[{"data":1,"prerenderedAt":-1},["ShallowReactive",2],{"assessment-did-test":3,"all-assessments-nav":435,"related-assessments-query":1115},{"id":4,"title":5,"body":6,"category":376,"categoryTitle":377,"clinicalCitations":378,"copyright":376,"description":391,"disclaimer":376,"downloadLink":376,"extension":392,"faqs":393,"featured":406,"i18nReady":406,"icon":376,"interpreter":407,"lastReviewed":425,"meta":426,"navigation":427,"path":428,"permissionsNote":376,"published":406,"recommendedFrequency":376,"relatedCodes":376,"relatedConditions":376,"reviewedBy":376,"seo":429,"slug":430,"stem":431,"summary":432,"takeaways":376,"timeline":376,"type":433,"usedToDiagnose":376,"__hash__":434},"assessments\u002Fassessments\u002Fdid-test.md","DID Test (Dissociative Identity Disorder)",{"type":7,"value":8,"toc":361},"minimark",[9,13,18,21,24,27,31,34,37,40,44,47,52,55,111,117,155,158,162,165,171,177,183,189,195,198,202,205,259,262,266,269,344,347,351,354,358],[10,11,12],"p",{},"A DID test screens for dissociative symptoms using the Dissociative Experiences Scale (DES-II). DID is characterized by distinct identity states, amnesia, and trauma-related dissociation. Diagnosis requires full psychiatric evaluation. Bernstein & Putnam (1986).",[14,15,17],"h2",{"id":16},"what-is-did-and-how-is-it-assessed","What is DID and How is it Assessed?",[10,19,20],{},"Dissociative Identity Disorder (DID) is a complex dissociative disorder characterized by the\npresence of two or more distinct personality states (alters),\nrecurrent gaps in memory for everyday events and personal information,\nand significant distress or impairment in daily functioning. DID is classified under\nDissociative Disorders in DSM-5-TR (300.14).",[10,22,23],{},"DID is strongly linked to severe, repeated early childhood trauma. It is understood as a complex adaptation to overwhelming\ntrauma in which the developing mind compartmentalizes experiences into separate\nidentity states. Research supports a prevalence of approximately 1% in the general population, with Sar et al. (2007) identifying DID in 1.1% of a community sample of women and Dorahy et al. (2014) placing general-population rates at around 1% based on a review of epidemiological studies. The disorder is frequently misdiagnosed or goes unrecognized\nfor years before correct diagnosis.",[10,25,26],{},"The criterion standard for diagnosis is the SCID-D (Structured Clinical\nInterview for DSM-5-TR Dissociative Disorders), a full clinician-administered\ninterview. The Dissociative Experiences Scale (DES), originally developed by Bernstein\nand Putnam (1986), is the most widely used screening tool — a 28-item self-report\nscale measuring the frequency of dissociative experiences. The revised DES-II format scores items on a 0–100 scale; the mean across all 28 items is the DES score. A cutoff of 30 was validated as a screening threshold in a multicenter study by Carlson et al. (1993), yielding sensitivity of 76% and specificity of 76–85%. However, elevated DES scores are\nnot specific to DID and can reflect other dissociative or trauma-related conditions\nsuch as PTSD, borderline personality disorder, and acute stress disorder.",[14,28,30],{"id":29},"des-ii-score-interpreter","DES-II Score Interpreter",[10,32,33],{},"Enter your DES-II average score (0–100) to interpret dissociation severity. The DES-II score is the mean of all 28 item scores, each rated 0–100.",[10,35,36],{},"Each item asks what percentage of time (0–100%) a dissociative experience occurs. Sum all 28 responses ÷ 28 = DES score.",[10,38,39],{},"DES-II © Carlson & Putnam (1993). Available for research and clinical use. A DES-II score alone cannot diagnose DID or any dissociative disorder; diagnosis requires full clinical evaluation including the SCID-D. If you are experiencing dissociative symptoms, please consult a