Dissociative Experiences Scale (DES-II)

1. Abstract

The Dissociative Experiences Scale (DES-II) is the premier self-report psychometric instrument designed to quantify the frequency and severity of dissociative experiences in both clinical and non-clinical populations. Developed originally by Eve M. Bernstein and Frank W. Putnam in 1986, and subsequently refined into a standardized forced-choice percentage format (DES-II) by Eve Bernstein Carlson and Frank W. Putnam in 1993, the instrument addresses alterations in memory, identity, awareness, and sensory perception. The scale comprises 28 items administered across an 11-point percentage-frequency response scale ranging from 0% (“never”) to 100% (“always”) in 10% increments. Factor-analytic and clinical investigations consistently delineate three primary subscales: Absorption and Imaginative Involvement, Depersonalization and Derealization, and Amnestic Dissociation. Beyond continuous dimensional measurement, the scale accommodates the taxometric identification of pathological dissociation via the 8-item Dissociative Experiences Scale Taxon (DES-T), established by Niels G. Waller, Frank W. Putnam, and Eve B. Carlson (1996). Psychometrically, the DES-II demonstrates exceptional internal consistency, with Cronbach's alpha values reliably ranging between .93 and .96, along with robust test-retest reliability (r = .79 to .96) across intervals spanning weeks to months. The measure possesses extensive construct, convergent, and discriminant validity, clearly differentiating normative non-pathological manifestations of absorption from severe trauma-related pathology, including Dissociative Identity Disorder (DID), Other Specified Dissociative Disorder (OSDD), and Post-Traumatic Stress Disorder (PTSD). Placed in the public domain by its authors to advance psychiatric epidemiology and trauma psychology, the DES-II remains the worldwide gold standard for initial clinical screening, dimensional symptom tracking, and neurobiological research on trauma-induced disintegration of consciousness.

2. Keywords

Dissociative Experiences Scale, DES-II, dissociation, depersonalization, derealization, dissociative amnesia, dissociative identity disorder, trauma-related dissociation, psychometrics, DES-T taxon, absorption, structural dissociation

3. Authors

The Dissociative Experiences Scale was conceptualized, developed, and empirically validated by two pioneering investigators in the fields of developmental psychopathology, trauma, and dissociative spectrum disorders:

• Eve Bernstein Carlson, Ph.D.: Research Psychologist at the National Center for PTSD, Dissemination and Training Division, Veterans Affairs Palo Alto Health Care System, Palo Alto, California; and former Associate Professor of Psychology at Beloit College. Dr. Carlson is a leading international authority on the assessment and longitudinal sequelae of trauma, psychological trauma measurement, and the epidemiology of post-traumatic stress and dissociation.
• Frank W. Putnam, M.D.: Professor of Pediatrics and Child Psychiatry at the University of North Carolina at Chapel Hill School of Medicine; Clinical Professor of Psychiatry at the Cincinnati Children's Hospital Medical Center; and former Chief of the Unit on Dissociative Disorders at the National Institute of Mental Health (NIMH). Dr. Putnam is renowned for his foundational clinical and neurobiological research on child abuse, complex trauma, and dissociative identity disorder.

Methodological refinement of the taxometric subscale (DES-T) was further spearheaded in collaboration with:

• Niels G. Waller, Ph.D.: Professor of Quantitative Psychology and Psychometrics at the University of Minnesota, whose expertise in mathematical psychometrics, taxometric methodology, and latent variable modeling enabled the statistical isolation of the pathological dissociation taxon.

4. Purpose

The primary purpose of the Dissociative Experiences Scale (DES-II) is to offer a rapid, reliable, and valid dimensional metric for screening, quantifying, and evaluating the entire spectrum of dissociative phenomena. Clinically, dissociation represents a disruption in the typically integrated functions of consciousness, memory, identity, emotion, perception, body representation, motor control, and behavior. Prior to the creation of the original DES in 1986, the empirical assessment of dissociation was severely constrained by the lack of standardized instruments; clinicians relied almost exclusively on unstructured, subjective clinical interviews that frequently failed to recognize dissociative symptoms or misattributed them to schizophrenia, bipolar disorder, or borderline personality disorder.

