Dissociative Experiences Scale – II (DES-II)

Abstract

The Dissociative Experiences Scale – II (DES-II) is an internationally recognized, 28-item self-report psychological instrument engineered to quantify the frequency and severity of dissociative phenomena in both clinical and non-clinical populations. Originally conceptualized by Eve B. Carlson and Frank W. Putnam as an operational refinement of the 1986 visual analog scale (DES-I), the DES-II utilizes a modernized 11-point percentage response format (ranging from 0% to 100% of the time, in 10% increments) that enhances administrative efficiency, respondent comprehension, and quantitative scoring fidelity. The instrument captures a multidimensional construct spanning normative dissociative absorption to profound post-traumatic and structural pathology, traditionally organized into three core empirical factors: Amnesia (memory loss for routine actions or significant personal events), Depersonalization/Derealization (perceptual estrangement from one’s self, bodily sensations, or the external environment), and Absorption and Imaginative Involvement (deep immersion in internal fantasy, media, or tasks accompanied by transient environmental obliviousness).

Extensive psychometric investigations, including benchmark meta-analyses by van IJzendoorn and Schuengel (1996) and Lyssenko et al. (2018), have established the DES-II as a gold standard in dissociation psychometrics. The measure exhibits exceptional internal consistency (Cronbach’s α typically ranging between .93 and .96) and robust test-retest reliability (ranging from r = .78 to .93). A global cutoff score of 30 reliably discriminates patients suffering from severe dissociative conditions, such as Dissociative Identity Disorder (DID) and Post-Traumatic Stress Disorder (PTSD), from general psychiatric and community samples. Taxometric analyses have further delineated an 8-item subscale, the DES-Taxon (DES-T), serving as a pseudo-typological marker for pathological dissociation. This comprehensive profile underscores the scale’s indispensability across diagnostic screening, trauma-informed treatment tracking, and transdiagnostic cognitive research.

Keywords

Dissociative Experiences Scale – II, DES-II, dissociation, psychological trauma, post-traumatic stress disorder, dissociative identity disorder, depersonalization, derealization, psychometrics, screening tool, structural dissociation

Authors

The Dissociative Experiences Scale – II was formulated and refined by two pioneering researchers in the field of trauma psychopathology, developmental psychology, and psychiatric assessment:

• Eve B. Carlson, Ph.D. — Senior Research Psychologist and Director at the National Center for Posttraumatic Stress Disorder (PTSD), Dissemination and Training Division, VA Palo Alto Health Care System, and Affiliated Clinical Professor in the Department of Psychiatry and Behavioral Sciences at Stanford University School of Medicine. Dr. Carlson is an internationally recognized authority on traumatic stress, the operational measurement of post-traumatic and dissociative symptoms, and evidence-based trauma assessment protocols.
• Frank W. Putnam, M.D. — Emeritus Professor of Pediatrics and Psychiatry at the University of Cincinnati College of Medicine and Research Professor of Psychiatry at the University of North Carolina at Chapel Hill. Dr. Putnam previously served as Chief of the Unit on Dissociative Disorders at the National Institute of Mental Health (NIMH). His groundbreaking research has systematically illuminated the developmental trajectory of child maltreatment, neuroendocrine dysfunction, and severe chronic structural dissociation.

Purpose

The primary clinical and empirical purpose of the Dissociative Experiences Scale – II (DES-II) is to serve as an ecologically valid, easily administered, and standardized self-report metric for quantifying the phenomenological spectrum of dissociation. Historically, clinical recognition of dissociative conditions was severely impeded by the absence of uniform, non-stigmatizing psychometric instruments capable of capturing experiences that patients frequently conceal due to shame, confusion, or fear of psychiatric labeling. The DES-II resolves this diagnostic barrier by framing items through a normative introductory vignette format (“Some people have the experience of…”) and explicitly instructing respondents to exclude states induced by alcohol, illicit substances, or prescribed intoxicants.

