Difficulties in Emotion Regulation Scale (DERS)

1. Abstract

The Difficulties in Emotion Regulation Scale (DERS) is a 36-item self-report questionnaire designed by Kim L. Gratz and Lizabeth Roemer (2004) to provide a comprehensive, multidimensional assessment of emotional dysregulation in adults and adolescents. Grounded in an integrative functionalist framework, the instrument conceptualizes emotion dysregulation not merely as the intensity or presence of negative affective states, but as a multifaceted deficit involving six distinct yet inter-correlated clinical dimensions: (1) Nonacceptance of Emotional Responses (Nonacceptance), (2) Difficulty Engaging in Goal-Directed Behavior (Goals), (3) Impulse Control Difficulties (Impulse), (4) Lack of Emotional Awareness (Awareness), (5) Limited Access to Emotion Regulation Strategies (Strategies), and (6) Lack of Emotional Clarity (Clarity).

Respondents evaluate each item on a 5-point Likert scale ranging from 1 (“Almost never” / 0–10%) to 5 (“Almost always” / 91–100%), with eleven items reverse-scored to ensure response validity. Across non-clinical, student, and clinical populations, the DERS exhibits robust psychometric properties, consistently demonstrating high overall internal consistency (Cronbach’s alpha ranging from α = .93 to .95; McDonald’s omega ω > .90) and satisfactory subscale reliabilities (α = .80 to .91). Test-retest reliability across 4- to 8-week intervals remains strong (intraclass correlation coefficients ≥ .88). Extensive structural equation modeling (SEM) and exploratory/confirmatory factor analyses support its underlying six-factor architecture, while also informing ongoing psychometric debates regarding the unique structural status of the Awareness dimension. The DERS serves as a preeminent measurement gold standard in transdiagnostic psychiatric research, affective neuroscience, and clinical behavior therapy, demonstrating robust predictive utility across disorders characterized by pervasive affective volatility, including borderline personality disorder, major depressive disorder, generalized anxiety disorder, substance use disorders, and complex post-traumatic stress.

2. Keywords

Difficulties in Emotion Regulation Scale, DERS, Emotion Dysregulation, Affective Science, Psychometrics, Factor Analysis, Transdiagnostic Vulnerability, Borderline Personality Disorder, Cognitive Behavioral Therapy, Affective Clarity

3. Authors

The Difficulties in Emotion Regulation Scale was originally developed and psychometrically validated by:

• Kim L. Gratz, Ph.D. — Professor and Chair of the Department of Psychology at the University of Toledo (formerly of the University of Mississippi Medical Center). Dr. Gratz is a recognized clinical psychologist whose research centers on the conceptualization, etiology, and treatment of severe emotion dysregulation, non-suicidal self-injury (NSSI), and borderline personality pathology.
• Lizabeth Roemer, Ph.D. — Professor of Psychology at the University of Massachusetts Boston. Dr. Roemer is a clinician-investigator specializing in generalized anxiety disorder, post-traumatic stress, and the integration of acceptance- and mindfulness-based behavioral therapies with functional cognitive-behavioral paradigms.

4. Purpose

Emotion regulation is an essential psychological process underpinning psychological resilience, social functioning, and goal attainment. Prior to the development of the DERS, contemporary psychological research lacked a comprehensive self-report measure that captured the complex, multifaceted nature of affective regulation. Historically, assessment tools primarily conceptualized emotion regulation in a unidimensional fashion, equating regulation almost exclusively with emotional modulation, emotional suppression, or the down-regulation of subjective negative affect. Such conceptualizations overlooked the critical clinical insights demonstrated by experiential therapies, functional analysis, and dialectical behavioral paradigms, which emphasize that healthy regulation involves experiencing, understanding, accepting, and tolerating emotions rather than merely eliminating or suppressing them.