The DES-II is engineered to serve three principal diagnostic and empirical functions:

• Primary Screening in Clinical Settings: The DES-II functions as a frontline screening tool to identify individuals who exhibit elevated levels of dissociation that warrant comprehensive diagnostic evaluation using structured clinical interviews, such as the Structured Clinical Interview for DSM-5 Dissociative Disorders (SCID-D-R) or the Dissociative Disorders Interview Schedule (DDIS). A cutoff score of 30 is widely recognized as indicating high clinical risk for complex dissociative disorders, including Dissociative Identity Disorder (DID) and Dissociative Amnesia.
• Quantification of Symptom Severity: Because the DES-II utilizes a continuous 0% to 100% percentage-frequency response format, it captures fine-grained dimensional variation. This enables clinicians to track longitudinal treatment outcomes, monitor therapeutic responses in trauma-informed psychotherapy, and evaluate changes in dissociative coping mechanisms following pharmacological or psychotherapeutic interventions.
• Epidemiological and Neuroscientific Research: In empirical research, the DES-II allows investigators to stratify non-clinical, trauma-exposed, and psychiatric populations along a dissociative continuum. It facilitates the study of neurobiological correlates of dissociation (e.g., functional magnetic resonance imaging paradigms examining cortico-limbic disconnectivity), cognitive deficits in working memory, information-processing anomalies, and gene-environment interactions following early childhood maltreatment.

Importantly, the DES-II was intentionally designed not as an infallible diagnostic instrument, but as an efficient self-report screener. It identifies symptoms that may otherwise remain covert, as patients suffering from severe dissociative pathology frequently experience intense shame, amnesia for their amnesia, or confusion regarding their experiences, rarely reporting them spontaneously during routine psychiatric examinations.

5. Psychological Construct

The psychological construct assessed by the DES-II is dissociation, defined as an operationalized continuum or multi-faceted construct characterized by the breakdown in the synthesis or integration of mental processes that are normally unified. The scale captures both normative, non-pathological manifestations of dissociative states and severe, trauma-generated, disintegrative psychopathology. Decades of structural and psychometric research have validated three primary dimensions underlying the 28 items of the DES-II, alongside a distinct qualitative taxon:

Absorption and Imaginative Involvement

This dimension reflects the tendency to become so profoundly engrossed in one's internal imaginative world, media, or focal perceptual stimuli that awareness of the surrounding external environment is temporarily diminished or extinguished. Items tapping absorption assess experiences such as becoming completely immersed in a film or book to the exclusion of external events (Item 17), entering deep daydreams or internal fantasies that feel intensely real (Item 18), or staring blankly into space while losing track of time (Item 20). In non-clinical populations, absorption is frequently conceptualized as a non-pathological, benign personality trait related to Tellegen's construct of absorption and hypnotic susceptibility. However, when highly elevated in trauma survivors, intense absorption may function as a defensive avoidance mechanism to wall off intrusive traumatic memories.

Depersonalization and Derealization

This subscale assesses profound alterations in the subjective experience of the self and the external environment:

• Depersonalization: Refers to a state in which an individual feels estranged, alienated, or detached from their own physical body, mental processes, or identity. On the DES-II, this is exemplified by feeling detached and observing oneself from the outside as if watching an external person (Item 7), failing to recognize one's own reflection in a mirror (Item 11), or feeling that one's body does not belong to oneself (Item 13).
• Derealization: Encompasses the subjective perception that the external world is artificial, dreamlike, foggy, or devoid of reality. This is operationalized through items describing familiar environments suddenly feeling alien or unfamiliar (Item 16) or experiencing the surrounding world as synthetic, muffled, or observed through a dense mist (Items 12 and 28).

These phenomena typically reflect severe disruptions in self-referential cognitive processing and are prominent manifestations of post-traumatic stress, panic disorder, and specific depersonalization-derealization disorders.

Amnestic Dissociation (Dissociative Amnesia)

Amnestic dissociation represents the most clinically severe dimension of the DES-II. It assesses recurrent, inexplicable gaps in autobiographical memory that exceed ordinary forgetfulness or absentmindedness. Items measuring this construct capture localized or generalized episodes of lost time, such as discovering oneself in a location without knowing how one arrived there (Item 3), finding newly purchased possessions without recalling the transaction (Item 5), encountering strangers who address one by an unfamiliar name (Item 6), having total amnesia for major autobiographical life milestones (Item 9), or discovering tangible physical evidence of completed actions with zero recollection of carrying them out (Item 25). Amnestic dissociation strongly signals compartmentalized identity structures and pathological trauma-related dissociative disorders.

