Death Anxiety Scale (DAS)

1. Abstract

The Death Anxiety Scale (DAS), developed by Donald I. Templer in 1970, remains one of the most extensively utilized, foundational psychometric instruments in the fields of clinical psychology, thanatology, gerontology, and behavioral medicine. Designed to quantify conscious apprehension, existential fear, and dread regarding mortality and the dying process, the instrument operationalizes the psychological construct of thanatophobia. The standard scale consists of 15 self-report items formatted primarily as a dichotomous (True/False) inventory, though subsequent psychometric research has frequently employed Likert-type response variants to enhance variance detection. The DAS evaluates a spectrum of mortality-related concerns, including somatic distress related to lethal illness, awareness of the rapid passage of time, existential apprehension about the afterlife, and generalized apprehension regarding personal extinction. Psychometric evaluations across diverse clinical and non-clinical populations have consistently demonstrated acceptable to robust psychometric properties: internal consistency coefficients (Kuder-Richardson Formula 20 and Cronbach’s alpha) typically range from .65 to .83, while test-retest reliability across a three-week interval has yielded a coefficient of .83. Construct validity has been established through convergent correlations with established measures of neuroticism, generalized anxiety (such as the Taylor Manifest Anxiety Scale and the State-Trait Anxiety Inventory), and condition-specific psychiatric indices, alongside discriminant validity demonstrated through low correlations with Marlowe-Crowne social desirability measures. Exploratory and confiratory factor analyses generally resolve the scale into a multidimensional structure comprising four primary factors: Cognitive-Affective Fear of Death, Physical and Somatic Vulnerability, Transience of Time, and Fear of Pain and Illness. This comprehensive article provides an exhaustive psychometric, theoretical, and practical review of the DAS, examining its foundational theories, empirical validations, structural characteristics, and utility across healthcare settings.

2. Keywords

Death Anxiety Scale, DAS, thanatophobia, Donald Templer, psychometrics, existential anxiety, Terror Management Theory, mortality salience, test reliability, construct validity, factor analysis, palliative care

3. Authors

The Death Anxiety Scale was formulated and standardized by:

• Donald I. Templer, Ph.D.: Clinician, psychometrician, and Professor Emeritus of Psychology at the California School of Professional Psychology (Alliant International University), Fresno, California, United States. Dr. Templer pioneered the systematic quantitative measurement of death-related attitudes and conducted foundational empirical work spanning clinical thanatology, forensic psychology, and neuropsychology.

Significant cross-cultural validations, structural revisions, and adaptation analyses have been carried out by international researchers, including Robert Neimeyer (University of Memphis), Richard Lonetto and Donald I. Templer (multidimensional factor analyses), Mark E. Hoelterhoff (University of Plymouth), and Mohammad Ali Tavakoli and Behrooz Ahmadzadeh (clinical validation studies).

4. Purpose

The primary purpose of the Death Anxiety Scale (DAS) is to provide an objective, standardized, and easily administrable self-report metric for quantifying an individual’s conscious apprehension, dread, and cognitive preoccupation with mortality and the process of dying. Before Templer’s work in 1970, thanatological literature was predominantly qualitative, psychoanalytic, or reliant on projective techniques that suffered from limited normative data, questionable internal consistency, and poor inter-rater reliability. Templer sought to construct a brief, psychometrically sound instrument capable of differentiating between normal, non-pathological existential awareness and clinically significant thanatophobia that impairs everyday functional adaptation.

In clinical contexts, the DAS is applied to screen, evaluate, and track therapeutic outcomes among individuals suffering from acute psychiatric disorders where mortality concerns frequently manifest as primary or comorbid symptoms. Such disorders include obsessive-compulsive disorder (OCD) with health-related obsessions, illness anxiety disorder, panic disorder characterized by catastrophic physical misinterpretations, and post-traumatic stress disorder (PTSD) stemming from combat, life-threatening accidents, or severe physical trauma. Clinicians utilize the scale to evaluate baseline psychological vulnerability, assess the exacerbation of existential distress during major life transitions, and determine the therapeutic efficacy of interventions such as Cognitive Behavioral Therapy (CBT), Acceptance and Commitment Therapy (ACT), and Meaning-Centered Psychotherapy.

