Difficulties in Emotion Regulation Scale (DERS)

1. Abstract

The Difficulties in Emotion Regulation Scale (DERS) is one of the most widely utilized and comprehensively validated self-report instruments designed to assess multidimensional patterns of emotion dysregulation in clinical and non-clinical populations. Developed by Kim L. Gratz and Lizabeth Roemer (2004), the instrument operationalizes emotion regulation not merely as the down-regulation of heightened negative affect, but as an integrative, multifaceted process involving emotional awareness, clarity, functional acceptance, impulse control, goal-directed behavioral engagement, and the flexible implementation of regulatory strategies. The original instrument consists of 36 items scored on a 5-point Likert scale ranging from 1 (Almost never [0–10%]) to 5 (Almost always [91–100%]). Factor-analytic investigations establish a robust six-factor structure: Nonacceptance of Emotional Responses (Nonacceptance), Difficulty Engaging in Goal-Directed Behavior (Goals), Impulse Control Difficulties (Impulse), Lack of Emotional Awareness (Awareness), Limited Access to Emotion Regulation Strategies (Strategies), and Lack of Emotional Clarity (Clarity). Psychometric evaluations consistently confirm high internal consistency across clinical and non-clinical cohorts (total Cronbach’s α ≥ .93; subscale alphas ranging from .80 to .91), excellent test-retest reliability over periods of 4 to 8 weeks (ρ = .88), and strong convergent, concurrent, and predictive validity across diverse forms of psychopathology, including borderline personality disorder, post-traumatic stress disorder, major depressive disorder, generalized anxiety disorder, and substance use disorders. This article presents an exhaustive psychometric and theoretical analysis of the DERS, detailing its conceptual architecture, validity parameters, factor structure, scoring mechanics, and clinical implications.

2. Keywords

Difficulties in Emotion Regulation Scale, DERS, emotion dysregulation, affective science, psychometrics, emotional awareness, impulse control, experiential avoidance, clinical assessment, psychological measurement

3. Authors

The Difficulties in Emotion Regulation Scale was conceptualized, developed, and empirically validated by:

• Kim L. Gratz, Ph.D. — Professor and Chair of the Department of Psychology at the University of Toledo (formerly at the University of Mississippi Medical Center). Dr. Gratz is an internationally recognized expert in the empirical study of emotion regulation, self-injurious behaviors, and borderline personality pathology. Correspondence: [email protected] / [email protected].
• Lizabeth Roemer, Ph.D. — Professor of Psychology at the University of Massachusetts Boston. Dr. Roemer is a prominent clinical scientist specializing in anxiety disorders, acceptance-based behavioral therapies, mindfulness, and the transdiagnostic mechanisms of emotional vulnerability.

4. Purpose

The primary purpose of the Difficulties in Emotion Regulation Scale is to provide a comprehensive, clinically nuanced, and psychometrically sound assessment of clinically relevant difficulties in emotion regulation. Historically, empirical research in personality, affective neuroscience, and clinical psychology conceptualized emotion regulation in a narrow, uni-dimensional fashion, often equating regulation with the simple control, inhibition, or reduction of subjective emotional intensity and negative affect. Gratz and Roemer (2004) recognized that such conceptual models failed to capture the functional utility of emotional states and neglected the paradoxical consequences of experiential suppression and avoidance.

Drawing on contemporary functionalist perspectives, the DERS was deliberately constructed to measure difficulties occurring across distinct stages of the emotional cascade. Specifically, the instrument seeks to capture deficits in:

• The conscious awareness, identification, and understanding of internal affective cues;
• The capacity to accept non-judgmentally both primary and secondary emotional responses without escalating into self-blame, guilt, or shame;
• The ability to modulate physiological arousal and refrain from impulsive, dysfunctional, or self-defeating behaviors when experiencing intense distress;
• The capability to orchestrate sustained concentration and accomplish daily academic, occupational, or interpersonal goals despite elevated emotional tension; and
• The cognitive and behavioral flexibility required to access adaptive context-appropriate strategies that modulate the duration and intensity of affective episodes rather than attempting to completely eliminate them.