Gratz and Roemer (2004) developed the DERS to address this theoretical and empirical void. The scale was constructed to measure clinically meaningful difficulties across emotional awareness, clarity, acceptance, behavioral inhibition, goal-directed behavior, and perceived self-efficacy in modifying emotional states. Rather than categorizing negative emotions as inherently pathological, the DERS operates on the premise that emotions are functionally informative survival signals; psychological distress arises when an individual is unable to recognize emotional signals, rejects affective experiences, acts impulsively when distressed, fails to maintain functional behavior, or perceives themselves as powerless to self-soothe.

From an applied clinical perspective, the DERS serves multiple essential purposes:

• Transdiagnostic Risk Profiling: Because emotion dysregulation constitutes a core transdiagnostic risk and maintenance mechanism across Axis I and Axis II psychiatric presentations, the DERS facilitates empirical indexing of vulnerability across diverse diagnostic categories, such as Borderline Personality Disorder (BPD), Generalized Anxiety Disorder (GAD), Major Depressive Disorder (MDD), Substance Use Disorders (SUD), Eating Disorders, and Complex Post-Traumatic Stress Disorder (C-PTSD).
• Treatment Customization and Case Formulation: The multidimensional profile generated by the six subscales enables clinicians to tailor specific interventions to individual deficit profiles. For example, a patient exhibiting elevated scores specifically on the Awareness and Clarity subscales requires interoceptive psychoeducation and affective labeling training (such as mentalization-based or emotional granularity training), whereas an individual scoring high on the Nonacceptance and Impulse subscales requires distress tolerance, radical acceptance, and dialectical behavior strategies.
• Clinical Trial Outcome Monitoring: The DERS is widely employed as a primary and secondary outcome measure in randomized controlled trials (RCTs) evaluating third-wave behavioral interventions, including Dialectical Behavior Therapy (DBT), Acceptance and Commitment Therapy (ACT), Emotion-Focused Therapy (EFT), and the Unified Protocol for Transdiagnostic Treatment of Emotional Disorders.

5. Psychological Construct

The construct assessed by the DERS is an integrative, multidimensional model of emotion dysregulation. Rather than defining regulation as the total absence or immediate suppression of negative emotions, Gratz and Roemer operationalize adaptive emotion regulation as involving: (a) awareness and understanding of emotional states, (b) non-judgmental acceptance of distress, (c) the capacity to inhibit impulsive behavioral patterns when experiencing distressing affect, (d) the capacity to deploy flexible situational strategies that modulate the duration and intensity of emotional responses rather than extinguishing them, and (e) the ability to direct cognitive and behavioral effort toward chosen personal goals even in the presence of intense arousal.

Deficits across these domains are operationalized via the six distinct subscales of the instrument:

1. Nonacceptance of Emotional Responses (Nonacceptance; 6 items)

This dimension assesses tendencies to generate secondary negative reactions to primary emotional distress, characterized by self-directed anger, guilt, shame, embarrassment, or severe self-criticism. Individuals scoring high on this dimension experience distress over being distressed (e.g., “When I’m upset, I feel ashamed with myself for feeling that way”). This secondary nonacceptance amplifies psychological suffering, fuels experiential avoidance, and is strongly associated with dissociative states and internalizing pathology.

2. Difficulty Engaging in Goal-Directed Behavior (Goals; 5 items)

This subscale captures difficulties in executive cognitive control, sustained attention, and task completion when experiencing negative affect. It assesses whether emotional arousal hijacks executive faculties (e.g., “When I’m upset, I have difficulty concentrating” and “When I’m upset, I have difficulty getting work done”). High scores reflect a disruption in top-down self-regulation, resulting in academic, vocational, and interpersonal impairment during stressful events.

3. Impulse Control Difficulties (Impulse; 6 items)

This dimension gauges the extent to which an individual loses control over motoric and behavioral responses when dysregulated. It indexes behavioral disinhibition, reactive acting out, and subjective loss of agency during negative emotional spikes (e.g., “When I’m upset, I lose control over my behaviours”). Elevated Impulse scores represent a key marker for behavioral externalizing, non-suicidal self-injury, aggressive outbursts, and substance misuse.

