[{"data":1,"prerenderedAt":-1},["ShallowReactive",2],{"assessment-emotion-dysregulation":3,"all-assessments-nav":310,"related-assessments-query":988},{"id":4,"title":5,"body":6,"category":264,"categoryTitle":265,"clinicalCitations":266,"copyright":264,"description":278,"disclaimer":264,"downloadLink":264,"extension":279,"faqs":280,"featured":299,"i18nReady":299,"icon":264,"interpreter":264,"lastReviewed":300,"meta":301,"navigation":302,"path":303,"permissionsNote":264,"published":299,"recommendedFrequency":264,"relatedCodes":264,"relatedConditions":264,"reviewedBy":264,"seo":304,"slug":305,"stem":306,"summary":307,"takeaways":264,"timeline":264,"type":308,"usedToDiagnose":264,"__hash__":309},"assessments\u002Fassessments\u002Femotion-dysregulation.md","Emotion Dysregulation (DERS Guide)",{"type":7,"value":8,"toc":253},"minimark",[9,13,18,21,24,27,31,34,37,40,45,48,155,158,162,165,243,246,250],[10,11,12],"p",{},"Emotion dysregulation is difficulty managing emotional responses in intensity, duration, or expression. A transdiagnostic feature of BPD, ADHD, PTSD, and depression. Measured by the DERS-36 or DERS-16 (Gratz & Roemer, 2004). DERS scores 16–80 (DERS-16).",[14,15,17],"h2",{"id":16},"what-is-emotion-dysregulation","What is Emotion Dysregulation?",[10,19,20],{},"Emotion dysregulation refers to difficulties in modulating the\nexperience, expression, and intensity of emotions. While all people occasionally\nstruggle to manage their emotional reactions, emotion dysregulation as a clinical\nconstruct involves persistent and significant difficulties that\ninterfere with daily functioning and goal-directed behaviour. It encompasses multiple\ndimensions: being aware of and accepting emotions, controlling behaviour when emotionally\ndistressed, effectively using emotion regulation strategies, and accessing strategies\nwhen needed.",[10,22,23],{},"Emotion dysregulation is considered a core transdiagnostic feature — it is\nnot limited to one condition but appears prominently across many conditions:\nborderline personality disorder (BPD) (the defining feature),\nADHD (especially emotional impulsivity), PTSD\n(hyperreactivity and emotional numbing), major depression\n(difficulty modulating sadness and anhedonia), bipolar disorder\n(mood lability), anxiety disorders (difficulty tolerating\ndistress), and eating disorders (using food to regulate affect).",[10,25,26],{},"The most widely used assessment tool is the DERS (Difficulties in Emotion\nRegulation Scale) by Gratz and Roemer (2004). The DERS measures six\nspecific dimensions of emotion dysregulation: non-acceptance of emotional responses,\ndifficulty engaging in goal-directed behaviour, impulse control difficulties, lack of\nemotional awareness, limited access to regulation strategies, and lack of emotional\nclarity. A validated 16-item short form (DERS-16) is also widely used.",[14,28,30],{"id":29},"ders-16-score-interpretation","DERS-16 Score Interpretation",[10,32,33],{},"The DERS-16 is rated on a 5-point Likert scale (1–5) for 16 items.\nTotal scores range from 16 to 80. Higher scores indicate greater emotion dysregulation.",[10,35,36],{},"Unlike brief screeners (such as the PHQ-9 or GAD-7), the DERS and DERS-16 were not designed around a single validated severity cut-point. Bjureberg et al. (2016) validated the DERS-16 by comparing it against the original 36-item DERS and a range of clinical constructs rather than establishing universal diagnostic thresholds. A 2024 systematic review confirmed that, even for the full DERS-36, a sufficiently robust normative reference interval has not yet been established. DERS scores are therefore best interpreted relative to clinical reference groups (e.g., BPD samples typically score substantially higher than community samples) or as a continuous index of treatment progress over time.",[10,38,39],{},"Educational reference only. Scores must be derived from formal assessment. Consult a mental health professional for evaluation.",[41,42,44],"h3",{"id":43},"ders-subscales-6-dimensions","DERS Subscales (6 Dimensions)",[10,46,47],{},"The original 36-item DERS yields six subscale scores that capture distinct facets of emotion dysregulation. The