trauma-informed mental health professional.",[14,41,43],{"id":42},"des-ii-score-reference","DES-II Score Reference",[10,45,46],{},"Bernstein & Putnam (1986); Carlson et al. (1993). DES-II norms vary across clinical and general population samples. Scores must be interpreted in clinical context with structured diagnostic interview.",[48,49,51],"h3",{"id":50},"score-interpretation","Score Interpretation",[10,53,54],{},"The table below summarizes the score ranges that are commonly used in clinical settings, based on the multicenter validation by Carlson et al. (1993) and general-population norms from multiple studies. These are screening guides, not diagnostic thresholds.",[56,57,58,74],"table",{},[59,60,61],"thead",{},[62,63,64,68,71],"tr",{},[65,66,67],"th",{},"DES-II Score (mean)",[65,69,70],{},"Interpretation",[65,72,73],{},"Clinical Implication",[75,76,77,89,100],"tbody",{},[62,78,79,83,86],{},[80,81,82],"td",{},"≥ 30",[80,84,85],{},"High dissociation",[80,87,88],{},"Warrants structured clinical evaluation (e.g., SCID-D); sensitivity 76%, specificity 76–85% for DID in psychiatric samples (Carlson et al., 1993)",[62,90,91,94,97],{},[80,92,93],{},"15–29",[80,95,96],{},"Moderate dissociation",[80,98,99],{},"Above general-population norms; may reflect trauma exposure, subclinical dissociation, PTSD, or other conditions",[62,101,102,105,108],{},[80,103,104],{},"0–14",[80,106,107],{},"Low dissociation",[80,109,110],{},"Typical of general-population samples; negative predictive value ~99% for DID at scores below 30",[10,112,113],{},[114,115,116],"strong",{},"DES-II subscale domains:",[56,118,119,129],{},[59,120,121],{},[62,122,123,126],{},[65,124,125],{},"Subscale",[65,127,128],{},"Description",[75,130,131,139,147],{},[62,132,133,136],{},[80,134,135],{},"Amnesia",[80,137,138],{},"Gaps in memory for everyday events or personal history",[62,140,141,144],{},[80,142,143],{},"Depersonalization\u002FDerealization",[80,145,146],{},"Feeling detached from the self or surroundings",[62,148,149,152],{},[80,150,151],{},"Absorption",[80,153,154],{},"Becoming so absorbed in an activity that awareness of surroundings is lost",[10,156,157],{},"The DES yields three subscale scores corresponding to amnesia, depersonalization\u002Fderealization, and absorption. Dubester & Braun (1995) reported test-retest reliability of r = .93 for total DES scores and demonstrated temporal stability across subscales in a clinical sample. Scores are not normally distributed in community samples, so parametric comparisons should be interpreted cautiously.",[48,159,161],{"id":160},"dsm-5-tr-did-diagnostic-criteria","DSM-5-TR DID Diagnostic Criteria",[10,163,164],{},"Diagnosis of DID under DSM-5-TR (APA, 2022) requires all five of the following criteria:",[10,166,167,170],{},[114,168,169],{},"Criterion A — Disruption of identity."," The individual experiences disruption of identity characterized by two or more distinct personality states (in some cultures described as an experience of possession). Each state involves a marked discontinuity in sense of self and agency, accompanied by related changes in affect, behaviour, consciousness, memory, perception, cognition, and sensory-motor functioning. These disruptions may be observed by others or reported by the individual.",[10,172,173,176],{},[114,174,175],{},"Criterion B — Recurrent amnesia."," The individual experiences recurrent gaps in recall for everyday events, important personal information, and\u002For traumatic events that are inconsistent with ordinary forgetting.",[10,178,179,182],{},[114,180,181],{},"Criterion C — Distress or dysfunction."," The symptoms cause clinically significant distress or impairment in social, occupational, or other important areas of functioning.",[10,184,185,188],{},[114,186,187],{},"Criterion D — Not a cultural or religious practice."," The