4. Lack of Emotional Awareness (Awareness; 6 items, all reverse-scored)

The Awareness subscale measures the tendency to attend to, acknowledge, and validate internal emotional signals (e.g., “I pay attention to how I feel” and “When I’m upset, I acknowledge my emotions”). High dysregulation scores indicate affective alexithymia-like deficits, somatic detachment, or chronic experiential neglect, wherein internal physiological shifts fail to reach conscious attentional processing.

5. Limited Access to Emotion Regulation Strategies (Strategies; 8 items)

This subscale assesses an individual’s subjective expectation of helplessness and perceived lack of efficacy in recovering from negative emotional states. Respondents with elevated scores believe that once they become upset, emotional stabilization is nearly impossible without external intervention, wallowing, or protracted suffering (e.g., “When I’m upset, I believe that there is nothing I can do to make myself feel better”). It reflects an absence of a flexible behavioral and cognitive regulatory repertoire.

6. Lack of Emotional Clarity (Clarity; 5 items)

This dimension indexes the degree to which an individual knows, distinguishes, and defines the specific qualitative nature of their emotional states (e.g., differentiating between sadness, anger, fear, and fatigue). Elevated scores reflect affective confusion, undifferentiated emotional experience, and difficulty making sense of internal feeling states (e.g., “I have difficulty making sense out of my feelings”).

6. Theoretical Framework

The DERS is theoretically embedded within functionalist theories of emotion, cognitive-behavioral conceptualizations, and evolutionary biology. Central to this theoretical architecture are the writings of James J. Gross, Marsha M. Linehan, Ross Thompson, and Pamela Cole. These frameworks converge on several foundational axioms:

Functionalism and Evolutionary Utility of Emotions

Functionalist models assert that emotions are evolved, patterned psychophysiological adaptations designed to coordinate systemic responses to environmental threats and opportunities. Emotions prepare the organism for adaptive action (e.g., fear triggers avoidance; anger mobilizes resource defense; sadness elicits interpersonal support and conserves metabolic resources). Consequently, Gratz and Roemer posited that attempts to suppress, purge, or eliminate negative emotionality are fundamentally maladaptive. Dysregulation, therefore, is not defined by emotional experiencing per se, but by interference with the functional action tendencies of emotions.

Biosocial Theory and Experiential Avoidance

The theoretical construction of the DERS heavily incorporates Linehan’s (1993) biosocial theory of borderline personality disorder. Linehan conceptualized pervasive emotion dysregulation as the consequence of biological affective vulnerability interacting dynamically with an invalidating developmental environment. In this environment, children learn that their private affective states are wrong, trivial, or shameful. Over time, individuals develop pronounced nonacceptance of emotional responses, pervasive self-invalidation, and extreme secondary emotional reactions, precluding the development of adequate regulatory self-soothing skills.

Similarly, the DERS reflects the tenets of experiential avoidance from Acceptance and Commitment Therapy (Hayes et al., 1996). When individuals lack emotional clarity and awareness, or when they view affective states as catastrophic, they engage in inflexible avoidance tactics (such as impulsive behavior, dissociation, or substance abuse) that perpetuate psychiatric symptomatology.

Gross’s Process Model of Emotion Regulation

The DERS broadens Gross’s (1998) classic modal model of emotion regulation. Gross categorizes regulatory strategies chronologically into antecedent-focused interventions (situation selection, situation modification, attentional deployment, cognitive reappraisal) and response-focused interventions (expressive suppression, physiological modulation). Gratz and Roemer incorporated these dynamic operational stages by emphasizing that access to effective cognitive strategies (Strategies) and the ability to maintain task-relevant focus (Goals) require intact prior stages of affective perception (Awareness) and cognitive processing (Clarity).

7. Validity

The psychometric validity of the DERS has been examined in hundreds of empirical studies spanning non-clinical community cohorts, collegiate populations, and severely distressed clinical psychiatric cohorts.

Construct and Structural Validity

Gratz and Roemer (2004) demonstrated that the 36 items load onto six discrete, theoretically meaningful dimensions that collectively index emotion dysregulation. Subsequent large-scale investigations, such as Hallion et al. (2018), utilizing samples of over 420 adults diagnosed with clinical DSM-5 anxiety and depressive disorders, confirmed that the multidimensional construct significantly distinguishes clinical patients from non-clinical healthy controls across all six dimensions.