In clinical practice, the DES-II is utilized as a frontline screening mechanism rather than an autonomous diagnostic criterion. Its primary functional objectives encompass:

• Screening for Complex Trauma and Dissociative Pathology: Rapidly identifying individuals at elevated risk for Dissociative Disorders as classified under the DSM-5-TR and ICD-11, such as Dissociative Amnesia, Depersonalization/Derealization Disorder, Other Specified Dissociative Disorder (OSDD), and Dissociative Identity Disorder (DID).
• Transdiagnostic Evaluation: Quantifying secondary dissociative manifestations frequently observed in borderline personality disorder (BPD), complex PTSD (C-PTSD), conversion (functional neurological symptom) disorder, and treatment-resistant major depression.
• Treatment Planning and Monitoring: Tracking therapeutic progress over time in trauma-focused interventions. Given that acute dissociative episodes often interfere with emotional processing and cognitive-behavioral exposure therapies, establishing a baseline DES-II score alerts clinicians to the potential need for stabilization, sensory grounding, and somatic containment strategies prior to trauma-memory processing.
• Epidemiological and Laboratory Research: Facilitating large-scale research studies on the cognitive, neuropsychological, and structural brain correlates of disrupted integrative consciousness, including neuroimaging studies examining functional connectivity anomalies between the amygdala, insula, and medial prefrontal cortex.

Psychological Construct

The psychological construct evaluated by the DES-II is dissociation, defined in contemporary clinical psychology as a disruption in the usually integrated functions of consciousness, memory, identity, emotion, perception, body representation, motor control, and behavior. Rather than representing an isolated symptom, dissociation manifests as a complex multifaceted phenomenon ranging from benign normative experiences to severe post-traumatic psychopathology.

1. Dissociative Amnesia

The amnesia dimension assesses severe lapses in autobiographical recall that cannot be attributed to ordinary neurobiological forgetfulness, fatigue, or medical illness. Within the DES-II framework, this factor captures dissociative memory barriers wherein conscious continuity is breached. Key manifestations include:

• Fugue-like Spatial Disorientation: Arriving at physical locations without conscious recollection of the transit process (Item 3).
• Evidence of Complex Unremembered Actions: Discovering acquired garments (Item 4), purchased objects (Item 5), or produced artwork and handwritten notes (Item 26) with complete absence of executive recall.
• Social Relational Lapses: Being confronted by acquaintances or family members whom the individual fails to recognize, or being addressed by unfamiliar names (Items 6 and 8).

2. Depersonalization and Derealization

This perceptual-cognitive factor captures profound alterations in the subjective experience of the self and the external environment:

• Depersonalization: Characterized by anomalous self-awareness wherein the individual feels disconnected from their own mental processes, thoughts, or physical anatomy. Classic indicators include autoscopic out-of-body experiences (feeling as though standing beside oneself, Item 7), somatic alienation (feeling that one’s body does not belong to oneself, Item 13), mirror self-unrecognition (Item 11), and internal auditory pseudo-hallucinations or commentaries (Item 27).
• Derealization: Denotes an experiential alienation from external reality, wherein the physical world, surroundings, and people appear dreamlike, artificial, two-dimensional, synthetic, or visual-perceptually obscured as if gazing through a heavy fog or glass wall (Items 12, 16, and 28).

3. Absorption and Imaginative Involvement

Absorption reflects an individual’s propensity to enter states of heightened, focal attention accompanied by total perceptual occlusion of surrounding environmental cues. While this dimension includes normative phenomena common in non-traumatized high-hypnotizability populations (e.g., profound immersion in movies, books, or daydreams; Items 17 and 18), within clinical populations it frequently correlates with traumatic intrusions, flashback revivification (reliving past events with overwhelming sensory vividness; Item 14), and spontaneous hypnotic trance phenomena (Items 2 and 20).

4. The DES-Taxon (DES-T) Dimension

Subsequent psychometric scholarship established that the construct contains a latent qualitative divergence. While mild absorption lies along a normal continuous spectrum of human consciousness, severe dissociative amnesia and depersonalization/derealization constitute a distinct taxonic entity. The DES-Taxon construct isolates structural psychopathology resulting from severe chronic developmental maltreatment, clearly delineating pathological structural dissociation from dimensional variations in cognitive daydreaming.

Theoretical Framework

The theoretical bedrock of the DES-II is rooted in historical psycho-traumatology, modern cognitive-developmental theories, and the structural dissociation framework:

1. Janetian Psychopathology and Structural Disintegration

The foundational paradigm traces directly to the pioneering clinical observations of Pierre Janet (1889). Janet posited that overwhelming emotional distress and psychological trauma exceed the synthesis capacity of the psyche, prompting a breakdown in what he termed mental synthesis. Janet theorized that fragments of traumatic memories, sensory fragments, and motor behaviors split off from conscious primary awareness to form autonomous subconscious systems (idées fixes). The DES-II operationalizes these Janettian conceptualizations by assessing the automatic, involuntary emergence of unintegrated memory states, spontaneous perceptual splits, and autonomous motor actions.

