DES-II (Dissociative Experiences Scale): Clinical Screening Tool for Dissociative Symptoms

The Dissociative Experiences Scale II (DES-II) is a 28-item self-report screening instrument designed to measure the frequency of dissociative experiences in daily life. Originally developed by Eve Bernstein Carlson and Frank Putnam in 1986, the scale was revised in 1993 to its current form — the DES-II — which replaced the original visual analog response format with a simpler percentage-based scale to improve reliability and ease of scoring.

The DES-II is not a diagnostic tool. It does not confirm or rule out any specific dissociative disorder. Rather, it functions as a screening measure that identifies individuals who report elevated levels of dissociative experiences and who may benefit from further comprehensive clinical evaluation. It remains one of the most widely used and extensively researched instruments in the dissociative disorders literature, with hundreds of published studies supporting its utility across diverse clinical and research settings.

Dissociation itself refers to a disruption or discontinuity in the normal integration of consciousness, memory, identity, emotion, perception, behavior, and sense of self. Dissociative experiences exist on a spectrum — from common, benign phenomena like daydreaming or highway hypnosis to clinically significant symptoms such as depersonalization, derealization, amnesia, and identity confusion. The DES-II captures this full spectrum, allowing clinicians to assess both the breadth and intensity of dissociative experiences a person reports.

The DES-II measures three broad categories of dissociative experience, each reflecting a different facet of the dissociative spectrum:

• Absorption and Imaginative Involvement: These items assess the tendency to become deeply engrossed in experiences — such as being so absorbed in a television program or fantasy that one loses awareness of surroundings. Absorption experiences are relatively common in the general population and are not inherently pathological.
• Depersonalization and Derealization: These items evaluate experiences of feeling detached from one's own body, thoughts, or actions (depersonalization) or perceiving the external world as unreal, distant, or dreamlike (derealization). While occasional episodes can occur in healthy individuals, persistent or distressing depersonalization and derealization are clinically significant.
• Amnestic Dissociation: These items assess gaps in memory for significant personal events, finding evidence of actions one does not remember performing, or discovering unfamiliar items among one's possessions. Amnestic symptoms are less common in the general population and are more strongly associated with dissociative identity disorder (DID) and other severe dissociative conditions.

Research by Carlson, Putnam, and colleagues has consistently identified these three factors through factor analytic studies, though the DES-II yields a single overall score rather than separate subscale scores in standard clinical use. A subset of eight items, known as the DES-Taxon (DES-T), was developed by Niels Waller and colleagues (1996) to specifically identify pathological dissociation that may be qualitatively distinct from normal dissociative experiences. The DES-T items focus on amnestic dissociation and depersonalization/derealization — the more clinically concerning domains.

The DES-II was developed for use with adults aged 18 and older. It is appropriate for screening across a wide range of clinical populations, including individuals presenting with:

• Suspected dissociative disorders (dissociative identity disorder, dissociative amnesia, depersonalization/derealization disorder, other specified dissociative disorder)
• Posttraumatic stress disorder (PTSD), particularly the dissociative subtype recognized in the DSM-5-TR
• Complex trauma histories, including childhood abuse and neglect
• Borderline personality disorder and other conditions with overlapping dissociative features
• Conversion disorder (functional neurological symptom disorder)
• Unexplained somatic symptoms with possible dissociative underpinnings

The scale is also used in non-clinical research settings to study dissociative phenomena in general population samples, college student populations, and specific at-risk groups.

The DES-II is not validated for children or young adolescents. For pediatric populations, clinicians typically use the Adolescent Dissociative Experiences Scale (A-DES), developed by Judith Armstrong and colleagues, which is designed for ages 11–18 and uses developmentally appropriate language.

Notably, the DES-II assumes a minimum reading comprehension level (approximately a sixth-grade reading level in English). Individuals with significant cognitive impairment, active psychosis, or limited literacy may not be able to complete the measure reliably. Clinician judgment is essential in determining whether the instrument is appropriate for a given individual.

Administration: The DES-II is a paper-and-pencil (or digital) self-report questionnaire. It takes approximately 10–15 minutes to complete. The individual reads each of the 28 items and selects a percentage — from 0% to 100%, in increments of 10% — that reflects how often the described experience happens to them when they are not under the influence of alcohol or drugs. This qualifier is critical: it ensures that the scale captures trait-level dissociative tendencies rather than substance-induced altered states.

Each item is phrased as a description of a specific dissociative experience. For example, items describe situations like finding oneself in a place with no memory of how one got there, being told about things one did but does not remember, or feeling as though one is standing next to oneself watching oneself.

Scoring: The DES-II yields a single overall score calculated as the mean of all 28 item responses. Since each item is rated on a 0–100 scale, the total DES-II score ranges from 0 to 100. A higher score indicates a greater frequency and breadth of reported dissociative experiences.