The Pathological Dissociation Taxon (DES-T)

Subsequent psychometric investigations demonstrated that dissociation cannot be described solely as a smooth, continuous spectrum extending from everyday daydreaming to DID. Instead, Waller, Putnam, and Carlson (1996) isolated an 8-item subscale (Items 3, 5, 7, 8, 12, 13, 22, and 27) that differentiates a discrete categorical entity—the dissociative taxon. Individuals within this taxon experience pathological dissociative detachment, identity fragmentation, and severe amnesia, separating them qualitatively, rather than merely quantitatively, from the normative population.

6. Theoretical Framework

The conceptual underpinnings of the Dissociative Experiences Scale are anchored in classical and contemporary psychiatric theories of psychological trauma, psychodynamics, cognitive architecture, and neuropsychology:

Janetian Dissociation Theory

The foundational bedrock of the DES-II traces directly to the pioneering formulations of French psychiatrist Pierre Janet (1859–1947). Janet introduced the concept of désagrégation mentale (mental disaggregation), arguing that under the impact of severe emotional shock or psychological trauma, the integrative capacity of the mind is overwhelmed. Consequently, specific systems of ideas, sensorimotor patterns, and memories become split off from the central hierarchy of consciousness, operating autonomously as subconscious automatisms. The DES-II operationalizes Janet's assertion that dissociative symptoms represent functional failures of synthesis, manifesting as fragmented memory systems, depersonalized states, and behavioral disruptions outside volitional control.

Hilgard’s Neodissociation Theory and the ‘Hidden Observer’

In the late 20th century, Ernest R. Hilgard formulated neodissociation theory to explain hypnotic analgesia and divided consciousness. Hilgard postulated an executive cognitive architecture comprising multiple cognitive subsystems governed by a central monitoring executive. In traumatic or hypnotic contexts, communication barriers are erected between these subordinate subsystems and the central executive, permitting autonomous cognitive, sensory, and motor operations to unfold simultaneously without conscious awareness. The DES-II incorporates this cognitive framework by querying instances of compartmentalized functioning, such as remaining unresponsive to physical pain (Item 19) or executing complex behaviors without executive awareness.

The Theory of Structural Dissociation of the Personality

Modern conceptualizations of the DES-II are strongly interpreted through the lens of the Theory of Structural Dissociation of the Personality, advanced by Onno van der Hart, Ellert Nijenhuis, and Kathy Steele. This theory posits that chronic, early developmental trauma prevents the integration of primary psychobiological action systems. The personality becomes structurally divided into an Apparently Normal Part of the Personality (ANP), dedicated to daily functioning and avoidance of traumatic memories, and one or more Emotional Parts of the Personality (EP), which remain fixated on defensive threat responses (fight, flight, freeze, collapse). The DES-II directly taps the intrusive manifestations of EPs breaking through into the awareness of the ANP—such as flashback memories recurring with vivid sensory intensity (Item 14), hearing internal auditory voices directing behavior (Item 27), or shifts in self-perception where the individual feels like distinct identities across varying contexts (Item 22).

Information Processing and Neurobiological Trauma Models

Neurobiologically, dissociative experiences are understood as severe cortico-limbic regulatory shifts. According to models articulated by Ruth Lanius, Bessel van der Kolk, and Ulrich Schnyder, acute trauma evokes either hyperarousal (sympathetic flight-or-fight response) or dissociative hypoarousal (parasympathetically driven tonic immobility, depersonalization, and derealization). Dissociation involves prefrontal hyper-inhibition over the amygdala, dampening emotional reactivity and causing temporal and spatial disorientation. The DES-II serves as a direct behavioral index of these functional neurocircuit disruptions.

7. Validity

The Dissociative Experiences Scale (and its revised DES-II iteration) has undergone extensive psychometric validation worldwide, demonstrating robust construct, convergent, discriminant, and criterion-related validity across clinical and non-clinical cohorts.

