Abstract
The Difficulties in Emotion Regulation Scale – Short Form (DERS-16) is a brief, psychometrically robust, self-report instrument developed to assess clinically meaningful dimensions of emotion dysregulation. Originating from the seminal 36-item Difficulties in Emotion Regulation Scale (DERS; Gratz & Roemer, 2004), the DERS-16 was created by Johan Bjureberg and colleagues in 2016 to meet the growing demand for an efficient, low-burden assessment tool suitable for intensive longitudinal designs, ecological momentary assessment (EMA), clinical trials, and high-throughput diagnostic screenings. The instrument comprises 16 items evaluated on a 5-point Likert response format ranging from 1 (Almost never [0–10%]) to 5 (Almost always [91–100%]).
Retaining the multidimensional theoretical framework of its parent scale, the DERS-16 captures five distinct dimensions of emotion regulation difficulty: Clarity (uncertainty and confusion regarding emotional states), Goals (difficulty concentrating and accomplishing goal-directed tasks when experiencing negative affect), Impulse (difficulties maintaining behavioral control when experiencing distressing emotions), Strategies (perceived limited access to effective strategies for feeling better once distressed), and Non-Acceptance (the tendency to experience secondary negative reactions or non-acceptance of one's own emotional distress). Notably, the original "Awareness" subscale was deliberately excluded based on persistent empirical and psychometric findings indicating poor factor loadings, problematic construct overlap, and weak correlations with transdiagnostic psychopathology.
Psychometric evaluations of the DERS-16 demonstrate exceptional internal consistency across clinical and community populations, with overall scale Cronbach's alpha coefficients typically exceeding .92, and subscale coefficients ranging from .79 to .91. Confirmatory factor analysis (CFA) reliably confirms a correlated five-factor structure with exemplary model fit indices (e.g., CFI > .95, RMSEA < .06). The scale shows near-perfect correlation with the full 36-item DERS (r > .90) and robust convergent validity with measures of depression, generalized anxiety, borderline personality pathology, and impulsivity, confirming its clinical utility and psychometric equivalence to the original inventory.
Keywords
Difficulties in Emotion Regulation Scale, DERS-16, emotion dysregulation, psychometrics, affective science, emotional clarity, impulse control, goal-directed behavior, non-acceptance of emotions, brief assessment, transdiagnostic mechanism, confirmatory factor analysis
Authors
The Difficulties in Emotion Regulation Scale – Short Form (DERS-16) was developed through an international collaboration of clinical psychologists and psychometric researchers specializing in affective science, borderline personality disorder, and cognitive-behavioral interventions:
- Johan Bjureberg, Ph.D. — Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden; and Department of Psychiatry, Harvard Medical School / McLean Hospital, Belmont, MA, USA.
- Brjánn Ljótsson, Ph.D. — Division of Psychology, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden.
- Matthew T. Tull, Ph.D. — Department of Psychology, University of Toledo, Toledo, OH, USA.
- Erik Hedman, Ph.D. — Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden; and Department of Psychology, Stockholm University, Stockholm, Sweden.
- Hanna Sahlin, Ph.D. — Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden.
- Lars-Gunnar Lundh, Ph.D. — Department of Psychology, Lund University, Lund, Sweden.
- Jonas Bjärehed, Ph.D. — Department of Psychology, Lund University, Lund, Sweden.
- David DiLillo, Ph.D. — Department of Psychology, University of Nebraska-Lincoln, Lincoln, NE, USA.
- Terri Messman-Moore, Ph.D. — Department of Psychology, Miami University, Oxford, OH, USA.
- Clara Hellner Gumpert, M.D., Ph.D. — Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden.
- Kim L. Gratz, Ph.D. — Department of Psychology, University of Toledo, Toledo, OH, USA (Senior author and original developer of the 36-item DERS).
