Difficulties in Emotion Regulation Scale (DERS)

Abstract

The Difficulties in Emotion Regulation Scale (DERS), developed by Kim L. Gratz and Lizabeth Roemer in 2004, is one of the most widely utilized and rigorously validated self-report instruments designed to assess comprehensive, multidimensional difficulties in emotion regulation. Comprising 36 self-report items scored on a 5-point Likert-type frequency scale ranging from 1 (“Almost never [0–10%]”) to 5 (“Almost always [91–100%]”), the DERS assesses clinically relevant patterns of affective dysregulation across six distinct, theoretically grounded dimensions: (1) Nonacceptance of emotional responses (Nonacceptance), (2) Difficulty engaging in goal-directed behavior (Goals), (3) Impulse control difficulties (Impulse), (4) Lack of emotional awareness (Awareness), (5) Limited access to emotion regulation strategies (Strategies), and (6) Lack of emotional clarity (Clarity). Psychometric evaluations consistently demonstrate that the DERS possesses exceptional internal consistency (full-scale Cronbach’s α ≥ .93; subscale α values typically ranging from .80 to .91), robust test-retest reliability across clinical and non-clinical intervals, and strong convergent validity with measures of experiential avoidance, generalized anxiety, depressive symptom severity, and borderline personality pathology. Furthermore, the instrument demonstrates discriminant validity against general distress and negative affectivity, confirming that it measures operational emotion regulation capabilities rather than affective intensity alone. By distinguishing between different mechanisms of emotional dysfunction, the DERS provides clinicians and researchers with an essential psychometric tool for identifying transdiagnostic vulnerability factors, monitoring therapeutic outcomes in cognitive-behavioral and acceptance-based frameworks, and personalizing psychiatric interventions.

Keywords

Difficulties in Emotion Regulation Scale, DERS, emotion dysregulation, emotional awareness, distress tolerance, psychological assessment, psychometrics, transdiagnostic mechanisms, experiential avoidance, borderline personality disorder

Authors

The Difficulties in Emotion Regulation Scale was formulated and validated by:

• Kim L. Gratz, Ph.D. — Professor and Chair of the Department of Psychology at the University of Toledo (formerly at the University of Mississippi Medical Center). Dr. Gratz is an internationally recognized expert in borderline personality disorder, non-suicidal self-injury, emotion regulation, and deliberate self-harm, with extensive contributions to clinical trials evaluating acceptance-based behavioral therapies.
• Lizabeth Roemer, Ph.D. — Professor of Psychology at the University of Massachusetts Boston. Dr. Roemer is a leading clinical scientist recognized for her pioneering work on the integration of mindfulness, experiential acceptance, and behavioral activation in the conceptualization and treatment of generalized anxiety disorder and trauma-related spectrum disorders.

The landmark validation paper was published in the Journal of Psychopathology and Behavioral Assessment under the title “Multidimensional Assessment of Emotion Regulation and Dysregulation: Development, Factor Structure, and Initial Validation of the Difficulties in Emotion Regulation Scale” (Gratz & Roemer, 2004).

Purpose

The primary purpose of the Difficulties in Emotion Regulation Scale is to provide a comprehensive, multifaceted operationalization of emotion regulation difficulties in clinical and research settings. Historically, emotion regulation research frequently conflated emotional regulation with the mere down-regulation or control of negative affect. In contrast, Gratz and Roemer (2004) developed the DERS to operationalize a functionalist, integrative conceptualization of emotional competence. Under this framework, adaptive emotion regulation involves not the avoidance or suppression of uncomfortable emotional states, but rather the ability to:

• Maintain conscious awareness, appraisal, and understanding of emotional experiences;
• Accept negative emotions without severe self-critical secondary evaluation or nonacceptance;
• Inhibit impulsive, maladaptive behaviors when experiencing heightened distress;
• Direct and sustain goal-oriented behaviors irrespective of distressing affective states; and
• Access and implement contextually appropriate strategies to modulate the intensity and duration of emotional arousal rather than eliminating affective experiences altogether.

Clinically, the DERS serves as a diagnostic screening instrument, treatment planning framework, and longitudinal outcome measure. Its multidimensional architecture allows clinicians to detect whether an individual’s primary deficit lies in cognitive appraisals (e.g., poor clarity or nonacceptance), attentional dysregulation (e.g., lack of awareness), executive deficits during emotional arousal (e.g., goal disruption and impulse control difficulties), or perceived hopelessness regarding coping flexibility (limited strategy access). This granular profiling is instrumental in guiding targeted psychiatric interventions, such as Dialectical Behavior Therapy (DBT), Acceptance and Commitment Therapy (ACT), and the Unified Protocol for Transdiagnostic Treatment of Emotional Disorders.