In medical and palliative healthcare environments, the DAS plays a vital role in oncology, cardiology, and hospice services. Patients diagnosed with terminal illnesses or chronic life-limiting conditions often experience profound fluctuations in death anxiety, which can adversely impact treatment adherence, symptom burden, pain perception, and end-of-life decision-making. Utilizing the DAS enables multidisciplinary teams to detect morbid preoccupation early, facilitate timely psychiatric consultation, and implement targeted existential and psychological support for both patients and their primary caregivers.

Within academic and empirical research, the DAS serves as a critical operationalization tool for testing hypotheses in social psychology, particularly investigations rooted in Terror Management Theory (TMT). Researchers utilize the DAS to observe how heightened mortality salience influences in-group defense mechanisms, moral judgments, worldview defense, and risk-taking behaviors. Furthermore, gerontologists employ the DAS to explore paradoxes of aging, investigating how death anxiety fluctuates across the adult lifespan and how factors like religious commitment, ego integrity, and social support mediate existential well-being in older adults.

5. Psychological Construct

The construct measured by the DAS is death anxiety (thanatophobia), defined as an unpleasant, conscious emotional state characterized by apprehension, tension, worry, and dread elicited by contemplation of the cessation of personal existence, the prospect of non-being, or the physical trauma and suffering associated with dying. Unlike generalized anxiety or state anxiety, death anxiety is intrinsically tied to the existential reality of finitude. Thanatologists make a clear distinction between death anxiety and necrophobia: whereas necrophobia constitutes an irrational, specific phobic aversion toward corpses, funerals, mortuary settings, and deceased organisms, death anxiety represents a broad cognitive-affective preoccupation with one’s own impending demise, physical dissolution, and the cessation of consciousness.

Although initially conceptualized and scored as a unidimensional total score, extensive psychometric inquiries demonstrate that the DAS captures multiple interrelated dimensions of mortality-related distress:

• Cognitive-Affective Concern and Personal Extinction: This dimension encapsulates the direct emotional dread of personal non-existence and the acute fear of death itself. It encompasses persistent thoughts and verbalizations regarding personal finitude, illustrated by items such as “I am very much afraid to die” and “The thought of death never bothers me” (reverse-scored). Elevation on this dimension reflects fundamental existential distress and an inability to achieve psychological peacefulness regarding personal mortality.
• Awareness of Transience and Temporal Acceleration: Existential theorists emphasize that human anxiety is intimately linked to the perception of time. This dimension reflects distress regarding the rapid, irreversible progression of chronological life and the inevitable truncation of opportunities. It is captured by statements such as “I am often distressed by the way time flies so very rapidly” and “I often think about how short life really is.” High scores here represent temporal dread and grief over the fleeting nature of life.
• Physical Vulnerability, Disease, and Pain: Death is rarely conceptualized solely as an abstract metaphysical event; it is frequently anticipated through the somatic trauma of chronic degeneration, terminal illness, and agony. This dimension assesses anticipatory fear regarding painful pathology, bodily decay, and medical intervention, represented by items such as “I fear dying a painful death,” “I am not particularly afraid of getting cancer,” and “I am really scared of having a heart attack.”
• Metaphysical Uncertainty and the Post-Mortem State: This dimension involves apprehension regarding the nature of the afterlife, divine judgment, or the ambiguous void following physical death. Manifested in items such as “The subject of life after death troubles me greatly,” this sub-construct captures the spiritual and philosophical disorientation that emerges when individuals confront uncertainty about what follows biological demise.

Collectively, these dimensions highlight that death anxiety is not an isolated symptom, but a multifaceted psychological state spanning cognitive rumination, somatic apprehension, existential dread, and temporal distress.

6. Theoretical Framework

The construction and interpretation of the Death Anxiety Scale are grounded in major psychiatric, psychoanalytic, and existential theories of human behavior and defense mechanisms.

Psychoanalytic Formulations: Freud and Defense Against Castration

In classical psychoanalysis, Sigmund Freud posited that the unconscious mind does not believe in its own mortality. In Thoughts for the Times on War and Death (1915), Freud argued that it is impossible to imagine our own annihilation; whenever an individual attempts to conceptualize their own death, they remain present as an observer. Freud consequently maintained that overt death anxiety is secondary, masking deeper underlying neuroses such as castration anxiety, abandonment anxiety, or unexpressed guilt. From this perspective, high scores on the DAS represent a breakdown of unconscious repression and denial mechanisms, forcing unresolved infantile anxieties to present as fear of mortality.