Purpose
The primary purpose of the DERS-16 is to provide a rapid, psychometrically sound, and clinically comprehensive assessment of multidimensional emotion regulation difficulties. In contemporary affective science and clinical psychology, emotion dysregulation is recognized as a fundamental transdiagnostic vulnerability underlying numerous psychiatric conditions, including borderline personality disorder (BPD), major depressive disorder, generalized anxiety disorder, post-traumatic stress disorder (PTSD), substance use disorders, and eating disorders.
Although the original 36-item DERS (Gratz & Roemer, 2004) established the benchmark for evaluating these self-regulatory processes, its length presents substantial challenges in intensive research designs and fast-paced clinical environments. Completing a 36-item battery can induce survey fatigue, elevate participant attrition in longitudinal studies, and impose an unsustainable administrative burden in routine outcome monitoring, daily diary protocols, and ecological momentary assessment (EMA) frameworks where participants report affective states multiple times per day.
To overcome these limitations, Bjureberg et al. (2016) developed the DERS-16 by employing rigorous statistical item-selection criteria across diverse clinical and community samples. The specific aims of the DERS-16 are:
- Minimizing Respondent Burden: Reducing completion time to under two minutes while maintaining the conceptual breadth and diagnostic precision of the original scale.
- Facilitating Session-by-Session Monitoring: Enabling psychotherapy practitioners (such as those administering Dialectical Behavior Therapy [DBT], Cognitive Behavioral Therapy [CBT], or Acceptance and Commitment Therapy [ACT]) to track weekly or bi-weekly fluctuations in specific emotion regulation deficits.
- Refining Psychometric Purity: Eliminating the statistically and conceptually problematic "Awareness" items of the original instrument, which frequently loaded poorly or created artificial multidimensionality uncorrelated with psychological distress.
- Supporting High-Throughput Research: Serving as a lean measurement module for large-scale epidemiological surveys, neuroimaging paradigms with pre- and post-scan assessments, and digital health applications.
Psychological Construct
The DERS-16 operationalizes emotion regulation not merely as the reduction or suppression of negative emotional arousal, but as an integrated, dynamic system comprising emotional understanding, behavioral flexibility, goal maintenance, and emotional acceptance. The instrument evaluates deficits across five core dimensions:
1. Emotional Clarity (Clarity)
The Clarity dimension assesses the extent to which an individual understands the nature of the emotions they are experiencing. Individuals with deficits in emotional clarity report profound uncertainty, confusion, and difficulty differentiating between distinct affective states (e.g., conflating anger, sadness, fear, or physical sensations of distress). In clinical practice, low clarity is closely tied to alexithymia, rendering individuals unable to label their internal states accurately, which is a prerequisite for selecting targeted coping mechanisms.
Example: An individual experiences intense visceral agitation but cannot determine whether they are angry, anxious, or disappointed ("I have difficulty making sense out of my feelings").
2. Difficulties Engaging in Goal-Directed Behavior (Goals)
The Goals dimension captures the disruption of cognitive and executive functioning under the influence of acute negative affect. When experiencing intense negative emotions, individuals high in this dimension struggle to focus their attention, concentrate on tasks, complete vocational or academic duties, and sustain purposive behavior. Rather than emotions acting as informational guides, affective arousal commandeers attentional bandwidth, resulting in perseveration or cognitive paralysis.
Example: A student receiving an ambiguous email becomes distressed and finds it impossible to concentrate on an upcoming exam or finish a class assignment ("When I am upset, I have difficulty getting work done").
3. Impulse Control Difficulties (Impulse)
The Impulse dimension reflects a subjective loss of behavioral control when distressed. It measures the degree to which an individual feels overwhelmed by affective states to the point of acting rashly, erratically, or aggressively. This construct aligns directly with the neurocognitive trait of negative urgency—the tendency to engage in impulsive, maladaptive behaviors (e.g., self-injury, substance consumption, interpersonal lashing out) to alleviate acute psychological pain.
Example: When experiencing acute interpersonal rejection, an individual feels powerless to stop themselves from shouting, breaking objects, or engaging in immediate reckless behavior ("When I am upset, I become out of control").