In empirical research, the DERS is one of the most prominent measures used to evaluate transdiagnostic vulnerability. Dysregulation identified by the DERS serves as a core maintenance factor across an expansive continuum of psychiatric disorders, including Borderline Personality Disorder (BPD), Post-Traumatic Stress Disorder (PTSD), Major Depressive Disorder, Generalized Anxiety Disorder, Anorexia and Bulimia Nervosa, Substance Use Disorders, and non-suicidal self-injury (NSSI).

Psychological Construct

The construct measured by the DERS is multidimensional emotion dysregulation. Rather than viewing emotion dysregulation as a single global deficit, Gratz and Roemer delineated six primary, inter-correlated dimensions. Each subscale addresses a specific component of emotional processing and response modulation under conditions of emotional distress:

1. Nonacceptance of Emotional Responses (Nonacceptance; 6 items)

This subscale evaluates the tendency to experience negative secondary reactions to one’s own emotional distress or a fundamental inability to accept emotional vulnerability. Individuals scoring high on this dimension exhibit secondary distress, self-directed hostility, shame, and guilt triggered by their initial emotional reactions. Examples include believing that one is weak for feeling upset (Item 23) or becoming angry and embarrassed with oneself for exhibiting emotional sensitivity (Items 11 and 12). In psychological models of experiential avoidance, nonacceptance magnifies primary emotional distress by compounding it with self-punitive cognitions.

2. Difficulty Engaging in Goal-Directed Behavior (Goals; 5 items)

The Goals subscale measures deficits in executive functioning and behavioral persistence during periods of heightened affective arousal. Individuals with elevated scores experience severe cognitive interference, task disruption, and an inability to concentrate or complete routine activities when distressed (Items 13, 18, 26, and 33). This dimension captures how negative affect disrupts attentional networks and task persistence, differentiating individuals who can function productively despite feeling upset from those whose goal pursuit collapses under affective load.

3. Impulse Control Difficulties (Impulse; 6 items)

This dimension assesses the self-perceived inability to control behavioral responses, urges, and expressions when experiencing intense negative emotions. High scores reflect feelings of being completely overwhelmed, behavioral dyscontrol, and acting out impulsively (Items 3, 14, 19, 27, and 32). Clinically, this subscale is strongly linked with externalizing behaviors, non-suicidal self-injury, substance misuse, and reactive aggression, representing an affective modulation failure wherein emotions rapidly translate into behavioral instability.

4. Lack of Emotional Awareness (Awareness; 6 items)

The Awareness subscale assesses the degree to which an individual pays attention to, acknowledges, and values their emotional experiences. Uniquely, all six items of this subscale (Items 2, 6, 8, 10, 17, and 34) are positively worded and reverse-scored. Elevated scores indicate that an individual tends to overlook, ignore, or invalidate emotional cues, exhibiting emotional avoidance or lack of somatic/affective attunement. This subscale reflects the attentional baseline necessary for initiating conscious regulation.

5. Limited Access to Emotion Regulation Strategies (Strategies; 8 items)

This subscale evaluates the belief that one has virtually no effective cognitive or behavioral tools to alleviate or modulate negative affect once activated. Elevated scores reflect a sense of affective helplessness, fatalism, and prolonged emotional recovery periods (Items 15, 16, 28, 30, 31, 35, and 36). Individuals scoring high on Strategies perceive negative moods as intractable states from which they cannot independently recover, which frequently drives desperate, maladaptive coping behaviors to forcibly terminate affective distress.

6. Lack of Emotional Clarity (Clarity; 5 items)

The Clarity subscale gauges the extent to which an individual understands, identifies, and differentiates their specific emotional states. High scores denote difficulty in emotional differentiation or high levels of alexithymia, where individuals know they are upset but cannot pinpoint whether they are experiencing anger, sadness, fear, or frustration (Items 4, 5, and 9; Items 1 and 7 are reverse-scored). Without emotional clarity, selecting context-appropriate regulation strategies is significantly impaired.

Theoretical Framework

The Difficulties in Emotion Regulation Scale is anchored within functionalist theories of emotion (functionalist emotion theory; e.g., Campos et al., 1994; Frijda, 1986) and contemporary third-wave cognitive-behavioral traditions, particularly Marsha Linehan’s Biosocial Theory of Borderline Personality Disorder and Acceptance and Commitment Therapy (Hayes et al., 1999).