Convergent Validity

The DES-II exhibits high convergent validity with both clinician-administered structured interviews and independent self-report measures of trauma and dissociation:

• Strong positive correlations (ranging from r = .68 to .84) are consistently observed between DES scores and the Structured Clinical Interview for DSM Dissociative Disorders (SCID-D / SCID-D-R).
• Moderate-to-high correlations (r = .55 to .75) have been documented with the Dissociative Disorders Interview Schedule (DDIS) and the Multidimensional Inventory of Dissociation (MID).
• The DES-II demonstrates substantial convergent associations with childhood trauma severity as measured by the Childhood Trauma Questionnaire (CTQ), with correlation coefficients typically falling between r = .40 and .60, affirming the profound empirical link between developmental trauma and dissociative psychopathology.

Discriminant and Known-Groups Validity

The DES-II effectively discriminates between psychiatric diagnostic categories, generating distinct group mean score distributions that mirror theoretical gradients of pathology:

Furthermore, the DES-II discriminates genuine dissociative disorders from general psychiatric distress, demonstrating low correlations with standard measures of generalized anxiety, unipolar depression, and neuroticism when dissociative symptoms are partialled out.

Criterion and Predictive Validity

Receiver Operating Characteristic (ROC) analyses establish that an overall DES-II cutoff score of 30 achieves an optimal balance between sensitivity (approximately 74% to 80%) and specificity (80% to 85%) for detecting Dissociative Identity Disorder. Lowering the screening cutoff to 20 or 25 boosts sensitivity over 90%, which is widely recommended when the instrument is employed in trauma-focused clinics to avoid false negatives.

8. Reliability

The Dissociative Experiences Scale (DES-II) exhibits outstanding psychometric reliability across diverse clinical environments, languages, cultures, and developmental cohorts.

Internal Consistency

Across empirical studies, the overall 28-item DES-II demonstrates exceptional internal consistency:

• Cronbach’s Alpha ($lpha$): Typically ranges from .93 to .96 in general adult and psychiatric clinical samples (Carlson & Putnam, 1993; van Ijzendoorn & Schuengel, 1996).
• Subscale Consistency: The specific subscales also demonstrate strong internal consistency: Absorption and Imaginative Involvement ($lpha pprox .82 – .88$), Depersonalization/Derealization ($lpha pprox .84 – .91$), and Amnestic Dissociation ($lpha pprox .80 – .87$).
• Split-Half Reliability: Split-half reliability coefficients calculated via the Spearman-Brown prophecy formula routinely exceed .90 (e.g., Bernstein & Putnam, 1986, reported an original split-half coefficient of .93).

Test-Retest Reliability and Temporal Stability

The temporal stability of the DES-II has been confirmed across diverse testing intervals:

• Short-Term Stability (1 to 4 weeks): Test-retest reliability estimates range from $r = .84$ to $.96$ in healthy volunteer cohorts and stable psychiatric outpatients.
• Long-Term Stability (6 to 12 months): Longitudinal studies tracking untreated cohorts or control subjects yield stability coefficients between $r = .74$ and $.84$, indicating that baseline dissociative tendencies function as a relatively stable trait unless modified by targeted clinical treatment.

Cross-Cultural and Linguistic Equivalence

The DES-II has been formally translated into dozens of languages—including Spanish, French, German, Dutch, Italian, Swedish, Turkish, Japanese, Chinese, and Hebrew. Cross-cultural adaptations have replicated the internal consistency indices of the English version, with Cronbach's alpha values universally exceeding .90, demonstrating remarkable cross-cultural robustness of the underlying psychometric construct.

9. Factor Analysis

The latent structure of the Dissociative Experiences Scale has been the subject of intensive psychometric investigation involving exploratory factor analysis (EFA), confirmatory factor analysis (CFA), and taxometric modeling.

Exploratory Factor Analytic (EFA) Models

In their initial development and validation studies, Carlson and Putnam (1993) performed principal components and principal axis factoring with orthogonal and oblique rotations. The analyses converged on a robust three-factor solution that accounted for over 50% of the total variance:

• Factor 1: Absorption and Imaginative Involvement (Items such as 14, 17, 18, 20, 24). This factor captures intense, non-pathological or dissociative absorption where focal attention isolates the individual from external reality.
• Factor 2: Depersonalization and Derealization (Items such as 7, 11, 12, 13, 16, 28). This factor reflects distorted perceptual processing of the self and one's immediate environment.
• Factor 3: Amnestic Dissociation (Items such as 3, 4, 5, 8, 9, 25, 26). This factor represents catastrophic memory failure, identity discontinuity, and unremembered behavior.