4. Limited Access to Emotion Regulation Strategies (Strategies)
The Strategies dimension reflects an individual's perceived inability to modulate negative emotional states once they have escalated. This dimension is characterized by feelings of helplessness, catastrophic expectations of enduring distress, and the conviction that no behavioral or cognitive strategy can restore emotional equilibrium. It does not necessarily measure the actual absence of coping skills in an individual's repertoire, but rather their pessimistic self-efficacy appraisal regarding the utility of coping efforts when upset.
Example: A person experiencing grief or frustration concludes that nothing will ever alleviate the feeling and that they are doomed to spiral into severe depression ("When I am upset, I believe that there is nothing I can do to make myself feel better").
5. Non-Acceptance of Emotional Responses (Non-Acceptance)
The Non-Acceptance dimension measures secondary affective reactivity—the tendency to respond to one's primary emotional distress with shame, self-blame, embarrassment, or self-judgment. Individuals characterized by high non-acceptance hold meta-emotional beliefs that experiencing sadness, vulnerability, or anger is a sign of weakness or character defect, creating a compounded cycle of secondary distress.
Example: An individual notices feelings of anxiety before a public presentation and subsequently feels disgusted, weak, and ashamed of themselves for being anxious ("When I am upset, I feel like I am weak").
The Omission of Emotional Awareness
A defining characteristic of the DERS-16 is the complete omission of the original DERS "Awareness" subscale (items measuring the tendency to attend to and acknowledge emotions). Extensive psychometric investigations prior to the construction of the DERS-16 (e.g., Bardeen et al., 2012; Fowler et al., 2014) revealed that the Awareness items reverse-loaded, demonstrated poor construct validity, failed to correlate positively with psychopathology, and frequently weakened the overall internal consistency of the instrument. By discarding this subscale, Bjureberg et al. (2016) significantly enhanced the unidimensionality of the total score and the theoretical coherence of the overall construct.
Theoretical Framework
The conceptual foundation of the DERS-16 is rooted in contemporary functionalist approaches to emotion and multi-system self-regulation models developed by Gratz and Roemer (2004), drawing substantially upon the work of James Gross and Marsha Linehan.
Functionalist Perspective on Emotion
Traditional psychiatric conceptualizations frequently viewed negative emotions as disruptive symptoms requiring suppression or elimination. In contrast, functionalist emotional theory posits that emotions are evolved, adaptive evolutionary responses designed to mobilize physiological resources, guide decision-making, and coordinate interpersonal communication. Under this framework, emotion regulation does not imply emotional inhibition or the absence of negative affect; rather, it entails the capacity to:
- Accurately detect and differentiate affective cues (Clarity).
- Accept the presence of distressing affect without secondary guilt or self-invalidation (Non-Acceptance).
- Maintain executive control over behavioral choices despite high affective arousal (Impulse and Goals).
- Deploy flexible cognitive and behavioral strategies to modulate the intensity and duration of affect when necessary (Strategies).
Integration with Gross's Process Model
The DERS-16 interfaces directly with James Gross's Process Model of Emotion Regulation (Gross, 1998, 2015), which outlines temporal checkpoints where regulation occurs: situation selection, situation modification, attentional deployment, cognitive reappraisal, and response modulation. The DERS-16 specifically captures deficits that occur downstream during cognitive reappraisal and response modulation. When individuals lack flexible strategies or view their affect as catastrophic, attentional deployment collapses into rumination, and behavioral response modulation fails, resulting in impulsive actions or cognitive incapacitation.
Linehan's Biosocial Theory
The DERS framework is deeply aligned with Marsha Linehan's biosocial theory of borderline personality disorder and pervasive emotion dysregulation (Linehan, 1993). Linehan posits that emotion dysregulation emerges from a transaction between biological emotional vulnerability (high sensitivity, high reactivity, slow return to baseline) and an invalidating developmental environment. In an invalidating environment, an individual's internal emotional experiences are routinely trivialized, criticized, or punished. Over time, this breeds self-invalidation (reflected in the DERS Non-Acceptance subscale), impairs the acquisition of emotional vocabulary (Clarity), and undermines confidence in one's coping capacity (Strategies).