The Functionalist Foundation

Traditional psychiatric conceptualizations frequently framed negative affect as inherently maladaptive phenomena requiring suppression, distraction, or elimination. Conversely, functionalist emotion perspectives assert that emotions are evolutionarily adaptive action tendencies designed to convey rapid environmental information, guide decision-making, and facilitate social communication. Under Gratz and Roemer’s model, distress is not pathogenic in isolation. Emotion dysregulation arises instead when individuals disrupt the functional signal of an emotion through invalidation, experiential avoidance, or behavioral inflexibility.

Integration of Acceptance and Behavioral Flexibility

Gratz and Roemer synthesized Linehan’s biosocial framework—which posits that emotional dysregulation results from transactions between biological affective vulnerability and invalidating developmental environments—with acceptance-based theories. Under this theoretical integration, emotional health is operationalized as emotional acceptance paired with behavioral control. Consequently, the DERS reflects four central theoretical assumptions:

1. Awareness and Clarity as Preconditions: Individuals cannot flexibly regulate an internal state that they actively ignore or cannot decipher.
2. Acceptance as an Alternative to Secondary Amplification: Nonacceptance and shame regarding emotional arousal serve as maladaptive secondary appraisals that exacerbate affective distress and disrupt problem-solving.
3. Separation of Emotion from Behavior: A regulated individual maintains the executive capacity to withhold behavioral impulsivity and pursue chosen valued goals, even in the presence of intense negative internal experiences.
4. Strategy Efficacy over Strategy Absence: Emotion regulation does not depend on suppressing all emotional displays, but rather on holding confident expectations that one can modulate affective experiences adaptively across time.

Validity

The psychometric validity of the DERS has been extensively investigated across diverse non-clinical, university, community, and severe psychiatric samples worldwide.

Construct and Convergent Validity

Gratz and Roemer (2004) established robust convergent validity by demonstrating significant positive correlations between the DERS total score and validated measures of emotional vulnerability, including the Negative Mood Regulation Scale (NMR; r = −.69, confirming that higher DERS scores reflect lower expected self-efficacy in mood repair) and the Acceptance and Action Questionnaire (AAQ; r = .70, demonstrating high convergence with generalized experiential avoidance). Furthermore, the DERS correlates positively with trait anxiety on the State-Trait Anxiety Inventory (STAI; r ≈ .50 to .65) and depressive symptomatology on the Beck Depression Inventory (BDI; r ≈ .55 to .70).

Subscale-specific convergent validity has been similarly documented. For example, the Clarity and Awareness subscales exhibit strong inverse associations with emotional intelligence measures (e.g., the Mayer-Salovey-Caruso Emotional Intelligence Test) and strong positive associations with the Toronto Alexithymia Scale (TAS-20). The Impulse subscale correlates heavily with behavioral impulsivity domains on the UPPS-P Impulsive Behavior Scale, particularly negative urgency (r > .60).

Predictive and Criterion-Related Validity

The DERS demonstrates exceptional criterion validity in differentiating clinical from non-clinical cohorts and predicting high-risk psychological behaviors:

• Borderline Personality Disorder: DERS full-scale scores accurately discriminate patients with BPD from both healthy controls and patients with other personality disorders. In particular, the Strategies, Nonacceptance, and Impulse subscales reliably predict BPD diagnostic symptom criteria beyond general negative affectivity.
• Self-Harm and Non-Suicidal Self-Injury (NSSI): Prospective and cross-sectional studies reveal that elevated DERS scores (specifically Impulse, Strategies, and Nonacceptance) significantly predict frequency of NSSI episodes, accounting for incremental variance after controlling for depressive symptom severity and past trauma.
• Eating Pathology and Substance Abuse: Subscales such as Goals and Impulse have been shown to predict binge-purge behaviors and relapse rates among substance-dependent individuals facing laboratory-induced emotional stressors.

Discriminant Validity

The DERS demonstrates strong discriminant validity against constructs such as cognitive intelligence, social desirability response biases (using the Marlowe-Crowne Social Desirability Scale; r values typically < −.20), and raw negative emotional intensity. While positive affectivity and negative affectivity (e.g., PANAS) share modest variance with DERS scores, hierarchical regression modeling reveals that the DERS predicts behavioral dysfunction, self-harm, and anxiety disorders above and beyond trait emotional reactivity.