Convergent Validity

The DERS exhibits robust convergent validity with established measures of affective pathology, negative emotionality, and related behavioral constructs:

• Experiential Avoidance: Substantial positive correlations have been repeatedly demonstrated with the Acceptance and Action Questionnaire (AAQ and AAQ-II; r values typically ranging between .55 and .72), indicating that elevated DERS dysregulation scores correspond strongly with psychological inflexibility.
• Affective Pathology: DERS total and subscale scores correlate significantly with the Beck Depression Inventory (BDI-II; r = .50 to .68) and the State-Trait Anxiety Inventory (STAI-Trait; r = .55 to .73).
• Borderline Personality Pathology: High correlations exist between the DERS (particularly Nonacceptance, Impulse, and Strategies) and the Personality Assessment Inventory Borderline Features Scale (PAI-BOR; r = .60 to .75).
• Alexithymia: The Clarity and Awareness subscales show strong convergent validity with the Toronto Alexithymia Scale (TAS-20), particularly the “Difficulty Identifying Feelings” and “Difficulty Describing Feelings” subscales (r > .60).

Discriminant Validity

The DERS successfully discriminates emotion dysregulation from related, but conceptually distinct, constructs such as positive emotionality, general physical health status, and unrelated personality dimensions (such as Openness to Experience or Extraversion on the NEO-PI-R). Furthermore, studies demonstrate that the DERS accounts for significant unique variance in clinical outcomes above and beyond general negative affectivity (e.g., PANAS-NA), confirming that the scale is not merely indexing trait neuroticism.

Predictive and Ecological Validity

The predictive utility of the DERS has been substantiated across diverse behavioral and clinical outcomes:

• Self-Directed Violence: Gratz and Roemer (2004, 2008) observed that DERS scores (specifically Impulse and Strategies) prospectively predict non-suicidal self-injury (NSSI) frequency and suicidal ideation, independently of depressive severity.
• Treatment Outcomes: In outpatient clinical settings, Hallion et al. (2018) established that pre-treatment DERS scores predict the magnitude of symptomatic reduction following Cognitive Behavioral Therapy (CBT). Patients with high baseline emotional dysregulation exhibited greater overall gains, demonstrating that therapeutic acquisition of emotion regulation skills is a functional mechanism of cognitive-behavioral recovery.

8. Reliability

The Difficulties in Emotion Regulation Scale demonstrates excellent internal consistency and temporal stability across a broad spectrum of empirical investigations.

Internal Consistency

In the seminal psychometric validation study by Gratz and Roemer (2004) utilizing undergraduate participants (N = 357), the internal consistency for the total scale was high (Cronbach’s α = .93). Subscale internal consistencies were consistently adequate to high:

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

Subsequent psychometric evaluations across diverse populations have systematically confirmed these findings. In a clinical outpatient sample of 427 adults diagnosed with mood and anxiety disorders, Hallion et al. (2018) documented an overall Cronbach’s alpha of .94, with subscale coefficients ranging from .80 to .91 (Nonacceptance: α = .89; Goals: α = .88; Impulse: α = .88; Awareness: α = .80; Strategies: α = .91; Clarity: α = .84). Modern evaluations computing McDonald’s hierarchical omega (ω_h) and total omega (ω_t) routinely report total scale ω_t exceeding .95.

Test-Retest Stability

Gratz and Roemer (2004) assessed the temporal stability of the DERS over an interval of 4 to 8 weeks (mean interval = 4.4 weeks) in a sub-sample of participants. Test-retest reliability was robust:

• Total Score: Intraclass correlation coefficient (r) = .88 (p < .001)
• Nonacceptance: r = .69
• Goals: r = .69
• Impulse: r = .57
• Awareness: r = .68
• Strategies: r = .89
• Clarity: r = .80

These coefficients illustrate that while the DERS measures a stable trait-like disposition toward emotional dysregulation, its subscales remain sufficiently sensitive to capture state-level therapeutic shifts resulting from clinical interventions.