General interpretive guidelines from the research literature include:

• 0–10: Low levels of dissociation, typical of the general adult population. Most healthy adults score in this range.
• 10–20: Mild dissociative experiences. Scores in this range may be seen in individuals with PTSD, anxiety disorders, or mild trauma-related symptoms.
• 20–30: Moderate dissociative experiences. This range warrants clinical attention and further evaluation. It is commonly seen in individuals with PTSD (including the dissociative subtype), borderline personality disorder, and some other specified dissociative disorders.
• 30 and above: Elevated dissociative experiences. Scores at or above 30 are commonly used as a clinical cutoff warranting structured diagnostic follow-up. Research consistently links scores in this range to dissociative identity disorder, though this score alone does not establish a diagnosis.

The most commonly referenced screening cutoff in the literature is a DES-II score of 30 or above, which has demonstrated good sensitivity for identifying individuals who meet diagnostic criteria for dissociative identity disorder upon structured interview. However, some researchers have advocated for a lower cutoff of 20 in general clinical populations to reduce false negatives, especially when screening for the full range of dissociative disorders.

The DES-Taxon (DES-T) score can be calculated separately from eight specific items (items 3, 5, 7, 8, 12, 13, 22, and 27). The DES-T uses a taxometric procedure and provides a probability estimate of belonging to a pathological dissociation taxon. DES-T scores above approximately 3.0 (on a rescaled metric) or a mean above 20 on the constituent items have been associated with pathological dissociation, though the taxon model itself has been debated in subsequent research.

The DES-II has been one of the most extensively validated self-report instruments in the dissociative disorders field over the past three decades. Its psychometric properties are well-established across numerous studies and populations.

Internal Consistency: The DES-II consistently demonstrates excellent internal consistency, with Cronbach's alpha values typically ranging from .90 to .96 across studies. This indicates that the 28 items reliably measure a coherent construct.

Test-Retest Reliability: Test-retest reliability is strong, with correlation coefficients generally ranging from .79 to .96 over intervals of four to eight weeks, indicating good temporal stability. This is important because it suggests the DES-II captures relatively stable trait-level tendencies rather than fleeting state-dependent responses.

Construct Validity: The DES-II correlates significantly with other established measures of dissociation, including the Somatoform Dissociation Questionnaire (SDQ-20), the Multidimensional Inventory of Dissociation (MID), and structured clinical interviews such as the Structured Clinical Interview for DSM Dissociative Disorders (SCID-D). It also shows expected patterns of association with measures of trauma exposure, PTSD severity, and absorption, supporting its convergent validity.

Discriminant Validity: The DES-II successfully discriminates between individuals with dissociative identity disorder and those with other psychiatric diagnoses. Research by Carlson and Putnam (1993) and subsequent meta-analyses have confirmed that DES-II scores are significantly higher in DID populations (mean scores typically between 40 and 57) compared to individuals with schizophrenia, borderline personality disorder, PTSD, or other anxiety and mood disorders.

Sensitivity and Specificity: At the commonly used cutoff of 30, the DES-II demonstrates sensitivity estimates typically between 74% and 82% for identifying DID, with specificity values generally ranging from 70% to 80% depending on the comparison sample. These values confirm its utility as a screening tool while also underscoring the critical point that a high DES-II score alone is insufficient for diagnosis — a structured clinical interview is always required.

Cross-Cultural Validation: The DES-II has been translated into numerous languages and validated across diverse cultural contexts, including Dutch, Japanese, Turkish, Spanish, German, and Chinese populations. While some cultural variability in mean scores has been observed — reflecting the cultural shaping of how dissociative experiences are expressed and reported — the overall factor structure and psychometric properties have been replicated internationally.

Despite its extensive research base and widespread clinical use, the DES-II has several important limitations that clinicians and researchers should consider:

• It is a screening tool, not a diagnostic instrument. The DES-II cannot diagnose dissociative identity disorder, depersonalization/derealization disorder, dissociative amnesia, or any other condition. Elevated scores indicate the need for further structured evaluation — not the presence of a disorder.
• Self-report bias. Because the DES-II relies entirely on self-report, it is susceptible to the limitations inherent in all self-report measures. Individuals may underreport experiences due to shame, lack of awareness (a core feature of dissociation itself), or poor insight. On the other hand, some individuals may over-endorse items due to suggestibility, malingering, or misunderstanding of the questions.
• Limited differentiation of pathological versus normative dissociation. The overall DES-II score combines items measuring benign absorption with items measuring pathological amnestic dissociation and depersonalization. A moderately elevated total score could reflect high levels of absorption (which is not necessarily clinically significant) rather than pathological dissociative processes. The DES-Taxon was developed to address this limitation, but its taxometric model has been questioned by some researchers who argue dissociation may be better conceptualized as dimensional rather than taxonic.
• No assessment of somatoform dissociation. The DES-II focuses on psychological forms of dissociation and does not assess somatoform dissociative symptoms — such as unexplained neurological symptoms, sensory disturbances, or motor impairments. Instruments like the SDQ-20 complement the DES-II by capturing this additional dimension.
• Limited utility in detecting malingering. The DES-II has no built-in validity scales to detect feigned or exaggerated responding. In forensic or disability evaluation contexts, this is a significant limitation. Clinicians in these settings should supplement the DES-II with measures that include validity indicators.
• Cultural and linguistic considerations. Although the DES-II has been translated and validated across many cultures, cultural differences in how dissociative experiences are understood, expressed, and reported may affect scores. Clinicians should interpret results within the individual's cultural context.
• Not suitable for children. As noted, the DES-II is validated for adults. Clinicians working with children and younger adolescents should use the A-DES or other developmentally appropriate measures.