DERS-16 short form provides only an overall score; the subscale structure belongs to the full 36-item version.",[49,50,51,70],"table",{},[52,53,54],"thead",{},[55,56,57,61,64,67],"tr",{},[58,59,60],"th",{},"Subscale",[58,62,63],{},"Abbreviation",[58,65,66],{},"Items (DERS-36)",[58,68,69],{},"What it Measures",[71,72,73,88,102,115,128,142],"tbody",{},[55,74,75,79,82,85],{},[76,77,78],"td",{},"Non-Acceptance of Emotional Responses",[76,80,81],{},"NONACCEPTANCE",[76,83,84],{},"6",[76,86,87],{},"Tendency to have negative secondary reactions to distress — feeling guilty, ashamed, or angry about one's own emotional responses",[55,89,90,93,96,99],{},[76,91,92],{},"Difficulties Engaging in Goal-Directed Behavior",[76,94,95],{},"GOALS",[76,97,98],{},"5",[76,100,101],{},"Difficulty concentrating or accomplishing tasks when experiencing negative emotions",[55,103,104,107,110,112],{},[76,105,106],{},"Impulse Control Difficulties",[76,108,109],{},"IMPULSE",[76,111,84],{},[76,113,114],{},"Difficulty controlling behaviour when experiencing negative emotions; tendency toward impulsive action",[55,116,117,120,123,125],{},[76,118,119],{},"Lack of Emotional Awareness",[76,121,122],{},"AWARENESS",[76,124,84],{},[76,126,127],{},"Tendency to not attend to or acknowledge emotions; failure to recognize emotional states (reverse-scored)",[55,129,130,133,136,139],{},[76,131,132],{},"Limited Access to Emotion Regulation Strategies",[76,134,135],{},"STRATEGIES",[76,137,138],{},"8",[76,140,141],{},"Belief that one has few effective strategies available to reduce or modulate emotional distress",[55,143,144,147,150,152],{},[76,145,146],{},"Lack of Emotional Clarity",[76,148,149],{},"CLARITY",[76,151,98],{},[76,153,154],{},"Difficulty identifying and describing the emotions one is experiencing",[10,156,157],{},"A note on the Awareness subscale: because its items are reverse-scored, they have shown lower item-total correlations and inconsistent factor loadings across samples (Lee et al., 2016; Bjureberg et al., 2016). The DERS-16 omits Awareness items entirely, which its authors found did not reduce overall construct validity. Clinicians using the full DERS-36 should interpret Awareness scores with this limitation in mind.",[41,159,161],{"id":160},"conditions-involving-emotion-dysregulation","Conditions Involving Emotion Dysregulation",[10,163,164],{},"Emotion dysregulation is a transdiagnostic construct — it appears across diagnostic categories and can be a treatment target independent of the presenting diagnosis. The conditions below show consistently elevated DERS scores in the research literature.",[49,166,167,177],{},[52,168,169],{},[55,170,171,174],{},[58,172,173],{},"Condition",[58,175,176],{},"Notes",[71,178,179,187,195,203,211,219,227,235],{},[55,180,181,184],{},[76,182,183],{},"Borderline Personality Disorder (BPD)",[76,185,186],{},"Emotion dysregulation is the defining feature of BPD; individuals with BPD typically show the highest DERS scores among psychiatric populations across all six subscales",[55,188,189,192],{},[76,190,191],{},"Post-Traumatic Stress Disorder (PTSD)",[76,193,194],{},"Both emotional hyperreactivity and numbing\u002Favoidance reflect disrupted regulation; the DERS is used as an outcome measure in trauma-focused therapies",[55,196,197,200],{},[76,198,199],{},"ADHD",[76,201,202],{},"Emotional impulsivity is a core but underrecognized feature of ADHD; impaired impulse control under emotional distress is particularly salient",[55,204,205,208],{},[76,206,207],{},"Major Depressive Disorder",[76,209,210],{},"Difficulty modulating low mood, anhedonia, and rumination; a 2023 meta-analysis (De Prisco et al.) found BD and MDD did not differ significantly on most maladaptive emotion regulation strategies",[55,212,213,216],{},[76,214,215],{},"Bipolar Disorder",[76,217,218],{},"Mood lability and maladaptive regulation strategies elevated; BPD scored higher overall than bipolar disorder in cross-diagnostic comparisons (De Prisco et al., 2023)",[55,220,221,224],{},[76,222,223],{},"Eating Disorders",[76,225,226],{},"Food-related behaviour as a primary emotion regulation strategy; DERS scores are elevated across eating disorder