From a research standpoint, the DERS serves as a foundational transdiagnostic instrument across psychiatric classifications. Emotion dysregulation is now widely acknowledged as a core phenotypic vulnerability underlying DSM-5-TR internalizing disorders (e.g., major depressive disorder, generalized anxiety disorder, panic disorder) and externalizing disorders (e.g., substance use disorders, intermittent explosive disorder, conduct problems), as well as trauma-related syndromes and personality pathology. In clinical settings, the DERS provides practitioners with an empirical baseline to identify distinct regulatory deficits, tailor individualized interventions (such as Dialectical Behavior Therapy [DBT], Acceptance and Commitment Therapy [ACT], or Emotion-Focused Therapy [EFT]), and systematically monitor therapeutic change throughout treatment trajectories.

5. Psychological Construct

The psychological construct assessed by the DERS is emotion dysregulation, conceptualized as a multi-component dynamic failure to flexibly modulate emotional arousal in service of goal-oriented functioning and psychological well-being. Gratz and Roemer (2004) operationalized this broad construct into six distinct, interrelated functional dimensions:

5.1. Nonacceptance of Emotional Responses (Nonacceptance)

This subscale comprises 6 items measuring the tendency to exhibit secondary negative reactions to one’s own emotional states, or non-accepting reactions to distress. Individuals scoring high on this dimension evaluate their emotional reactions pejoratively, exhibiting self-directed anger, guilt, embarrassment, or shame (e.g., Item 11: “When I’m upset, I become angry with myself for feeling that way”; Item 25: “When I’m upset, I feel guilty for feeling that way”). This construct directly parallels the concept of emotional invalidation and experiential nonacceptance, where the primary affective distress is amplified by meta-emotional condemnation.

5.2. Difficulty Engaging in Goal-Directed Behavior (Goals)

Composed of 5 items, this dimension assesses the inability to concentrate on and execute essential life tasks, academic assignments, or vocational responsibilities when experiencing negative affect. Elevated scores indicate that negative affect hijacks executive control mechanisms, rendering the individual cognitively incapacitated or paralyzed (e.g., Item 13: “When I’m upset, I have difficulty getting work done”; Item 26: “When I’m upset, I have difficulty concentrating”). The construct reflects executive functioning disruption under high autonomic and affective load.

5.3. Impulse Control Difficulties (Impulse)

This 6-item subscale captures difficulties maintaining behavioral self-control and behavioral inhibition during affective storms. It measures the subjective perception of becoming completely out of control and unable to restrain impulsive or destructive behaviors when experiencing negative emotions (e.g., Item 14: “When I’m upset, I become out of control”; Item 27: “When I’m upset, I have difficulty controlling my behaviours”; Item 32: “When I’m upset, I lose control over my behaviours”). High scores on Impulse are strongly predictive of dysregulated behaviors such as non-suicidal self-injury (NSSI), binge eating, substance misuse, and aggressive outbursts.

5.4. Lack of Emotional Awareness (Awareness)

Comprising 6 items (all reverse-scored), this dimension taps into the degree to which an individual attends to, values, and consciously monitors their inner emotional life. Individuals exhibiting high dysregulation in this domain routinely ignore, dismiss, or detach from their affective signals (e.g., Item 2 [R]: “I pay attention to how I feel”; Item 6 [R]: “I am attentive to my feelings”; Item 8 [R]: “I care about what I am feeling”). Conceptually, this construct mirrors the affective monitoring deficits observed in alexithymia and affective somatic dissociation.

5.5. Limited Access to Emotion Regulation Strategies (Strategies)

Consisting of 8 items, this subscale reflects the subjective belief that once negative affect is triggered, there is virtually nothing an individual can do to alleviate the distress or adaptively modulate their affective state (e.g., Item 15: “When I’m upset, I believe that I will remain that way for a long time”; Item 28: “When I’m upset, I believe that there is nothing I can do to make myself feel better”; Item 31: “When I’m upset, I believe that wallowing in it is all I can do”). This construct reflects perceived regulatory helplessness, self-efficacy deficits in emotional recovery, and perceived affective permanence.