In clinical practice, the DES-II serves several important functions within a broader assessment framework:

1. Initial Screening in Trauma Populations: Many clinicians administer the DES-II as part of a standard intake battery for individuals presenting with trauma histories, PTSD symptoms, or unexplained gaps in memory. It provides a quick, low-burden way to identify individuals who may have dissociative features that warrant more detailed exploration. Given that dissociative disorders are frequently undiagnosed or misdiagnosed — research suggests that individuals with DID typically spend an average of 5 to 12 years in the mental health system before receiving an accurate diagnosis — routine screening with the DES-II can help close this diagnostic gap.

2. Guiding Further Assessment: When an individual scores at or above the clinical cutoff (typically 30, though some clinicians use 20 as a lower threshold), the standard recommendation is to follow up with a structured clinical interview. The gold standard diagnostic instruments include the Structured Clinical Interview for DSM-5 Dissociative Disorders (SCID-D-R) and the Dissociative Disorders Interview Schedule (DDIS). These interviews provide the comprehensive, clinician-administered assessment necessary for differential diagnosis.

3. Treatment Planning and Monitoring: The DES-II can be readministered periodically during treatment to track changes in dissociative symptom frequency over time. Decreases in DES-II scores over the course of trauma-focused therapy — such as phase-oriented treatment for dissociative disorders — can serve as one indicator of clinical progress, alongside other outcome measures and clinical observation.

4. Research Applications: The DES-II is the most commonly used measure of dissociation in research studies examining the prevalence, correlates, neurobiology, and treatment of dissociative phenomena. Its brevity and strong psychometric properties make it well-suited for inclusion in large-scale surveys and clinical trials.

5. Differential Diagnosis: Elevated DES-II scores help clinicians consider dissociative disorders in the differential diagnosis, particularly when individuals present with symptoms that may overlap with other conditions — such as mood instability, auditory hallucinations (which occur in DID but are often misattributed to schizophrenia), or identity disturbance seen in borderline personality disorder. The DES-II does not resolve these diagnostic questions on its own, but it alerts clinicians to the possibility of a dissociative process that might otherwise be overlooked.

The DES-II is a publicly available instrument that is not proprietary or copyrighted for clinical use. It can be used without charge in both clinical and research settings. This accessibility has contributed significantly to its widespread adoption.

The scale can be accessed through the following resources:

• Published literature: The DES-II items and scoring instructions are published in the original articles by Carlson and Putnam. The key reference is: Carlson, E. B., & Putnam, F. W. (1993). An update on the Dissociative Experiences Scale. Dissociation, 6(1), 16–27.
• International Society for the Study of Trauma and Dissociation (ISSTD): The ISSTD provides information about dissociative disorder assessment tools, including guidance on using the DES-II in clinical practice.
• Trauma research centers and academic repositories: Many university-based trauma research programs make the DES-II available for download in multiple languages.
• Sidran Institute: This organization, dedicated to traumatic stress education and advocacy, has historically provided access to the DES-II and related resources.

Clinicians seeking to incorporate the DES-II into their practice should familiarize themselves with the scoring procedures, interpretive guidelines, and the instrument's limitations before using it with clients. Training in trauma-informed assessment and dissociative disorders is strongly recommended, particularly for clinicians who will be conducting follow-up diagnostic evaluations based on DES-II screening results.

If you recognize patterns in your own experience that align with the types of dissociative experiences described in this article — such as frequent memory gaps for significant events, feeling persistently detached from your body or surroundings, or discovering evidence of actions you don't recall — it is important to seek evaluation from a qualified mental health professional.

Dissociative symptoms can be deeply disorienting and are often accompanied by significant distress, functional impairment, and confusion about one's own experiences. Many people with dissociative symptoms do not initially recognize them as such, or may minimize them because they have been present since childhood and feel "normal."

A thorough evaluation by a clinician experienced in trauma and dissociation — typically a licensed psychologist, psychiatrist, or clinical social worker with specialized training — is the appropriate path forward. This evaluation will go far beyond any single screening instrument and will include a comprehensive clinical interview, detailed history, and consideration of differential diagnoses.

The DES-II is an educational and screening tool — not a substitute for professional evaluation. If you are experiencing distressing dissociative symptoms, or if a clinician has recommended screening for dissociative experiences, professional guidance is the essential next step.