2. Neodissociation Theory and the Divided Consciousness

In the mid-20th century, Ernest Hilgard advanced his Neodissociation Theory, proposing that human cognitive architecture is governed by a hierarchical network of cognitive control systems supervised by an executive monitoring mechanism. Under conditions of hypnosis, acute stress, or survival threat, functional barriers can erect between these cognitive subsystems. Hilgard posited the existence of a ‘hidden observer’—a latent cognitive monitoring stream that processes incoming data while primary awareness remains insulated. The DES-II items systematically probe instances where executive monitoring is bypassed, leading to experiences such as speaking aloud without conscious intent, tuning out severe physical pain (Item 19), or losing executive access to recent behavioral outputs.

3. The Theory of Structural Dissociation of the Personality

Developed by Onno van der Hart, Ellert Nijenhuis, and Kathy Steele, the Theory of Structural Dissociation of the Personality conceptualizes trauma-induced dissociation as a failure of integration between two distinct psychological systems: the Apparently Normal Part of the Personality (ANP), dedicated to managing daily survival and social functioning, and the Emotional Part of the Personality (EP), fixated on defense mechanisms (fight, flight, freeze, or collapse) and harboring unintegrated traumatic memories. In tertiary structural dissociation (DID), multiple ANPs and EPs emerge. The DES-II captures this internal division through items assessing profound personality shifts across situations (Item 22), abrupt affective changes, and intrusive internal auditory commands or dialogues (Item 27).

4. Betrayal Trauma and Evolutionary Defense Mechanisms

Jennifer Freyd’s Betrayal Trauma Theory provides an evolutionary rationale for dissociative amnesia and absorption. When trauma is inflicted by essential caregivers, conscious recognition of the abuse threatens survival attachment. Dissociation allows children to maintain adaptive blindness toward maltreatment to preserve necessary attachment bonds. In adulthood, these conditioned dissociative defense mechanisms persist, manifesting as the pervasive amnesic and depersonalizing symptomatology indexed by the DES-II.

Validity

The construct, convergent, discriminant, and predictive validity of the DES-II have been extensively corroborated across diverse clinical and cross-cultural cohorts:

1. Convergent and Concurrent Validity

The DES-II shows robust positive correlations with other standardized instruments designed to quantify trauma and dissociation. Across the literature, DES scores correlate strongly with:

• Structured Clinical Interview for DSM-IV Dissociative Disorders (SCID-D): Pearson correlation coefficients typically range from r = .68 to .84, demonstrating excellent concurrent alignment with gold-standard diagnostic clinician interviews.
• Dissociative Disorders Interview Schedule (DDIS): Demonstrates high convergent convergence (r = .70 to .82).
• Trauma Symptom Checklist / Trauma Symptom Inventory (TSI): Strong positive associations with the Dissociation and Intrusive subscales (r = .60 to .75).
• Childhood Trauma Questionnaire (CTQ): High predictive validity regarding historical severe childhood emotional, physical, and sexual maltreatment (r = .40 to .62).

2. Discriminant Validity

The scale effectively differentiates dissociative pathology from general psychiatric distress, neuroticism, and psychotic conditions. Although schizophrenia spectrum disorders may yield moderately elevated scores due to confusion regarding auditory hallucinations, qualitative scoring of items 7, 11, 12, and 13 successfully separates primary dissociative alienation from true psychotic reality distortions. Furthermore, correlation coefficients with basic somatic symptom inventories or non-trauma-related anxiety inventories rarely exceed r = .30, establishing clear discriminant boundaries.

3. Predictive and Criterion Validity (Normative and Clinical Data)

The benchmark meta-analysis conducted by van IJzendoorn and Schuengel (1996) synthesized data across 40+ empirical investigations (N = 4,960) and delineated distinct, robust normative reference profiles across populations:

• Non-clinical Adult Community Samples: Mean = 11.6 (SD = 10.6)
• Adolescent and Student Samples: Mean = 14.3 (SD = 14.3)
• General Psychiatric Outpatients: Mean = 16.7 (SD = 16.4)
• Borderline and Personality Disorders: Mean = 19.6 (SD = 16.2)
• Individuals with Documented History of Severe Abuse: Mean = 29.2 (SD = 21.0)
• Post-Traumatic Stress Disorder (PTSD): Mean = 32.0 (SD = 19.2)
• Dissociative Disorders (OSDD, DID): Mean = 41.2 (SD = 22.0), with verified DID cohorts frequently exhibiting mean scores exceeding 50.0.