5.6. Lack of Emotional Clarity (Clarity)

This 5-item dimension measures the extent to which an individual accurately identifies and differentiates specific feeling states. Individuals with deficits in emotional clarity experience their internal environment as an undifferentiated, confusing, or ambiguous state of distress (e.g., Item 4: “I have no idea how I am feeling”; Item 5: “I have difficulty making sense out of my feelings”; Item 9: “I am confused about how I feel”). This subscale relates directly to emotional granularity, emotional differentiation, and the cognitive labeling of visceral sensations.

6. Theoretical Framework

The theoretical architecture of the Difficulties in Emotion Regulation Scale is anchored in the convergence of modern functionalist approaches to emotion, experiential avoidance paradigms, and dialectical biosocial theories of affective vulnerability.

6.1. Functionalist Perspectives of Emotion

Traditional cognitive-behavioral paradigms frequently framed negative emotions (e.g., sadness, anger, fear) as problematic states requiring cognitive restructuring or active suppression. In contrast, Gratz and Roemer (2004) grounded the DERS in functionalist affective theory, formulated by scholars such as James J. Gross (1998), Leslie Greenberg (2002), and Paul Ekman. Under functionalist theory, emotions are evolved, biologically driven physiological and psychological response tendencies that provide invaluable informational cues regarding the environment, guide decision-making, and prepare the organism for adaptive behavioral action.

Consequently, emotion regulation is defined not as the eradication of negative emotions, but as the ability to utilize emotional data to navigate environmental demands. Regulatory success entails experiencing the full spectrum of emotional states while remaining capable of functioning in accordance with one’s contextual goals.

6.2. Linehan’s Biosocial Model of Dysregulation

A major theoretical pillar of the DERS is Marsha M. Linehan’s (1993) biosocial theory of Borderline Personality Disorder. Linehan conceptualizes emotion dysregulation as the transactional product of an innate neurobiological vulnerability (high emotional sensitivity, heightened reactivity, and slow return to emotional baseline) interacting with an invalidating environment. In an invalidating environment, the developing child’s internal affective experiences are trivialized, punished, or characterized as illegitimate.

The child internalizes this invalidation, leading to profound meta-emotional non-acceptance (measured by the DERS Nonacceptance subscale), a failure to acquire accurate emotional labeling skills (measured by Clarity), and pervasive feelings of helplessness regarding affective recovery (measured by Strategies). When heightened physiological arousal occurs, it overtaxes cognitive resources (Goals) and breaks down behavioral restraint (Impulse).

6.3. Relational Frame Theory and Experiential Avoidance

The DERS is further informed by modern third-wave behavioral models, specifically Acceptance and Commitment Therapy (ACT) and Relational Frame Theory (Hayes et al., 1996). These paradigms posit that psychopathology often stems from experiential avoidance: the unwillingness to remain in contact with particular private experiences (e.g., bodily sensations, emotions, thoughts) and the futile attempts to alter the form or frequency of these events. The DERS operationalizes experiential avoidance across its Awareness and Nonacceptance dimensions, demonstrating that attempts to suppress, ignore, or condemn internal emotional experiences generate cognitive exhaustion and behavioral dysregulation.

7. Validity

Extensive empirical investigations spanning two decades have affirmed the robust psychometric validity of the DERS across clinical cohorts, community adults, and adolescent populations internationally.

7.1. Construct and Convergent Validity

In the seminal validation study by Gratz and Roemer (2004; N = 357 undergraduate students), the DERS total score and subscales demonstrated expected and statistically robust convergent correlations with established affective and personality scales:

• Experiential Avoidance: Strong positive correlations were observed with the Acceptance and Action Questionnaire (AAQ; r = .68, p < .001), indicating that elevated emotion dysregulation closely aligns with psychological inflexibility and experiential avoidance.
• Emotional Expressivity and Ambivalence: The DERS correlated significantly with the Ambivalence over Emotional Expressiveness Questionnaire (AEQ; r = .53, p < .001) and negatively with the Berkeley Expressivity Scale (BES; r = -.30, p < .01).
• Alexithymia: Substantial convergence has been established between the Toronto Alexithymia Scale (TAS-20) and the DERS Clarity (r > .65) and Awareness (r > .55) subscales, demonstrating construct convergence in affective labeling and monitoring deficits.