disruption is not a normal part of a broadly accepted cultural or religious practice.",[10,190,191,194],{},[114,192,193],{},"Criterion E — Not substance or medical."," The symptoms are not attributable to the physiological effects of a substance (e.g., blackouts during alcohol intoxication) or another medical condition (e.g., complex partial seizures).",[10,196,197],{},"DSM-5-TR also requires clinicians to assess the level of distress associated with identity disruption and whether the individual has awareness of the alternate identity states, as many individuals with DID have limited or no conscious awareness of their alters. The diagnosis falls under the broader DSM-5-TR category of Dissociative Disorders (300.14 \u002F F44.81).",[48,199,201],{"id":200},"dissociative-disorders-spectrum","Dissociative Disorders Spectrum",[10,203,204],{},"Dissociation exists on a spectrum from normal (highway hypnosis, daydreaming) to pathological. DSM-5-TR dissociative disorders include five diagnoses.",[56,206,207,217],{},[59,208,209],{},[62,210,211,214],{},[65,212,213],{},"DSM-5-TR Disorder",[65,215,216],{},"Key Features",[75,218,219,227,235,243,251],{},[62,220,221,224],{},[80,222,223],{},"Dissociative Identity Disorder (DID)",[80,225,226],{},"Multiple distinct identity states; recurrent amnesia; significant functional impairment",[62,228,229,232],{},[80,230,231],{},"Dissociative Amnesia",[80,233,234],{},"Inability to recall important autobiographical information, often trauma-related; may include dissociative fugue",[62,236,237,240],{},[80,238,239],{},"Depersonalization\u002FDerealization Disorder",[80,241,242],{},"Persistent or recurrent experiences of detachment from one's mental processes or body (depersonalization) or of being detached from one's surroundings (derealization)",[62,244,245,248],{},[80,246,247],{},"Other Specified Dissociative Disorder (OSDD)",[80,249,250],{},"Significant dissociative symptoms that do not fully meet criteria for the above disorders",[62,252,253,256],{},[80,254,255],{},"Unspecified Dissociative Disorder",[80,257,258],{},"Dissociative symptoms causing distress or impairment where a clinician chooses not to specify the reason criteria are not met",[10,260,261],{},"DID sits at the severe end of the spectrum and is distinguished from OSDD primarily by the completeness of identity disruption and the severity of amnesia between states.",[48,263,265],{"id":264},"dissociation-assessment-tools","Dissociation Assessment Tools",[10,267,268],{},"Clinicians and researchers use several complementary instruments to assess dissociation, each suited to different assessment contexts. The DES-II is the most commonly used screener, while the SCID-D is the criterion-standard diagnostic interview.",[56,270,271,287],{},[59,272,273],{},[62,274,275,278,281,284],{},[65,276,277],{},"Tool",[65,279,280],{},"Type",[65,282,283],{},"Items",[65,285,286],{},"Primary Purpose",[75,288,289,303,317,330],{},[62,290,291,294,297,300],{},[80,292,293],{},"DES-II (Bernstein & Putnam, 1986; Carlson et al., 1993)",[80,295,296],{},"Self-report",[80,298,299],{},"28",[80,301,302],{},"Dimensional screening for dissociation frequency across three domains; ≥30 cutoff for follow-up",[62,304,305,308,311,314],{},[80,306,307],{},"SCID-D \u002F SCID-D-R (Steinberg et al., 1990; Steinberg, 2000)",[80,309,310],{},"Clinician-administered",[80,312,313],{},"Multiple structured sections across 5 symptom clusters",[80,315,316],{},"Criterion-standard diagnostic interview assessing amnesia, depersonalization, derealization, identity confusion, and identity alteration; good-to-excellent reliability",[62,318,319,322,324,327],{},[80,320,321],{},"Multidimensional Inventory of Dissociation — MID (Dell, 2006)",[80,323,296],{},[80,325,326],{},"218",[80,328,329],{},"Comprehensive assessment of 14 facets of pathological dissociation; includes