Reliability

The DERS exhibits outstanding internal consistency, test-retest stability, and cross-cultural measurement reliability.

Internal Consistency

In the initial psychometric validation study by Gratz and Roemer (2004) involving 357 undergraduate participants, the full scale displayed high internal consistency (α = .93). Subscale internal consistencies were similarly robust:

• Nonacceptance: α = .85
• Goals: α = .89
• Impulse: α = .86
• Awareness: α = .80
• Strategies: α = .88
• Clarity: α = .84

Subsequent investigations across clinical populations (e.g., Fowler et al., 2014; Hallion et al., 2018) have confirmed Cronbach’s alpha (α) and McDonald’s omega (ω) values for the total score ranging from .93 to .97, with individual subscales routinely maintaining reliability coefficients between .80 and .92 across both adult and adolescent clinical cohorts.

Test-Retest Stability

Gratz and Roemer (2004) assessed test-retest reliability across a subset of participants (n = 21) over a period ranging from 4 to 8 weeks. The test-retest reliability coefficient for the full score was r = .88 (p < .01). Individual subscales yielded stable correlations over this interval:

• Nonacceptance: r = .69
• Goals: r = .69
• Impulse: r = .57
• Awareness: r = .68
• Strategies: r = .89
• Clarity: r = .80

These findings substantiate that although the DERS assesses situational difficulties in emotion regulation, it reliably captures an enduring, trait-like psychological vulnerability structure while remaining sensitive to clinical change following interventions.

Factor Analysis

The factor structure of the DERS was originally derived via exploratory factor analysis (EFA) and has subsequently been examined using confirmatory factor analysis (CFA) and exploratory structural equation modeling (ESEM) across numerous samples.

Original Exploratory Factor Analysis

Gratz and Roemer (2004) subjected an initial pool of 41 items to principal components analysis followed by an oblique (Promax) rotation. Analysis of the scree plot and eigenvalues revealed a clean six-factor solution accounting for 55.68% of the total variance. Five items demonstrating cross-loadings greater than .35 or item-to-factor loadings beneath .40 were systematically eliminated, yielding the final, psychometrically refined 36-item instrument. The factor structure aligned with the hypothesized theoretical dimensions: Strategies (Factor 1, accounting for 19.34% of variance), Nonacceptance (Factor 2, 7.82%), Impulse (Factor 3, 6.78%), Goals (Factor 4, 5.72%), Awareness (Factor 5, 4.41%), and Clarity (Factor 6, 3.86%). Subscale correlations ranged from .11 to .62, supporting the use of oblique rotations reflecting correlated latent factors.

Confirmatory Factor Analysis and Model Fit

Subsequent confirmatory factor analyses (e.g., Bardeen et al., 2012; Fowler et al., 2014) have generally confirmed that the correlated six-factor model yields superior fit relative to single-factor or orthogonal models. Standard fit indices in clinical cohorts typically demonstrate acceptable to good structural fit (e.g., χ²/df < 3.0, Comparative Fit Index [CFI] ≥ .90–.94, Tucker-Lewis Index [TLI] ≥ .90–.93, and Root Mean Square Error of Approximation [RMSEA] ≈ .05–.07).

The Awareness Subscale Debate and Bifactor Modeling

A notable topic in psychometric literature concerns the Awareness subscale (Bardeen et al., 2012; Hallion et al., 2018). In multiple CFA studies, the Awareness subscale demonstrates lower loadings onto a general second-order “Emotion Dysregulation” superordinate factor compared to the other five subscales (frequently displaying loadings < .30), and occasionally demonstrates weak or non-significant correlations with Nonacceptance and Strategies. Psychometricians note two primary reasons for this phenomenon:

1. Method Effect: All items on the Awareness subscale are reverse-worded, introducing potential method-specific variance.
2. Conceptual Independence: Attending to emotions is an informational prerequisite for regulation, but high emotional awareness can coexist with high or low regulation capacity. For instance, individuals with severe anxiety can be acutely aware of physiological arousal without being able to modulate it.

Consequently, many contemporary researchers utilize bifactor CFA models, which model a global emotion dysregulation factor alongside specific group factors, or examine the subscales as an interrelated profile rather than solely relying on the composite total score.