Existential Psychotherapy: Yalom, Frankl, and Becker

In contrast to classical psychoanalysis, existential theorists consider death anxiety an innate, foundational reality of the human condition. Irvin D. Yalom identified death as one of the four ultimate concerns of human existence (alongside freedom, existential isolation, and meaninglessness). Yalom argued that psychological dysfunction typically arises from maladaptive defenses against the awareness of death, such as denial through beliefs in personal specialness or the fantasy of an ultimate rescuer. When these defense systems collapse under the weight of illness, aging, or trauma, overt thanatophobia erupts.

This perspective was advanced by cultural anthropologist Ernest Becker in his seminal work The Denial of Death (1973). Becker argued that human civilization and individual personality structures are driven by the terror of mortality. Because humans possess sophisticated intellects capable of anticipating their inevitable physical decay, they build cultural and personal hero-systems to achieve symbolic immortality. When these cultural or personal narratives are compromised, individuals experience elevated conscious death anxiety as measured by instruments like the DAS.

Terror Management Theory (TMT)

Directly operationalizing Becker’s hypotheses within social psychology, Jeff Greenberg, Sheldon Solomon, and Tom Pyszczynski formulated Terror Management Theory (TMT). TMT asserts that the juxtaposition of an instinctive biological drive for self-preservation with the cognitive awareness of inevitable death creates the potential for debilitating terror. To mitigate this terror, individuals construct a dual-component anxiety buffer consisting of: (1) faith in a culturally derived worldview that imbues existence with meaning, stability, and significance; and (2) personal self-esteem, derived from belief that one is adhering to the standards prescribed by that cultural worldview. The DAS functions within TMT as a direct assessment tool for evaluating the efficacy or collapse of this anxiety buffer.

Robert Langs and Adaptive Psychotherapy

Psychotherapist Robert Langs proposed an adaptive psychoanalytic model centering heavily on death anxiety. Langs organized death anxiety into three distinct clinical manifestations: predatory death anxiety (the primitive, evolutionary survival mechanism triggered by immediate external physical danger), predator death anxiety (unconscious guilt and psychological conflict stemming from one’s own destructive impulses toward others), and existential death anxiety (the cognitive apprehension regarding human finitude and vulnerability). The DAS captures these dimensions by presenting stimuli that evoke direct existential reflection (predatory and existential anxiety) while probing fears of somatic vulnerability and catastrophic illness.

7. Validity

The construct, convergent, discriminant, and criterion-related validity of the Death Anxiety Scale have been corroborated through hundreds of independent empirical studies conducted globally over five decades.

Convergent Validity

During the initial validation of the DAS, Templer (1970) correlated the instrument with established clinical inventories. The DAS demonstrated significant, moderate-to-strong positive correlations with the Taylor Manifest Anxiety Scale (TMAS) (r = .36 to .43, p < .001) and the Welsh Anxiety Scale from the MMPI (r = .39, p < .001). These correlations confirm that the DAS evaluates true affective anxiety, while remaining sufficiently distinct from generalized neurosis. When compared directly with alternative thanatological instruments, the DAS demonstrates robust convergent coefficients, correlating strongly with Boyar’s Fear of Death Scale (FODS) (r = .74, p < .001) and the Collett-Lester Fear of Death Scale (CL-FODS) dimensions (r values typically ranging between .50 and .68 across subscales evaluating fear of personal death and personal dying).

Discriminant Validity

To demonstrate that the DAS is not confounded by response biases or generalized social conformity, Templer evaluated its relationship with the Marlowe-Crowne Social Desirability Scale (MCSDS). The resulting correlation was non-significant and negligible (r = -.03), indicating that scores on the DAS are not skewed by tendencies to present oneself in a socially desirable manner. Furthermore, discriminant validity is demonstrated in psychiatric settings where DAS scores do not show isomorphic overlap with pure indices of depression (such as the Beck Depression Inventory), demonstrating that existential anxiety and depressive dysphoria operate as clinically distinct entities, even when moderately comorbid.

Criterion and Known-Groups Validity

Criterion validity has been consistently confirmed through known-groups methodologies. In his original 1970 monograph, Templer administered the DAS to psychiatric patients hospitalized with explicit, clinically documented thanatophobic preoccupations and compared their scores to a matched cohort of non-thanatophobic psychiatric controls. Patients with verified death obsessions scored significantly higher on the DAS than control participants (mean difference = 3.82, t = 4.23, p < .001). Subsequent studies have replicated this discriminant capacity: individuals facing acute mortal hazards, such as oncology patients undergoing initial chemotherapy or combat veterans recovering from combat-related post-traumatic stress disorder, register significantly elevated DAS baseline scores compared to normative reference groups.