Validity
The DERS-16 has undergone extensive psychometric validation across diverse clinical, non-clinical, adolescent, and cross-cultural cohorts, consistently demonstrating superior construct, convergent, discriminant, and predictive validity.
Construct and Structural Validity
In the original validation study by Bjureberg et al. (2016), which analyzed data from five independent clinical and community samples comprising over 2,200 individuals across the United States and Sweden, the five-factor structure of the DERS-16 demonstrated exceptional structural validity. Confirmatory factor analyses confirmed that the brief version retained the identical five latent dimensions of the original 36-item model (excluding Awareness) without item cross-loadings or structural degradation.
Convergent Validity
Convergent validity is extraordinarily high. Bjureberg et al. reported correlation coefficients between the DERS-16 total score and the original 36-item DERS total score ranging between r = .98 and r = .99 across samples. Correlations between corresponding subscales in the 16-item and 36-item versions were equally remarkable:
- Clarity: r = .86 to .91
- Goals: r = .90 to .95
- Impulse: r = .92 to .96
- Strategies: r = .94 to .97
- Non-Acceptance: r = .89 to .93
Furthermore, the DERS-16 correlates robustly with established clinical scales measuring psychological distress and psychopathology:
- Depressive Symptoms: Highly correlated with the Beck Depression Inventory-II (BDI-II; r = .60 to .68).
- Anxiety Symptoms: Significantly associated with the State-Trait Anxiety Inventory (STAI; r = .58 to .65).
- Borderline Personality Severity: Strongly correlated with the Borderline Symptom List (BSL-23; r = .69 to .75).
- Impulsive Urgency: Positively correlated with the Negative Urgency subscale of the UPPS-P Impulsive Behavior Scale (r = .52 to .63).
Discriminant Validity
The DERS-16 demonstrates adequate discriminant validity against constructs unrelated to affective control. Correlations with demographic variables (such as age, educational attainment, or socioeconomic status) are consistently weak or negligible (r < .15). Furthermore, its correlation with somatic symptom severity and general cognitive aptitude is substantially lower than its association with affective and psychiatric symptom measures.
Predictive and Criterion Validity
The scale effectively differentiates between clinical and non-clinical populations. Individuals diagnosed with borderline personality disorder, major depression, substance dependence, or eating disorders score significantly higher on both the total score and subscales than healthy community controls (Cohen's d effect sizes ranging from 1.10 to 1.85). Longitudinal clinical trials have demonstrated that reductions in DERS-16 scores over the course of evidence-based psychotherapy (such as DBT or exposure therapy) prospectively predict reductions in non-suicidal self-injury (NSSI), suicidal ideation, and behavioral relapses.
Reliability
The reliability of the DERS-16 has been verified across multiple independent investigations, exhibiting excellent internal consistency and temporal stability.
Internal Consistency
In the foundational study by Bjureberg et al. (2016), the overall DERS-16 demonstrated outstanding internal consistency across clinical, undergraduate, and community samples:
- Total Score: α = .92 to .95 across all validation samples.
- Clarity Subscale: α = .79 to .82 (2 items).
- Goals Subscale: α = .85 to .89 (3 items).
- Impulse Subscale: α = .86 to .91 (3 items).
- Strategies Subscale: α = .87 to .91 (5 items).
- Non-Acceptance Subscale: α = .81 to .88 (3 items).
Subsequent psychometric examinations, including adolescent validations and international adaptations (e.g., Spanish, Italian, and Chinese versions), have similarly reported McDonald's omega (ω) and Cronbach's alpha coefficients exceeding .90 for the total score, confirming that item reduction did not compromise measurement precision.
Test-Retest Reliability
The temporal stability of the DERS-16 is substantial. Over a two-week interval among stable community participants, the intraclass correlation coefficient (ICC) and Pearson test-retest correlation for the total score were reported at r = .85 to .88 (p < .001). Subscale test-retest coefficients ranged from .75 (Clarity) to .86 (Strategies). Despite this high baseline stability, the instrument demonstrates high sensitivity to clinical change, showing statistically significant reductions following active psychiatric and psychotherapeutic interventions.