9. Factor Analysis

The factorial validity of the DERS has been subjected to rigorous exploratory factor analyses (EFA), confirmatory factor analyses (CFA), and exploratory structural equation modeling (ESEM) across numerous independent cultures and languages.

Exploratory Factor Analysis (EFA)

In the scale development phase, Gratz and Roemer (2004) subjected an initial 43-item experimental pool to principal axis factoring with promax (oblique) rotation. Item retention was governed by strict psychometric criteria: item loadings ≥ .40 on the primary factor and cross-loadings < .25 on all secondary factors. Seven items failed to satisfy these criteria and were eliminated, yielding the final 36-item, six-factor solution accounting for 48.6% of the total variance.

Confirmatory Factor Analysis (CFA) and Goodness-of-Fit

Numerous CFA studies have compared competing factor structures, such as a unidimensional model, an uncorrelated orthogonal model, a correlated six-factor model, and a second-order hierarchical model where the six factors load onto a general emotion dysregulation construct.

Across empirical datasets (e.g., Bardeen et al., 2012; Hallion et al., 2018; Osborne et al., 2017), the correlated six-factor model systematically outperforms both unidimensional and orthogonal structures. Standard goodness-of-fit indices typically conform to modern structural benchmarks:

• Root Mean Square Error of Approximation (RMSEA): Values consistently range between .045 and .062 (indicating close approximate fit).
• Comparative Fit Index (CFI): Ranges between .91 and .95 in adequately powered clinical and non-clinical cohorts.
• Tucker-Lewis Index (TLI): Typically > .90.
• Standardized Root Mean Square Residual (SRMR): Values consistently < .06.

The Awareness Subscale Debate

A recurring topic within the psychometric literature focuses on the Awareness subscale. During second-order factor modeling, the Awareness dimension often demonstrates low or non-significant factor loadings on the overarching emotion dysregulation higher-order factor (often λ < .30), whereas the remaining five subscales load strongly (λ = .65 to .90). Furthermore, Bardeen et al. (2012) and Hallion et al. (2018) noted that when Awareness is excluded from the total score, the internal consistency, convergent validity with clinical psychopathology, and overall model fit of the DERS frequently improve.

Psychometricians interpret this anomaly through several lenses: first, all items on the Awareness subscale are reverse-scored, introducing potential method-effect variance related to negative item phrasing. Second, attending to emotions (Awareness) is conceptually distinct from knowing what one feels (Clarity) or tolerating what one feels (Nonacceptance). Individuals with high somatic awareness who lack regulation strategies may experience greater subjective distress, whereas some individuals who completely disregard emotions may report fewer dysregulation symptoms despite functional impairment. Despite this nuance, clinical consensus maintains the inclusion of the Awareness subscale because conscious processing of emotional stimuli is clinically indispensable for adaptive emotional functioning.

10. Instrument / Measurement Tool

The Difficulties in Emotion Regulation Scale (DERS) is a self-administered psychometric assessment that can be implemented in paper-and-pencil or computerized formats.