A global cutoff score of 30.0 is widely recognized in psychiatric literature as offering optimal diagnostic utility. Operating at this threshold yields sensitivity estimates of approximately 74% to 80% and specificity estimates ranging from 80% to 87% for identifying covert and overt dissociative disorders within clinical intake environments.

Reliability

The DES-II exhibits high reliability across varied linguistic, cultural, and psychiatric cohorts:

1. Internal Consistency

Across non-clinical populations, university cohorts, and clinical samples, Cronbach’s alpha (α) coefficients routinely span from .93 to .96. The subscales similarly demonstrate strong internal cohesion:

• Amnesia Subscale: α = .82 to .89
• Depersonalization/Derealization Subscale: α = .84 to .92
• Absorption Subscale: α = .80 to .88

Split-half reliability coefficients, calculated utilizing the Guttman and Spearman-Brown formulas, consistently exceed .90, demonstrating exceptional internal homogeny across the 28 items.

2. Test-Retest Reliability

Temporal stability assessments have demonstrated that the DES-II maintains impressive stability over both short and longitudinal time horizons:

• Across a 2- to 4-week test-retest period in stable clinical cohorts, Pearson’s r correlation coefficients consistently range between .84 and .93.
• Over extended intervals (e.g., 6 to 12 months) in non-treatment cohorts, coefficients remain robust (r = .78 to .85), demonstrating that the underlying construct functions as a stable trait in the absence of targeted trauma psychotherapy.

The Standard Error of Measurement (SEM) remains low (approximately 3.5 to 4.2 points on a 0–100 scale), confirming that observed changes of 10 points or more during longitudinal therapeutic interventions represent true clinical symptom shifts rather than psychometric measurement error.

Factor Analysis

The internal factorial architecture of the DES and DES-II has been the subject of extensive psychometric investigation, yielding both continuous dimensional and taxonic models:

1. The Three-Factor Model

Carlson and Putnam’s initial exploratory factor analyses (EFA), replicated across multiple clinical populations using principal components analysis with varimax rotation, identified a classic three-factor structure accounting for 45% to 58% of the total variance:

• Factor 1: Dissociative Amnesia (Items 3, 4, 5, 8, 25, 26; factor loadings ranging from .55 to .78).
• Factor 2: Depersonalization / Derealization (Items 7, 11, 12, 13, 27, 28; factor loadings ranging from .58 to .82).
• Factor 3: Absorption / Imaginative Involvement (Items 2, 14, 15, 17, 18, 20; factor loadings ranging from .49 to .74).

2. The Unifactorial / General Dissociation Model

In contrast to the three-factor model, meta-analytic structural evaluations (van IJzendoorn & Schuengel, 1996) and several large-sample confirmatory factor analyses (CFA) have demonstrated that the intercorrelations between these three factors are exceptionally high (often r > .75). Consequently, a hierarchical higher-order or unifactorial model frequently provides equivalent or superior parsimonious fit indices:

• Comparative Fit Index (CFI): .92 to .95
• Tucker-Lewis Index (TLI): .91 to .94
• Root Mean Square Error of Approximation (RMSEA): .052 to .068

These findings substantiate the practice of calculating and prioritizing the single composite DES-II Total Score over individual subscale interpretations in clinical decision-making.

3. The Taxometric DES-T Structure

Utilizing taxometric methodologies developed by Paul Meehl (including MAMBAC, MAXCOV, and MAXEIG procedures), Waller, Putnam, and Carlson (1996) established that the DES items capture two qualitatively distinct populations: a normative dimensional continuum and a discrete pathological taxon. They isolated an 8-item pseudo-subscale known as the DES-Taxon (DES-T), comprised of Items 3, 5, 7, 8, 12, 13, 22, and 27. When an individual scores heavily on these specific items, Bayesian analysis yields a high posterior taxon probability, signaling severe pathological dissociation rather than benign absorption.

