinicians to identify specific symptom domains that are elevated and may warrant focused assessment or intervention.
When multiple administrations are available, the Total Score Bar Chart and Horizontal Distribution Chart are replaced by a Multi-Administration Line Plot. This chart displays the Total Mean Score across all administrations as a line graph plotted against time, with severity descriptor bands shown in the background. The vertical axis automatically adjusts based on the range of scores to optimise readability. This visualisation enables clinicians to monitor treatment progress, track symptom trajectories, and identify patterns of improvement or deterioration over time. The Subscale Bar Chart continues to be displayed for the most recent administration, allowing comparison of current subscale elevations alongside longitudinal total score trends.
The MID-60 is a short version of the 218-item Multidimensional Inventory of Dissociation, a diagnostic instrument (Dell, 2006). The MID-60 was derived from the five items with the highest pattern matrix loading for each of the MID’s 12 factors (Dell & Lawson, 2009). The MID-60 has a nearly identical factor structure to the full MID, excellent internal reliability (α = .97-.98) and content and convergent validity (Kate et al., 2021a, 2021b, 2023, 2026).
The Community sample is derived from an Australian university sample (n = 313; M =13.0, SD = 13.8; Kate et al., 2021a) and a United Kingdom general population sample (n = 701; M = 12.9, SD = 13.1; McRoberts, 2025). This combined community sample has a mean of 12.94 and a standard deviation of 13.32 (n = 1,014). Dissociation is highest among younger adults, particularly those aged 18-20, and declines steadily with age. The lowest median scores were observed among clients aged 75-84 (Kate et al., 2026).
NovoPsych clinical data finds no statistically significant differences in dissociation between females (n = 8,401, M = 25.50, SD = 18.60) and males (n = 2,834, M = 24.60, SD = 17.90) but clients coded as non-binary/other by their clinician had notably higher scores (n = 339, M = 37.20, SD = 19.20), which is in part, attributed to their younger age (Kate et al., 2026). Females with a dissociative disorder diagnosis (N = 30) had a mean MID-60 score of 56.8 (SD = 18.8; Kate, Jamieson & Middleton, 2023). This is consistent with the mean for the 218-item MID, i.e., DID (N = 76, M = 51.3, SD = 18.7) and OSDD-1 (N = 40, M = 39, SD 19.4; Dell et al., 2017).
Developer
American Psychiatric Association. (2022). Diagnostic and Statistical Manual of Mental Disorders (Fifth Edition, Text Revision (DSM-5-TR). American Psychiatric Association Publishing.
Dell, P. F. (2006). The Multidimensional Inventory of Dissociation (MID): A Comprehensive measure of pathological dissociation. Journal of Trauma & Dissociation, 7(2), 77-106. https://doi.org/10.1300/j229v07n02_06
Dell, P. F., Coy, D. M., & Madere, J. (2017). An Interpretive Manual for the Multidimensional Inventory of Dissociation (MID). In (2nd ed.). http://www.mid-assessment.com
Kate, M.-A. & Hegarty, D. L. (2026). A Review of the Clinical Utility and Psychometric Properties of the Multidimensional Inventory of Dissociation – 60-item Version (MID-60): Norms, Percentile Rankings, and Qualitative Descriptors. https://doi.org/10.17605/OSF.IO/E83KC
Kate, M.-A., Hopwood, T., & Jamieson, G. (2020b). The prevalence of Dissociative Disorders and dissociative experiences in college populations: a meta-analysis of 98 studies. Journal of Trauma & Dissociation, 21(1), 16-61. https://doi.org/10.1080/15299732.2019.1647915
Kate, M.-A., Jamieson, G., Dorahy, M. J., & Middleton, W. (2021a). Measuring Dissociative Symptoms and Experiences in an Australian College Sample Using a Short Version of the Multidimensional Inventory of Dissociation. Journal of Trauma & Dissociation, 22(3), 265-287. https://doi.org/10.1080/15299732.2020.1792024
Kate, M.-A., Jamieson, G., & Middleton, W. (2021b). Childhood Sexual, Emotional, and Physical Abuse as Predictors of Dissociation in Adulthood. Journal of Child Sexual Abuse, 1-24. https://doi.org/10.1080/10538712.2021.1955789
Kate, M.-A., Jamieson, G., & Middleton, W. (2023). Parent-child dynamics as predictors of dissociation in adulthood. European Journal of Trauma & Dissociation, 7(1), Article 100312. https://doi.org/10.1016/j.ejtd.2023.100312
Kate, M.-A., Swinfield, H., Hegarty, D. L., Buchanan, B., & Dorahy, M. J. (2026 – manuscript under review). Validation of the Multidimensional Inventory of Dissociation–60 items (MID-60) in a clinical population.
Korzekwa, M. I., Dell, P. F., Links, P. S., Thabane, L., & Fougere, P. (2009). Dissociation in Borderline Personality Disorder: A Detailed Look. Journal of Trauma & Dissociation, 10(3), 346-367. https://doi.org/10.1080/15299730902956838
Laddis, A., & Dell, P. F. (2012). Dissociation and Psychosis in Dissociative Identity Disorder and Schizophrenia. Journal of Trauma & Dissociation, 13(4), 397-413. https://doi.org/10.1080/15299732.2012.664967
Moskowitz, A., Longden, E., Varese, F., Mosquera, D., & Read, J. (2023). The nature of psychotic symptoms: Traumatic in origin and dissociative in kind? In M. J. Dorahy, S. N. Gold, & J. A. O’Neil (Eds.), Dissociation and the dissociative disorders: Past, present, future (2nd ed., pp. 513–527). Routledge.