7.2. Criterion and Concurrent Validity

The DERS demonstrates exceptional criterion validity in distinguishing clinical from non-clinical samples. In clinical investigations involving patients with Borderline Personality Disorder (BPD), Major Depressive Disorder (MDD), Post-Traumatic Stress Disorder (PTSD), and Generalized Anxiety Disorder (GAD), clinical cohorts consistently display significantly higher scores across all DERS subscales compared to healthy matched controls (Tull et al., 2007; Gratz et al., 2006). For instance, Gratz et al. (2008) demonstrated that psychiatric outpatients meeting criteria for BPD had significantly elevated total DERS scores (M = 127.8, SD = 21.4) compared to outpatient controls without BPD (M = 98.4, SD = 24.1; p < .001).

7.3. Predictive and Incremental Validity

Multiple longitudinal and laboratory-based studies highlight the predictive validity of the DERS:

• Self-Injurious Behaviors: Gratz and Roemer (2004, 2008) demonstrated that the DERS, specifically the Impulse and Strategies subscales, prospectively predicted deliberate self-harm behaviors above and beyond the effects of negative affectivity, depression, and borderline traits alone (ΔR² = .08, p < .001).
• Substance Use and Risky Behaviors: In experimental stress induction paradigms, Tull et al. (2009) established that individuals with elevated DERS scores exhibit shorter distress tolerance latencies during computer-automated distress tasks (e.g., Paced Auditory Serial Addition Task; PASAT) and display higher rates of substance relapse.

7.4. Discriminant Validity

The DERS discriminates effectively between emotional regulation deficits and general psychological distress. While the DERS total score correlates moderately with measures of negative affectivity such as the Positive and Negative Affect Schedule (PANAS-Negative; r ≈ .45 to .52), factor-analytic studies confirm that the DERS items do not cross-load onto negative affectivity or trait neuroticism factors, confirming that emotion regulation represents a distinct mechanistic construct from affective trait valence.

8. Reliability

The psychometric evaluation of the DERS across diverse cultural, developmental, and clinical contexts demonstrates exceptional internal consistency and temporal stability.

8.1. Internal Consistency

In the original validation study by Gratz and Roemer (2004), the total DERS scale demonstrated exemplary internal consistency, yielding a total Cronbach’s alpha (α) of .93. The subscale reliability estimates were similarly robust:

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

Subsequent psychometric evaluations across global populations have replicated these high internal consistency metrics. For example, in an adolescent sample (N = 427), Weinberg and Klonsky (2009) reported a total scale alpha of .94, with subscale alphas ranging from .78 (Awareness) to .89 (Strategies). In a comprehensive Italian validation (Giromini et al., 2012; N = 643), total alpha was .92, with subscale alphas between .82 and .90. McDonald’s omega (ω) hierarchical coefficients routinely exceed .88 for the total score across studies, verifying structural reliability without relying solely on tau-equivalence assumptions.

8.2. Test-Retest Reliability

Gratz and Roemer (2004) assessed the temporal stability of the DERS over an assessment window ranging from 4 to 8 weeks (subsample n = 56). The intraclass correlation coefficient for the overall instrument was highly stable:

• Total Score Test-Retest: r = .88, p < .001
• Subscale Test-Retest: Nonacceptance (r = .69), Goals (r = .69), Impulse (r = .57), Awareness (r = .68), Strategies (r = .89), and Clarity (r = .80).

Subsequent investigations by Bardeen et al. (2012) over a 2-week interval confirmed even higher stability coefficients (ρ > .85 for all subscales), demonstrating that the DERS measures a stable, trait-like psychological construct that nevertheless remains sensitive to clinical intervention and therapeutic change.