• Scale Name: Difficulties in Emotion Regulation Scale (DERS)
• Original Developers: Kim L. Gratz, Ph.D., and Lizabeth Roemer, Ph.D. (2004)
• Measurement Format: 36 items; self-report questionnaire
• Response Modality: 5-point Likert scale:
  • 1 = Almost never (0–10%)
  • 2 = Sometimes (11–35%)
  • 3 = About half the time (36–65%)
  • 4 = Most of the time (66–90%)
  • 5 = Almost always (91–100%)
• Administration Time: Approximately 7 to 10 minutes
• Target Population: Adults and adolescents (ages 12 and older; an adolescent-validated version, DERS-A, is also widely utilized)
• Scoring and Reverse Items:
  • Reverse-Scored Items (11 items): Items 1, 2, 6, 7, 8, 10, 17, 20, 22, 24, and 34. For these items, values must be inverted prior to calculation: 1 becomes 5, 2 becomes 4, 3 remains 3, 4 becomes 2, and 5 becomes 1.
  • Direct-Scored Items (25 items): Items 3, 4, 5, 9, 11, 12, 13, 14, 15, 16, 18, 19, 21, 23, 25, 26, 27, 28, 29, 30, 31, 32, 33, 35, and 36 are scored using their face value (1 to 5).
• Subscale Item Composition:
  • Nonacceptance of Emotional Responses: Items 11, 12, 21, 23, 25, 29 (Score range: 6–30)
  • Difficulty Engaging in Goal-Directed Behavior: Items 13, 18, 20R, 26, 33 (Score range: 5–25)
  • Impulse Control Difficulties: Items 3, 14, 19, 24R, 27, 32 (Score range: 6–30)
  • Lack of Emotional Awareness: Items 2R, 6R, 8R, 10R, 17R, 34R (Score range: 6–30)
  • Limited Access to Emotion Regulation Strategies: Items 15, 16, 22R, 28, 30, 31, 35, 36 (Score range: 8–40)
  • Lack of Emotional Clarity: Items 1R, 4, 5, 7R, 9 (Score range: 5–25)
• Total Score Calculation: Summation of all 36 items following appropriate item reversal. Total raw scores range from 36 to 180, where higher scores signify greater severity of emotion regulation difficulties.
• Clinical Reference Norms (Adult Outpatient Sample; Hallion et al., 2018):
  • Total DERS: Mean = 89.33, SD = 22.64
  • Nonacceptance: Mean = 14.67, SD = 5.92
  • Goals: Mean = 15.42, SD = 4.22
  • Impulse: Mean = 12.58, SD = 4.97
  • Awareness: Mean = 15.55, SD = 4.92
  • Strategies: Mean = 19.67, SD = 7.31
  • Clarity: Mean = 12.01, SD = 4.04

11. Permissions & Fee and Test Year

The Difficulties in Emotion Regulation Scale was formally published in 2004 by Kim L. Gratz and Lizabeth Roemer in the Journal of Psychopathology and Behavioral Assessment (Volume 26, Issue 1, pp. 41–54). The scale was placed in the public domain for academic, clinical, and non-commercial empirical research purposes by its authors. Clinicians, researchers, and healthcare organizations may administer and score the original 36-item DERS without royalty fees or formal licensing requirements, provided appropriate academic citation and attribution are given to Gratz and Roemer (2004). Commercial enterprises seeking to package the scale into proprietary commercial software suites or profit-generating testing batteries are advised to seek direct written permissions via the copyright holder (Springer Science+Business Media / Springer Nature).

12. References

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-x

Cole, P. M., Michel, M. K., & Teti, L. O. (1994). The development of emotion regulation and dysregulation: A clinical perspective. Monographs of the Society for Research in Child Development, 59(2–3), 73–100. https://doi.org/10.2307/1166139

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., & Roemer, L. (2008). The relationship between emotion dysregulation and deliberate self-harm among inpatients with substance use disorders. Cognitive Therapy and Research, 32(1), 14–26. https://doi.org/10.1007/s10608-007-9168-4

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

Hallion, L. S., Steinman, S. A., Tolin, D. F., & Diefenbach, G. J. (2018). Psychometric properties of the Difficulties in Emotion Regulation Scale (DERS) and its short forms in adults with emotional disorders. Frontiers in Psychology, 9, Article 539. https://doi.org/10.3389/fpsyg.2018.00539

Hayes, S. C., Wilson, K. G., Gifford, E. V., Follette, V. M., & Strosahl, K. (1996). Experiential 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.

Osborne, T. L., Michielsens, S., Rollins, A. T., & Billingsley, A. L. (2017). Factor structure of the Difficulties in Emotion Regulation Scale in a diverse psychiatric outpatient sample. Journal of Psychopathology and Behavioral Assessment, 39(4), 698–709. https://doi.org/10.1007/s10862-017-9613-2

Thompson, R. A. (1994). Emotion regulation: A theme in search of definition. Monographs of the Society for Research in Child Development, 59(2–3), 25–52. https://doi.org/10.2307/1166137

13. Items of the Scale