Confirmatory Factor Analysis (CFA) and Bifactor Structures

Subsequent CFA investigations across large non-clinical and clinical samples (e.g., Stockdale et al., 2002) confirmed that while a single general dissociation factor explains substantial common variance, a three-factor correlated model or a bifactor model provides superior fit indices:

• Comparative Fit Index (CFI): Ranging between .91 and .95 in adequately specified models.
• Root Mean Square Error of Approximation (RMSEA): Typically falling between .045 and .062.
• Standardized Root Mean Square Residual (SRMR): Consistently $< .05$.

In the bifactor representation, a robust global dissociation factor accounts for the shared variance among all 28 items, while domain-specific group factors (Absorption, Depersonalization, Amnesia) capture residual variance unique to each phenomenological presentation.

Taxometric Findings: Dimensional vs. Taxonic Structure

One of the most consequential psychometric breakthroughs surrounding the DES was conducted by Niels Waller, Frank Putnam, and Eve Carlson in 1996 using Paul Meehl's taxometric methodologies (MAXCOV, MAMBAC, and MAXENG). Their analyses revealed that dissociation is not purely dimensional:

• Absorption reflects a continuous, dimensional trait shared across the normal population.
• A specific subset of 8 items (Items 3, 5, 7, 8, 12, 13, 22, 27) constitutes a distinct, non-arbitrary categorical taxon—the Dissociative Taxon (DES-T).
• Approximately 1% to 3% of the general population and up to 50% to 70% of individuals with severe trauma spectrum disorders belong to this taxon, characterized by severe compartmentalization, depersonalization, and amnestic disruptions.

10. Instrument / Measurement Tool

The operational characteristics, administration parameters, and scoring architecture of the Dissociative Experiences Scale (DES-II) are detailed below:

• Test Type: Standardized psychological self-report screening instrument.
• Administration Format: Paper-and-pencil questionnaire or computerized/digital administration.
• Target Population: Adults and adolescents aged 16 and older (a distinct validated adolescent version, the A-DES, exists for younger youth).
• Administration Time: Approximately 10 to 15 minutes.
• Item Count: 28 self-report items.
• Authentic Response Scale: 11-point percentage scale (0%, 10%, 20%, 30%, 40%, 50%, 60%, 70%, 80%, 90%, 100% of the time).
• Instructions to Respondent: Respondents are asked to indicate what percentage of the time they experience each phenomenon when they are not under the influence of alcohol, recreational drugs, or acute medical conditions.
• Scoring Methodology:
  • Total Score Calculation: The overall DES-II score is computed by summing the numerical percentage values selected for all 28 items and dividing the sum by 28. This yields an overall continuous mean percentage score ranging from 0 to 100.
  • Subscale Scores: Subscale means can be derived by averaging the responses of their respective items: Absorption (Items 2, 14, 15, 17, 18, 20, 24); Depersonalization/Derealization (Items 7, 11, 12, 13, 16, 28); Amnestic Dissociation (Items 3, 4, 5, 6, 8, 9, 10, 25, 26).
  • DES-T (Taxon) Score Calculation: Derived from the 8 taxon items: 3, 5, 7, 8, 12, 13, 22, and 27. In clinical practice, an average percentage score across these 8 items $ge 20$ indicates a high probability of taxon membership and severe dissociative psychopathology. In rigorous research psychometrics, Bayesian latent class probabilities are computed using Waller's taxometric scoring algorithm.
• Clinical Cutoff Benchmarks:
  • Scores < 15: Normal range; consistent with non-clinical populations endorsing occasional absorption or mild highway hypnosis.
  • Scores 15 – 29: Mild-to-moderate dissociation; commonly seen in patients with post-traumatic stress disorder, borderline personality disorder, or affective disorders.
  • Scores $ge$ 30: High clinical marker; indicates significant trauma-related dissociative psychopathology. Approximately 70% to 80% of individuals scoring at or above 30 meet full diagnostic criteria for a complex dissociative disorder (OSDD or DID).