8. Reliability

The psychometric stability of the Death Anxiety Scale has been established across clinical, college, community, and geriatric cohorts.

Internal Consistency

In Templer’s initial standardization sample involving 31 undergraduate students and 77 psychiatric hospital residents, the scale demonstrated acceptable internal consistency. Because the DAS was designed with a dichotomous (True/False) format, reliability was initially calculated using the Kuder-Richardson Formula 20 (KR-20), yielding a coefficient of .76. Subsequent psychometric research across international contexts has reported KR-20 and Cronbach’s alpha coefficients typically ranging between .65 and .83. While internal consistency values slightly below .70 have been observed in some culturally adapted versions—often attributable to the brevity of the scale (15 items) and its multidimensional thematic structure—studies utilizing Likert-type response scales generally yield enhanced internal consistency figures, often exceeding .80 to .85.

Test-Retest Reliability

Temporal stability represents one of the strongest psychometric properties of the DAS. In the original test-retest assessment conducted by Templer, a sample of 31 undergraduate students completed the inventory twice across a three-week interval. The test-retest correlation coefficient was r = .83 (p < .001), indicating high temporal stability in non-clinical environments. Subsequent replication studies with intervals extending from two weeks to three months have reported test-retest coefficients consistently hovering between .78 and .85, confirming that the DAS reliably measures stable trait-like death anxiety while remaining sensitive to genuine therapeutic interventions or existential crises.

9. Factor Analysis

Although Templer initially treated the DAS as a unidimensional composite index of death anxiety, structural investigations using both Exploratory Factor Analysis (EFA) and Confirmatory Factor Analysis (CFA) have confirmed that the instrument assesses a multidimensional construct.

Exploratory Factor Analyses

A landmark investigation by Richard Lonetto, Donald I. Templer, and colleagues (1979) conducted principal components analysis with varimax rotation on DAS responses collected from large heterogeneous cohorts. Their analyses consistently extracted four distinct, conceptually coherent factors accounting for approximately 45% to 55% of the total scale variance:

• Factor 1: Cognitive-Affective Preoccupation with Death: This factor accounts for the largest proportion of common variance (typically 20–25%) and is defined by high loadings from items 1, 2, 3, 5, and 7. These items capture conscious, direct acknowledgment of mortality terror and the frequency with which thoughts of personal death occupy consciousness.
• Factor 2: Time Acceleration and Finitude: This factor reflects existential distress regarding the transience of life, defined by strong primary loadings from item 8 (“I am often distressed by the way time flies so very rapidly”) and item 12 (“I often think about how short life really is”).
• Factor 3: Somatic and Physical Vulnerability: Loading heavily on items 4, 6, 9, and 11, this factor taps into the somatic dread of medical trauma, surgical interventions, cancer, heart attacks, and the physical agony of a painful death.
• Factor 4: Awareness of External and Post-Mortem Mortality: Defined by items 10, 13, 14, and 15, this factor captures metaphysical anxiety concerning the afterlife, the emotional horror of confronting a deceased human body, and anxieties provoked by catastrophic external events such as war.

Confirmatory Factor Analyses

Modern Confirmatory Factor Analyses (CFA) have compared Templer’s original unidimensional model against oblique four-factor and hierarchical models. Findings across cross-cultural research (e.g., Saggino & Kline, 1996; Tavakoli & Ahmadzadeh, 2011) demonstrate that a multidimensional or bifactor model exhibits superior fit indices compared to a strictly unidimensional specification:

• Comparative Fit Index (CFI): typically between .90 and .95 in four-factor oblique formulations.
• Root Mean Square Error of Approximation (RMSEA): consistently within the acceptable range of .045 to .068.
• Standardized Root Mean Square Residual (SRMR): generally < .06.

These empirical findings validate the use of the DAS both as a global summary score and as a multi-component profile for clinical and research applications.