Instrument / Measurement Tool

• Test Type: Multidimensional self-report rating scale
• Target Population: Adults and adolescents (≥ 11 years of age; validated across clinical and community populations)
• Administration Format: Paper-and-pencil questionnaire, computerized survey, or clinical assessment portal
• Item Count: 36 items
• Administration Time: Approximately 5 to 10 minutes
• Response Format: 5-point Likert scale:
  • 1 = Almost never (0–10%)
  • 2 = Sometimes (11–35%)
  • 3 = About half the time (36–65%)
  • 4 = Most of the time (66–90%)
  • 5 = Almost always (91–100%)
• Scoring and Reverse Coding:
  • Eleven (11) items are reverse-scored before computing totals: Items 1, 2, 6, 7, 8, 10, 17, 20, 22, 24, and 34 (Recoded such that: 1 → 5, 2 → 4, 3 → 3, 4 → 2, 5 → 1).
  • Total DERS Score: Sum of all 36 items (ranging from 36 to 180). Higher scores consistently indicate greater severity of emotion regulation difficulties.
• Subscale Breakdown:
  • Nonacceptance of emotional responses (Nonacceptance): Items 11, 12, 21, 23, 25, 29 (6 items; Range: 6–30)
  • Difficulty engaging in goal-directed behavior (Goals): Items 13, 18, 20R, 26, 33 (5 items; Range: 5–25)
  • Impulse control difficulties (Impulse): Items 3, 14, 19, 24R, 27, 32 (6 items; Range: 6–30)
  • Lack of emotional awareness (Awareness): Items 2R, 6R, 8R, 10R, 17R, 34R (6 items; Range: 6–30; all reverse-scored)
  • Limited access to emotion regulation strategies (Strategies): Items 15, 16, 22R, 28, 30, 31, 35, 36 (8 items; Range: 8–40)
  • Lack of emotional clarity (Clarity): Items 1R, 4, 5, 7R, 9 (5 items; Range: 5–25)

Permissions & Fee and Test Year

The Difficulties in Emotion Regulation Scale was formally published in 2004 by Kim L. Gratz and Lizabeth Roemer. The copyright for the empirical article is held by Springer Science+Business Media within the Journal of Psychopathology and Behavioral Assessment. However, consistent with academic open-science traditions in psychological assessment, the scale items and scoring guidelines were published directly within the seminal 2004 journal article for non-commercial research and clinical applications.

Researchers and clinical practitioners may administer the original 36-item DERS without payment of licensing or royalty fees, provided that appropriate bibliographic attribution is granted to the original authors (Gratz & Roemer, 2004). Commercial use, digital electronic integration into fee-for-service healthcare platforms, or publishing translations may require formal permissions from the authors and the original publisher.

References

• Bardeen, J. R., Fergus, T. A., & Orcutt, H. K. (2012). An examination of the latent structure of the Difficulties in Emotion Regulation Scale. Journal of Psychopathology and Behavioral Assessment, 34(3), 382–392. https://doi.org/10.1007/s10862-012-9288-6
• Campos, J. J., Mumme, D. L., Kermoian, R., & Campos, R. G. (1994). A functionalist perspective on the nature of emotion. Monographs of the Society for Research in Child Development, 59(2–3), 284–303. https://doi.org/10.1111/j.1540-5834.1994.tb01289.x
• Fowler, J. C., Charak, R., Elhai, J. D., Allen, J. G., Frueh, B. C., & Oldham, J. M. (2014). Construct validity and factor structure of the Difficulties in Emotion Regulation Scale among adults with severe mental illness. Journal of Psychiatric Research, 58, 175–180. https://doi.org/10.1016/j.jpsychires.2014.07.029
• Frijda, N. H. (1986). The emotions. Cambridge University Press.
• Gratz, K. L., & Roemer, L. (2004). Multidimensional assessment of emotion regulation and dysregulation: Development, factor structure, and initial validation of the Difficulties in Emotion Regulation Scale. Journal of Psychopathology and Behavioral Assessment, 26(1), 41–54. https://doi.org/10.1023/B:JOBA.0000007455.08539.94
• Hallion, L. S., Steinman, S. A., Tolin, D. F., & Diefenbach, G. J. (2018). Psychometric properties of the Difficulties in Emotion Regulation Scale (DERS) and its short forms in adults with emotional disorders. Frontiers in Psychology, 9, Article 539. https://doi.org/10.3389/fpsyg.2018.00539
• Hayes, S. C., Strosahl, K. D., & Wilson, K. G. (1999). Acceptance and commitment therapy: An experiential approach to behavior change. Guilford Press.
• Linehan, M. M. (1993). Cognitive-behavioral treatment of borderline personality disorder. Guilford Press.

13. Items of the Scale (Questionnaire)