Factor Analysis
The structural composition of the DERS-16 was developed and validated using rigorous Exploratory Factor Analysis (EFA) followed by Confirmatory Factor Analysis (CFA).
Item Selection Process
Bjureberg et al. (2016) derived the 16 items through a two-stage process. First, they removed the entire Awareness subscale due to its established psychometric deficits. Next, utilizing large clinical datasets, they examined item-total correlations, factor loadings from the original 36-item structure, and clinical representativeness. Items that exhibited the highest standardized factor loadings onto their designated latent factors while showing minimal residual covariance and cross-loadings were selected for retention.
Confirmatory Factor Analytic Fit
CFA conducted on independent testing samples confirmed that a correlated five-factor model provided an outstanding fit to the empirical data. Model fit indices consistently met or exceeded the stringent criteria established by Hu and Bentler (1999):
- Comparative Fit Index (CFI): .96 to .98 across samples (benchmark ≥ .95).
- Tucker-Lewis Index (TLI): .95 to .97 across samples (benchmark ≥ .95).
- Root Mean Square Error of Approximation (RMSEA): .045 to .058 (90% CI [.038, .064]; benchmark ≤ .06).
- Standardized Root Mean Square Residual (SRMR): .032 to .042 (benchmark ≤ .08).
Factor Loadings and Structural Comparisons
Standardized factor loadings for all 16 items onto their respective latent factors are robust, with all loadings exceeding .65, and the majority falling between .75 and .90 (p < .001). Competing models—including a single-factor unidimensional model and an orthogonal five-factor model—demonstrated significantly inferior fit (e.g., unidimensional CFI < .75, RMSEA > .13), confirming that emotion regulation is inherently multidimensional. Furthermore, higher-order hierarchical models and bifactor models have indicated that while the subscales capture distinct processes, a strong general factor of emotion dysregulation justifies calculating and interpreting a total composite score.
Instrument / Measurement Tool
Below are the structural, administrative, and scoring specifications for the DERS-16:
- Instrument Name: Difficulties in Emotion Regulation Scale – Short Form (DERS-16).
- Construct Assessed: Multidimensional difficulties in emotion regulation.
- Administration Format: Self-report paper-and-pencil questionnaire, digital survey, or ecological momentary assessment platform.
- Target Population: Adolescents (ages 12+) and adults across clinical and non-clinical settings.
- Completion Time: Approximately 1 to 2 minutes.
- Number of Items: 16 items.
- Response Scale: 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%)
- Subscale Item Composition:
- Clarity (2 items): Items 1, 2
- Goals (3 items): Items 3, 7, 15
- Impulse (3 items): Items 4, 8, 11
- Strategies (5 items): Items 5, 6, 12, 14, 16
- Non-Acceptance (3 items): Items 9, 10, 13
- Scoring and Reverse-Scoring Rules:
- There are no reverse-scored items in the DERS-16. All items are scored directly as rated (1 to 5).
- Subscale Scores: Calculated by summing the item ratings belonging to each specific dimension.
- Total Score: Calculated by summing all 16 items. Scores range from 16 to 80.
- Interpretation: Higher scores reflect greater severity of emotion regulation difficulties. Total scores above 45–50 are frequently observed in clinical populations presenting with prominent affective instability, trauma, or borderline personality features.
Permissions & Fee and Test Year
The Difficulties in Emotion Regulation Scale – Short Form (DERS-16) was published in 2016 by Johan Bjureberg and colleagues in the Journal of Psychopathology and Behavioral Assessment. In accordance with open-science practices in clinical psychology, the instrument is available in the public domain for non-commercial academic research and clinical assessment purposes. No licensing fees, royalties, or formal permissions are required for clinical or non-profit educational and scientific utilization, provided that the original authors and validation publication are cited accurately. For commercial digital health deployment or copyrighted book reproduction, standard publisher permissions via Springer Nature may apply.
References
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