9. Factor Analysis

The structural composition of the DERS has been subjected to rigorous exploratory factor analysis (EFA) and confirmatory factor analysis (CFA) across numerous independent samples.

9.1. Exploratory Factor Analysis (EFA)

During scale development, Gratz and Roemer (2004) administered an initial item pool of 43 candidate items to 357 undergraduate participants. Principal Axis Factoring (PAF) with oblique (Promax) rotation was employed under the empirical assumption that the underlying dimensions of emotion regulation are inherently correlated. Examination of the scree plot and eigenvalues (> 1.0) supported a six-factor solution accounting for 55.68% of the total variance.

Items were retained based on strict psychometric criteria: a primary factor loading ≥ .40 and no cross-loadings ≥ .35. Seven items failed to meet these criteria and were eliminated, resulting in the final 36-item, six-factor instrument. Primary factor loadings for retained items were substantial, ranging from .42 to .88 across their designated factors, with minimal residual cross-loadings.

9.2. Confirmatory Factor Analysis (CFA) and Model Fit

Subsequent investigations have tested the latent dimensionality of the DERS via Confirmatory Factor Analysis. Bardeen, Fergus, and Orcutt (2012) conducted a detailed structural comparison across competing latent models in a large community sample (N = 1,174):

• Unidimensional Model: Fitting all 36 items onto a single latent dysregulation factor demonstrated poor fit: χ²(594) = 5124.32, CFI = .71, TLI = .69, RMSEA = .094.
• Six-Factor Correlated Model: The proposed six-factor correlated model provided an acceptable-to-good fit across standard structural equation modeling indices: χ²(579) = 2241.16, CFI = .91, TLI = .90, RMSEA = .054 (90% CI [.051, .056]), SRMR = .052.
• Higher-Order Bifactor Model: Bifactor modeling frequently reveals that while the total score accounts for substantial general variance, the specific subscales retain significant unique variance, validating the clinical reporting of both total and subscale metrics.

9.3. Methodological Nuances: The Awareness Subscale

Multiple CFA studies (e.g., Bardeen et al., 2012; Fowler et al., 2014) have noted that the Awareness subscale (items 2, 6, 8, 10, 17, 34) occasionally exhibits weak factor correlations with the remaining five subscales (inter-factor r values typically ranging between .12 and .25, compared to inter-correlations of .45 to .75 among the other subscales). Furthermore, because all Awareness items are reverse-worded, researchers have identified a method effect associated with item valence. While some researchers have explored a 30-item modified model omitting Awareness (or creating short forms such as the DERS-16 or DERS-18), the complete 36-item six-factor architecture remains the standard, ecologically valid gold standard for multidimensional assessment.

10. Instrument / Measurement Tool

The structural characteristics, administration parameters, and scoring conventions of the Difficulties in Emotion Regulation Scale are summarized below:

• Test Type: Standardized self-report psychometric rating scale.
• Format: Pen-and-paper or digital/computerized survey administration.
• Item Count: 36 items.
• Administration Time: Approximately 7 to 10 minutes.
• Target Population: Adolescents (aged 12–17; often validated as DERS-A) and adults (aged 18+).
• Response Scale: 5-point Likert-type scale reflecting frequency of occurrence:
  • 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%)
• Reverse-Scored Items (11 items): Items 1, 2, 6, 7, 8, 10, 17, 20, 22, 24, and 34 are positively worded and MUST be reverse-scored prior to calculating subscale or total sums:
  Recoding transformation: 1 → 5, 2 → 4, 3 → 3, 4 → 2, 5 → 1.
• Subscale Item Composition:
  • Nonacceptance (6 items): 11, 12, 21, 23, 25, 29 (Score range: 6 to 30)
  • Goals (5 items): 13, 18, 20[R], 26, 33 (Score range: 5 to 25)
  • Impulse (6 items): 14, 19, 24[R], 27, 32, 36 (Score range: 6 to 30)
  • Awareness (6 items): 2[R], 6[R], 8[R], 10[R], 17[R], 34[R] (Score range: 6 to 30)
  • Strategies (8 items): 15, 16, 22[R], 28, 30, 31, 35, 36 (Score range: 8 to 40)
  • Clarity (5 items): 1[R], 4, 5, 7[R], 9 (Score range: 5 to 25)
• Total Score Calculation: Sum of all 36 items (after reversing designated items). Total score ranges from 36 to 180. Higher scores indicate greater severity of emotion regulation difficulties and affective dysfunction.