Instrument / Measurement Tool

The DES-II is organized with the following structural, quantitative, and administrative parameters:

• Test Type: Standardized self-report psychiatric screening questionnaire.
• Administrative Format: Paper-and-pencil, computer-based assessment, or clinical interview prompt. Self-administered.
• Completion Duration: Approximately 10 to 15 minutes.
• Target Demographics: Adolescents and adults (ages 12 and older; developmental adaptations exist for younger cohorts).
• Number of Items: 28 items.
• Item Phrasing Structure: Formulated as non-pathologizing, third-person vignettes (“Some people have the experience of…”).
• Authentic Response Scale: 11-point percentage scale (0%, 10%, 20%, 30%, 40%, 50%, 60%, 70%, 80%, 90%, 100% of the time).
• Explicit Exclusionary Condition: Respondents are explicitly directed to answer reflecting only times when they were not under the influence of alcohol, recreational drugs, or medication-induced intoxication.
• Scoring Algorithm:
  • Global Total Score: Calculated by summing the numerical percentage ratings across all 28 items and dividing by 28 (i.e., the mathematical mean). The resulting score spans from 0.0 to 100.0.
  • Subscale Scores:
    • Amnesia Factor: Mean of Items 3, 4, 5, 8, 25, 26.
    • Depersonalization/Derealization Factor: Mean of Items 7, 11, 12, 13, 27, 28.
    • Absorption Factor: Mean of Items 2, 14, 15, 17, 18, 20.
  • DES-Taxon (DES-T) Score: Calculated by taking the mean of Items 3, 5, 7, 8, 12, 13, 22, and 27. Scores > 20 on the DES-T convey a heightened Bayesian probability of categorical structural dissociation.
• Clinical Interpretation Ranges:
  • 0.0 to 15.0: Normal range. Characteristic of healthy community adults, common daydreams, and benign absorption.
  • 15.1 to 29.9: Mild to moderate dissociation. Typical of general psychiatric outpatients, mood disorders, or anxiety spectrums; elevated trauma vigilance.
  • 30.0 or Higher: Clinically elevated range. Signals probable post-traumatic stress disorder, severe borderline personality disorder, or a dissociative disorder. Thorough clinician evaluation using the SCID-D or DDIS is strongly indicated.
  • 45.0 or Higher: Severe dissociative pathology. Highly indicative of Dissociative Identity Disorder (DID) or Other Specified Dissociative Disorder (OSDD-1).

Permissions & Fee and Test Year

The original Dissociative Experiences Scale (DES-I) was introduced in 1986 by Elizabeth M. Bernstein and Frank W. Putnam, utilizing a 100mm visual analog scale. In 1993, Eve B. Carlson and Frank W. Putnam published the Dissociative Experiences Scale – II (DES-II), replacing the cumbersome physical visual analog line with the modern 11-point numerical percentage response scale (0% to 100% in 10% steps).

Licensing and Accessibility: The authors placed the DES and DES-II in the public domain to ensure universal access for psychiatric researchers, clinical practitioners, and academic institutions worldwide. There are no proprietary purchase fees, royalties, or mandatory scoring licensing charges. Qualified researchers and clinicians may freely reproduce, translate, and digitize the instrument, provided that standard academic attribution is preserved and items remain unaltered.

References

Bernstein, E. M., & Putnam, F. W. (1986). Development, reliability, and validity of a dissociation scale. The Journal of Nervous and Mental Disease, 174(12), 727–735. https://doi.org/10.1097/00005053-198612000-00004

Carlson, E. B., & Putnam, F. W. (1993). An update on the Dissociative Experiences Scale. Dissociation: Progress in the Dissociative Disorders, 6(1), 16–27. https://scholarsbank.uoregon.edu/xmlui/handle/1794/1454

Hilgard, E. R. (1977). Divided consciousness: Multiple controls in human thought and action. John Wiley & Sons.

Janet, P. (1889). L’Automatisme psychologique: Essai de psychologie expérimentale sur les formes inférieures de l’activité humaine. Felix Alcan.

Lyssenko, L., Schmahl, C., Bockhacker, L., Vonderlin, R., Bohus, M., & Kleindienst, N. (2018). Dissociation in psychiatric disorders: A meta-analysis of studies using the Dissociative Experiences Scale. American Journal of Psychiatry, 175(1), 37–46. https://doi.org/10.1176/appi.ajp.2017.17010025

van der Hart, O., Nijenhuis, E. R. S., & Steele, K. (2006). The haunted self: Structural dissociation and the treatment of chronic traumatization. W. W. Norton & Company.

van IJzendoorn, M. H., & Schuengel, C. (1996). The measurement of dissociation in normal and clinical populations: Meta-analytic validation of the Dissociative Experiences Scale (DES). Clinical Psychology Review, 16(5), 365–382. https://doi.org/10.1016/0272-7358(96)00006-2

Waller, N. G., Putnam, F. W., & Carlson, E. B. (1996). Types of dissociation and dissociative types: A taxometric analysis of dissociative experiences. Psychological Methods, 1(3), 300–321. https://doi.org/10.1037/1082-989X.1.3.300

Items of the Scale