diagnostic scale for DID; designed for complex presentations with mixed PTSD\u002Fborderline symptoms",[62,331,332,335,338,341],{},[80,333,334],{},"Dissociative Disorders Interview Schedule — DDIS (Ross)",[80,336,337],{},"Structured interview",[80,339,340],{},"Multiple sections",[80,342,343],{},"Structured interview assessing DSM dissociative disorder diagnoses, somatic symptoms, secondary features of DID, and childhood trauma history",[10,345,346],{},"The SCID-D-R systematically evaluates five core dissociative symptom clusters — amnesia, depersonalization, derealization, identity confusion, and identity alteration — and assigns severity ratings for each cluster. Studies across multiple countries have found good-to-excellent reliability and validity for the SCID-D-R (Steinberg, 2000).",[48,348,350],{"id":349},"treatment-approaches","Treatment Approaches",[10,352,353],{},"Evidence-based treatment for DID is phase-based trauma therapy: Phase 1 (safety, stabilization, symptom management), Phase 2 (trauma processing with EMDR or modified CPT), Phase 3 (integration and rehabilitation). Leading approaches include the ISSTD (International Society for the Study of Trauma and Dissociation) Treatment Guidelines (2011). Treatment is typically long-term but outcomes are generally positive with skilled, trauma-informed care. Many individuals with DID achieve significant symptom reduction and improved daily functioning.",[14,355,357],{"id":356},"trauma-dissociation-outcome-monitoring","Trauma & Dissociation Outcome Monitoring",[10,359,360],{},"PCL-5, DES-II, PHQ-9, and trauma-specific outcome measures, integrated trauma and dissociation monitoring for complex PTSD and dissociative disorder programs.",{"title":362,"searchDepth":363,"depth":363,"links":364},"",3,[365,367,368,375],{"id":16,"depth":366,"text":17},2,{"id":29,"depth":366,"text":30},{"id":42,"depth":366,"text":43,"children":369},[370,371,372,373,374],{"id":50,"depth":363,"text":51},{"id":160,"depth":363,"text":161},{"id":200,"depth":363,"text":201},{"id":264,"depth":363,"text":265},{"id":349,"depth":363,"text":350},{"id":356,"depth":366,"text":357},null,"Dissociative Disorders Assessment",[379,382,385,388],{"text":380,"link":381},"Bernstein EM, Putnam FW. Development, reliability, and validity of a dissociation scale. J Nerv Ment Dis. 1986;174(12):727-35.","https:\u002F\u002Fpubmed.ncbi.nlm.nih.gov\u002F3783140\u002F",{"text":383,"link":384},"Carlson EB, Putnam FW, Ross CA, et al. Validity of the Dissociative Experiences Scale in screening for multiple personality disorder: a multicenter study. Am J Psychiatry. 1993;150(7):1030-6.","https:\u002F\u002Fpubmed.ncbi.nlm.nih.gov\u002F8317572\u002F",{"text":386,"link":387},"Steinberg M, Rounsaville B, Cicchetti DV. The Structured Clinical Interview for DSM-III-R Dissociative Disorders: preliminary report on a new diagnostic instrument. Am J Psychiatry. 1990;147(1):76-82.","https:\u002F\u002Fpubmed.ncbi.nlm.nih.gov\u002F2293792\u002F",{"text":389,"link":390},"Dorahy MJ, Brand BL, Sar V, et al. Dissociative identity disorder: An empirical overview. Aust N Z J Psychiatry. 2014;48(5):402-17.","https:\u002F\u002Fpubmed.ncbi.nlm.nih.gov\u002F24788904\u002F","DID screening guide with DES-II score interpreter (0–100; ≥30 high dissociation). DSM-5-TR criteria, dissociative disorders spectrum, and SCID-D...","md",[394,397,400,403],{"question":395,"answer":396},"What does a DES-II score of 30 or above mean?","A score of 30 or above is the widely used screening threshold for identifying individuals who may warrant a more thorough dissociation evaluation, based on Carlson et al.'s 1993 multicenter study. It does not diagnose DID or any other condition. The majority of people who score above 30 do not have DID — the positive predictive value in the original study was only 17%, meaning most high