11. Permissions & Fee and Test Year

The Difficulties in Emotion Regulation Scale was originally published in 2004 by Kim L. Gratz and Lizabeth Roemer in the Journal of Psychopathology and Behavioral Assessment.

Licensing and Accessibility: The DERS is classified as an open-access psychological instrument for academic, clinical, and non-commercial research purposes. The scale authors have generously placed the measure in the public domain for research and clinical assessment without licensing fees or per-administration royalties. Clinicians and empirical researchers are permitted to reproduce and administer the scale provided that full bibliographic attribution is granted to Gratz and Roemer (2004). Commercial utilization, incorporation into paid proprietary digital health platforms, or fee-based clinical diagnostic batteries requires explicit written permission from the copyright holders and the scale authors.

12. References

The following peer-reviewed publications provide foundational theoretical and psychometric documentation for the DERS:

• Bardeen, J. R., Fergus, T. A., & Orcutt, H. K. (2012). An examination of the latent structure of the Difficulties in Emotion Regulation Scale. Journal of Psychopathology and Behavioral Assessment, 34(3), 382–392. https://doi.org/10.1007/s10862-012-9288-6
• Fowler, J. C., Charak, R., Elhai, J. D., Allen, J. G., Frueh, B. C., & Oldham, J. M. (2014). Construct validity and factor structure of the Difficulties in Emotion Regulation Scale among adults with severe mental illness. Journal of Psychiatric Research, 58, 175–180. https://doi.org/10.1016/j.jpsychires.2014.07.029
• Giromini, L., Velotti, P., de Campora, G., Bonalume, L., & Cesare Zavattini, G. (2012). Cultural adaptation of the Difficulties in Emotion Regulation Scale (DERS) in Italy: A study with regular and clinical adult populations. Journal of Psychopathology and Behavioral Assessment, 34(3), 393–404. https://doi.org/10.1007/s10862-012-9290-z
• Gratz, K. L., & Roemer, L. (2004). Multidimensional assessment of emotion regulation and dysregulation: Development, factor structure, and initial validation of the Difficulties in Emotion Regulation Scale. Journal of Psychopathology and Behavioral Assessment, 26(1), 41–54. https://doi.org/10.1023/B:JOBA.0000007455.08539.94
• Gratz, K. L., & Gunderson, J. G. (2006). Preliminary data on an acceptance-based emotion regulation group intervention for deliberate self-harm among women with borderline personality disorder. Behavior Therapy, 37(1), 25–35. https://doi.org/10.1016/j.beth.2005.03.002
• Gross, J. J. (1998). The emerging field of emotion regulation: An integrative review. Review of General Psychology, 2(3), 271–299. https://doi.org/10.1037/1089-2680.2.3.271
• Hayes, S. C., Wilson, K. G., Gifford, E. V., Follette, V. M., & Strosahl, K. (1996). Experimental avoidance and behavioral disorders: A functional dimensional approach to etiology and treatment. Journal of Consulting and Clinical Psychology, 64(6), 1152–1168. https://doi.org/10.1037/0022-006X.64.6.1152
• Linehan, M. M. (1993). Cognitive-behavioral treatment of borderline personality disorder. Guilford Press.
• Tull, M. T., Barrett, H. M., McMillan, E. S., & Roemer, L. (2007). A preliminary investigation of the relationship between emotion regulation difficulties and posttraumatic stress symptoms. Behavior Therapy, 38(3), 303–313. https://doi.org/10.1016/j.beth.2006.10.001
• Weinberg, A., & Klonsky, E. D. (2009). Measurement of emotion dysregulation in adolescents. Psychological Assessment, 21(4), 616–621. https://doi.org/10.1037/a0016669

13. Items of the Scale