11. Permissions & Fee and Test Year

• Publication History: The original Dissociative Experiences Scale (DES-I), which utilized a 100-millimeter visual analogue scale (VAS), was published in 1986 by Eve M. Bernstein and Frank W. Putnam. Due to the labor-intensive scoring of visual analogue lines, Eve Bernstein Carlson and Frank W. Putnam developed the DES-II in 1993, replacing the VAS with the standardized 11-point percentage-frequency format (0% to 100%).
• Licensing and Copyright Status: The Dissociative Experiences Scale (both DES-I and DES-II) is firmly placed in the public domain. The authors dedicated the instrument to open academic, empirical, and clinical access to encourage trauma screening and dissociative disorder research globally.
• User Fees: Free of charge. There are no royalty fees, licensing expenses, or commercial per-use charges associated with the non-commercial administration, reproduction, or software integration of the DES-II.
• Reproduction Guidelines: Researchers and clinicians are authorized to reproduce and administer the DES-II without formal written permission, provided that appropriate scholarly attribution is accorded to the original authors (Bernstein & Putnam, 1986; Carlson & Putnam, 1993) and that the item wording and response anchors remain unaltered to preserve psychometric validity.

12. References

• Bernstein, E. M., & Putnam, F. W. (1986). Development, reliability, and validity of a dissociation scale. Journal of Nervous and Mental Disease, 174(12), 727–735. https://doi.org/10.1097/00005053-198612000-00004
• Carlson, E. B., & Putnam, F. W. (1993). An update on the Dissociative Experiences Scale. Dissociation: Progress in the Dissociative Disorders, 6(1), 16–27. https://hdl.handle.net/1794/1458
• Carlson, E. B., Putnam, F. W., Ross, C. A., Torem, M., Coons, P., Dill, D. L., Loewenstein, R. J., & Braun, B. G. (1993). Validity of the Dissociative Experiences Scale in screening for multiple personality disorder: A multicenter study. The American Journal of Psychiatry, 150(7), 1030–1036. https://doi.org/10.1176/ajp.150.7.1030
• Hilgard, E. R. (1986). Divided consciousness: Multiple controls in human thought and action (Expanded ed.). John Wiley & Sons.
• Janet, P. (1907). The major symptoms of hysteria: Fifteen lectures given in the medical school of Harvard University. Macmillan.
• Lanius, R. A., Vermetten, E., Loewenstein, R. J., Brand, B., Schmahl, C., Bremner, J. D., & Spiegel, D. (2010). Emotion modulation in PTSD: Clinical and neurobiological evidence for a dissociative subtype. The American Journal of Psychiatry, 167(6), 640–647. https://doi.org/10.1176/appi.ajp.2009.09081168
• Ross, C. A., Joshi, S., & Currie, R. (1991). Dissociative experiences in the general population: A factor analysis. Hospital and Community Psychiatry, 42(3), 297–301. https://doi.org/10.1176/ps.42.3.297
• Stockdale, G. D., Gridley, B. E., Baluch, S. P., & Holtgraves, T. (2002). Confirmatory factor analysis of the Dissociative Experiences Scale and development of an abbreviated version. Journal of Trauma & Dissociation, 3(4), 75–102. https://doi.org/10.1300/J229v03n04_06
• van der Hart, O., Nijenhuis, E. R. S., & Steele, K. (2006). The haunted self: Structural dissociation and the treatment of chronic traumatization. W. W. Norton & Company.
• 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. https://doi.org/10.1016/0272-7358(96)00006-2
• Waller, N. G., Putnam, F. W., & Carlson, E. B. (1996). Types of dissociation and dissociative types: A taxometric analysis of dissociative experiences. Psychological Methods, 1(3), 300–321. https://doi.org/10.1037/1082-989X.1.3.300
• Waller, N. G., & Ross, C. A. (1997). The prevalence and biometric structure of pathological dissociation in the general population: Taxometric and behavior genetic findings. Journal of Abnormal Psychology, 106(4), 499–510. https://doi.org/10.1037/0021-843X.106.4.499

13. Items of the Scale