10. Instrument / Measurement Tool

• Test Type: Self-report psychological scale / psychometric inventory.
• Construct Assessed: Death anxiety, thanatophobia, and existential dread regarding mortality and somatic dissolution.
• Item Count: 15 items.
• Administration Format: Paper-and-pencil questionnaire, computerized survey, or structured clinical interview.
• Time to Complete: Approximately 3 to 5 minutes.
• Target Population: Adolescents and adults (ages 16 and older); adapted for clinical, community, and geriatric populations.
• Original Response Format: Dichotomous: True or False.
• Alternative Response Format: 5-point Likert scale (1 = Strongly Disagree to 5 = Strongly Agree) utilized in specialized empirical settings to increase variance.
• Scoring Guidelines (Standard True/False):
  • One point is awarded for each response keyed toward death anxiety.
  • Direct-Keyed Items (1 point for “True”, 0 points for “False”):
    • Item 1: “I am very much afraid to die.”
    • Item 4: “I dream to think about having to have an operation.” (Original: dread)
    • Item 8: “I am often distressed by the way time flies so very rapidly.”
    • Item 9: “I fear dying a painful death.”
    • Item 10: “The subject of life after death troubles me greatly.”
    • Item 11: “I am really scared of having a heart attack.”
    • Item 12: “I often think about how short life really is.”
    • Item 13: “I shudder when I hear people talk about a World War III.”
    • Item 14: “The sigh of a dead body is horrifying to me.” (Original: sight)
  • Reverse-Keyed Items (1 point for “False”, 0 points for “True”):
    • Item 2: “The thought of death seldom enters my mind.”
    • Item 3: “It does not make me nervous when people talk about death.”
    • Item 5: “I am not at all afraid to die.”
    • Item 6: “I am not particularly afraid of getting cancer.”
    • Item 7: “The thought of death never bothers me.”
    • Item 15: “I feel that the future holds nothing for me to fear.”
  • Total Score Range: 0 to 15 points. Higher scores indicate greater levels of death anxiety and thanatophobia.
  • Normative Reference Values: In standard non-clinical adult populations, mean scores generally fall between 4.5 and 7.0 (Standard Deviation ≈ 3.0). Scores of 9 and above typically indicate clinically significant death anxiety warranting comprehensive evaluation.

11. Permissions & Fee and Test Year

The Death Anxiety Scale was formulated and published in 1970 by Donald I. Templer in The Journal of General Psychology. As an academic psychometric tool developed over five decades ago, the instrument is widely treated within the psychological research community as being in the public domain for non-commercial research, academic, and instructional applications.

No licensing fee is mandated for academic dissertations, clinical training, or non-profit institutional research studies. However, commercial applications, integration into proprietary diagnostic software systems, or mass reproduction within fee-charging clinical batteries should seek permission from the copyright holder of the journal (Taylor & Francis / Informa UK Limited, which acquired the archival holdings of The Journal of General Psychology). Proper academic attribution and citation of Dr. Donald I. Templer’s original 1970 landmark publication are required in all empirical presentations.

12. References

• Becker, E. (1973). The denial of death. Free Press.
• Devins, G. M. (1979). Death anxiety and depression: Concurrent and dynamic relationships. Journal of Consulting and Clinical Psychology, 47(4), 770–772. https://doi.org/10.1037/0022-006X.47.4.770
• Greenberg, J., Pyszczynski, T., & Solomon, S. (1986). The causes and consequences of a need for self-esteem: A terror management theory. In R. F. Baumeister (Ed.), Public self and private self (pp. 189–212). Springer-Verlag. https://doi.org/10.1007/978-1-4613-9564-5_10
• Hoelterhoff, M. E. (2010). Resilience against death anxiety in relationship to post-traumatic stress disorder and psychiatric co-morbidity (Doctoral dissertation, University of Plymouth). PEARL Research Repository. http://pearl.plymouth.ac.uk/pearl_jspui/bitstream/10026.1/306/4/Hoelterhoff%20M%20E_2010.pdf
• Lonetto, R., Fleming, S., & Mercer, G. W. (1979). The factor structure of the Death Anxiety Scale. The Journal of General Psychology, 100(2), 247–258. https://doi.org/10.1080/00221309.1979.9920932
• Saggino, A., & Kline, P. (1996). The factor structure of the Italian version of the Death Anxiety Scale. The Journal of Psychology, 130(4), 441–446. https://doi.org/10.1080/00223980.1996.9915031
• Tavakoli, M. A., & Ahmadzadeh, B. (2011). Investigation of validity and reliability of Templer Death Anxiety Scale. Thought & Behavior in Clinical Psychology, 6(21), 47–56. http://www.sid.ir/en/VEWSSID/J_pdf/1000520112101.pdf
• Templer, D. I. (1970). The construction and validation of a Death Anxiety Scale. The Journal of General Psychology, 82(2), 165–177. https://doi.org/10.1080/00221309.1970.9920634
• Yalom, I. D. (1980). Existential psychotherapy. Basic Books.

13. Items of the Scale