scorers have other trauma-related conditions such as PTSD or borderline personality disorder.",{"question":398,"answer":399},"Is the DES-II self-report or clinician-administered?","The DES-II is a self-report questionnaire. Respondents rate the frequency of 28 dissociative experiences on a 0–100 scale, and the final score is the mean across all items. It is used as a screening tool, not for diagnosis. Full diagnosis of a dissociative disorder requires clinician-administered assessment, most rigorously with the SCID-D (Structured Clinical Interview for Dissociative Disorders).",{"question":401,"answer":402},"Can the DES-II diagnose DID?","No. The DES-II cannot diagnose DID or any dissociative disorder. A high score signals that a thorough clinical evaluation is warranted, including a structured diagnostic interview such as the SCID-D. Diagnosis requires clinician assessment of all DSM-5-TR criteria for DID, including identity disruption, amnesia, and significant functional impairment.",{"question":404,"answer":405},"How long does it take to complete the DES-II?","Most people complete the 28-item DES-II in approximately 10 minutes. Items ask about the percentage of time (0–100%) a person experiences various dissociative phenomena such as amnesia, absorption, depersonalization, and derealization. No time limit is set.",false,{"heading":30,"scaleLabel":408,"min":409,"max":410,"start":411,"note":412,"source":413,"bands":414},"Total score",0,100,30,"28-item self-report scale. Each item rates how often a dissociative experience occurs on a 0–100% scale. Score = mean of all 28 items. Higher scores indicate more frequent dissociation.","Carlson EB et al., Am J Psychiatry 1993. Cutoff ≥30 per multicenter validation (sensitivity 76%, specificity 76–85%). Intermediate band per clinical convention. Educational reference only — not a diagnostic tool.",[415,418,422],{"min":411,"label":85,"level":416,"note":417},"error","Warrants structured clinical evaluation, including SCID-D interview. Not specific to DID — elevated scores also occur in PTSD, BPD, and other trauma-related conditions.",{"min":419,"label":96,"level":420,"note":421},15,"warning","Above general-population norms (clinical convention). May reflect trauma exposure, adjustment difficulties, or subclinical dissociative experiences. Clinical context required.",{"min":409,"label":107,"level":423,"note":424},"success","Within the range typical of general population samples. Scores below 30 have a negative predictive value of approximately 99% for DID in clinical settings.","2026-06-03",{},true,"\u002Fassessments\u002Fdid-test",{"title":5,"description":391},"did-test","assessments\u002Fdid-test","DID screening guide with DES-II score interpreter (0–100; ≥30 high dissociation). DSM-5-TR criteria, dissociative disorders spectrum, and SCID-D comparison. Bernstein & Putnam (1986).","assessment","sB9YPUvXe_hSppL_LqF6MrJJznac9hzatwqB_d66r9o",[436,441,446,450,454,459,464,468,473,478,483,488,493,498,502,506,511,516,521,525,529,534,539,544,548,552,556,561,565,570,575,580,585,590,594,598,603,607,611,615,619,623,628,633,637,642,647,652,657,662,666,670,675,679,683,684,688,693,697,702,706,710,714,719,724,728,733,738,742,746,750,754,759,763,767,771,775,779,784,789,793,797,801,805,809,814,818,822,826,831,835,840,845,849,853,857,861,865,870,875,879,883,887,891,895,899,903,907,911,916,920,924,928,932,936,941,945,950,954,958,963,967,971,975,979,983,988,992,996,1001,1005,1009,1013,1017,1021,1025,1029,1034,1039,1044,1049,1053,1057,1061,1065,1069,1073,1077,1081,1086,1090,1094,1098,1102,1106,1111],{"title":437,"slug":438,"path":439,"categoryTitle":440},"ACE Score","aces","\u002Fassessments\u002Faces","Trauma & PTSD",{"title":442,"slug":443,"path":444,"categoryTitle":445},"ADHD Clinical Outcome Scale, Self-Report 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