McRoberts, K. J. (2025). Examining Whether There is a Relationship Between Embodied Sense of Self and Dissociative Experiences [Unpublished Masters thesis]. University of Canterbury.
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The MID-60 intentionally does not specify a timeframe so that infrequent but clinically important symptoms are captured. Clients may anchor their responses to their current functioning, a longer-standing baseline, or another meaningful reference period. Some clients who have experienced substantial symptom change, and who are completing the MID-60 for the first time, choose to complete it twice: once based on a period when symptoms were worse and once based on their current state. This can help contextualise improvement and avoid under-representing historically significant symptoms.
Yes. Clients with dissociative parts may choose to complete the MID-60 from a particular part or self-state. This should always be at the client’s discretion. When done intentionally, it can provide clinically useful information, provided the context of completion is documented and considered in interpretation.
Ratings reflect the estimated percentage of time a symptom is experienced. Clients may interpret this as the proportion of total time in a day, or as the proportion of time the symptom could realistically occur, which can lead to higher overall scores. Clinicians are encouraged to clarify how the client understood the scale and to factor this into interpretation.
If a symptom has occurred at all in the recent past, even infrequently, it is usually more accurate to select a low rating rather than “never.” “Never” should be reserved for symptoms that are genuinely absent.
Higher scores may reflect increased insight, improved access to and understanding of dissociative experiences, or greater willingness to disclose. Symptom exacerbation is also common when treatment moves from safety and stabilisation into trauma processing, consistent with treatment guidelines for complex dissociation. In work with dissociative disorders, a common clinical principle applies: the slower you go, the faster you get there.
The MID-60 is a brief screening instrument derived from the full 218-item Multidimensional Inventory of Dissociation. It retains the original MID’s 12-factor structure and conceptual breadth while substantially reducing assessment burden. The full MID provides more detailed symptom coverage, includes validity scales, and generates diagnostic impressions. Which measure is most appropriate depends on the client and clinical context. Many clients struggle with very long questionnaires. The MID-60 is commonly recommended by EMDR trainers as part of pre-treatment assessment, as standard EMDR protocols often require modification when clinically significant dissociation is present. The MID-60 may also be more expedient when dissociation is not initially suspected.
The MID-60 and DES-II both assess dissociation, but they differ in scope and sensitivity. The MID-60 replicates the 218-tem MID’s 12-factor structure, each with clinically meaningful cut-offs. This gives the MID-60 an important advantage over the DES-II, which was primarily designed to detect dissociative identity disorder and does this very well. However, the commonly recommended DES-II cut-off of 30 misses the majority of cases of dissociative amnesia, depersonalization/derealization disorder, and milder forms of other specified dissociative disorder (OSDD). As a result, the MID-60 is better suited to identifying a broader range of clinically significant dissociative presentations.
No. The MID-60 is a screening instrument only and should not be used as the sole basis for diagnosis. Clinicians are encouraged to follow up clinically significant elevations with targeted questioning to clarify whether the nature and severity of the symptoms match the item content. Where indicated, further assessment can be undertaken using structured interviews such as the Structured Clinical Interview for DSM-5 Dissociative Disorders (SCID-D; Marlene Steinberg, MD), the Dissociative Disorders Interview Schedule (DDIS; Colin Ross, MD), or the Trauma and Dissociative Symptoms Interview (TADS-I; Suzette Boon), or by administering the full 218-item MID. It is important to note that the MID does not generate diagnostic impressions for depersonalization/derealization disorder or dissociative amnesia.
High scores are not uncommon in clients with dissociative identity disorder, and scores of 65 or above can be entirely consistent with genuine, severe dissociation. However, very high scores, particularly those over 80, can also arise for several other clinically relevant reasons and should always be interpreted in context.
Some clients, particularly autistic individuals, may find the “percentage of time” format difficult to interpret, which can lead to over (or under) endorsement of items. Some clients may endorse items reflecting more normative experiences, such as ego states or role-based shifts, as dissociative self-states, or may confuse everyday forgetfulness or attentional lapses with dissociative amnesia. Symptoms associated with other conditions, such as inattention in ADHD or camouflaging in autism, can also overlap phenomenologically with dissociative items and inflate scores.
In some cases, elevated endorsement may reflect heightened distress, a wish to communicate the seriousness of one’s difficulties, or a need to be taken seriously by services, rather than deliberate deception. Since the COVID-19 pandemic, some individuals have also sought diagnostic labels for reasons related to identity, validation, or belonging, which can influence how symptoms are reported.
For these reasons, high MID-60 scores should never be interpreted in isolation. Clinicians are encouraged to follow up elevations with careful clinical inquiry to clarify the nature, context, and functional impact of endorsed symptoms, and to differentiate dissociation from overlapping or mimicking phenomena.