diagnoses and often decrease with effective treatment",[55,228,229,232],{},[76,230,231],{},"Anxiety Disorders",[76,233,234],{},"Difficulty tolerating emotional distress and difficulty concentrating or completing tasks while emotionally activated are commonly elevated",[55,236,237,240],{},[76,238,239],{},"Substance Use Disorders",[76,241,242],{},"Using substances as an emotion regulation strategy is a recognized pattern; elevated DERS scores are found across substance use populations",[10,244,245],{},"Emotion dysregulation does not require a single diagnosis. Where DERS scores are elevated in the absence of a clear primary diagnosis, this finding can itself guide treatment planning toward emotion regulation-focused approaches such as dialectical behaviour therapy (DBT) or Unified Protocol (UP) transdiagnostic treatment.",[14,247,249],{"id":248},"emotion-regulation-outcome-tracking-in-hiboop","Emotion Regulation Outcome Tracking in HiBoop",[10,251,252],{},"DERS alongside PHQ-9, GAD-7, PCL-5, and MDQ, longitudinal emotion regulation and symptom tracking to monitor treatment impact across your patient panel.",{"title":254,"searchDepth":255,"depth":255,"links":256},"",3,[257,259,263],{"id":16,"depth":258,"text":17},2,{"id":29,"depth":258,"text":30,"children":260},[261,262],{"id":43,"depth":255,"text":44},{"id":160,"depth":255,"text":161},{"id":248,"depth":258,"text":249},null,"Other",[267,269,272,275],{"text":268},"Gratz KL, Roemer L. Multidimensional assessment of emotion regulation and dysregulation: Development, factor structure, and initial validation of the Difficulties in Emotion Regulation Scale. J Psychopathol Behav Assess. 2004;26(1):41–54.",{"text":270,"link":271},"Bjureberg J, Ljótsson B, Tull MT, et al. Development and Validation of a Brief Version of the Difficulties in Emotion Regulation Scale: The DERS-16. J Psychopathol Behav Assess. 2016;38(2):284–296.","https:\u002F\u002Fpubmed.ncbi.nlm.nih.gov\u002F27239096\u002F",{"text":273,"link":274},"De Prisco M, Oliva V, Fico G, et al. Emotion dysregulation in bipolar disorder compared to other mental illnesses: a systematic review and meta-analysis. Psychol Med. 2023;53(16):7484–7503.","https:\u002F\u002Fpubmed.ncbi.nlm.nih.gov\u002F37842774\u002F",{"text":276,"link":277},"Lee DJ, Witte TK, Bardeen JR, Davis MT, Weathers FW. A Factor Analytic Evaluation of the Difficulties in Emotion Regulation Scale. J Clin Psychol. 2016;72(9):933–946.","https:\u002F\u002Fpubmed.ncbi.nlm.nih.gov\u002F27018649\u002F","Guide to emotion dysregulation and DERS-16 score interpretation. Transdiagnostic feature of BPD, ADHD, PTSD, and depression. DERS-16 scores 16–80; higher scores indicate greater difficulty with emotion regulation. Gratz & Roemer (2004).","md",[281,284,287,290,293,296],{"question":282,"answer":283},"What is the score range of the DERS-16?","The DERS-16 consists of 16 items each rated on a 1–5 scale, giving a total score range of 16 to 80. Higher scores indicate greater difficulties with emotion regulation. Unlike screeners with validated cut-points, the DERS is designed to be interpreted relative to normative or clinical reference groups rather than by a single universal threshold.",{"question":285,"answer":286},"What is the difference between the DERS-36 and the DERS-16?","The original DERS (Difficulties in Emotion Regulation Scale) by Gratz and Roemer (2004) contains 36 items scored 1–5, with a total score range of 36–180, and yields six subscale scores. The DERS-16 is a validated short form developed by Bjureberg et al. (2016) containing 16 items with scores ranging from 16 to 80. The DERS-16 provides a valid overall score of emotion regulation difficulties but does not retain separate subscale scores; it shows excellent internal consistency (α = .92) and good convergent validity with the full DERS.",{"question":288,"answer":289},"What conditions are associated with high DERS scores?","Emotion dysregulation as measured by the DERS is elevated across borderline personality disorder (the defining feature), PTSD and complex trauma, ADHD (particularly emotional impulsivity), major depression, bipolar disorder, eating disorders (where food is used to regulate affect), and anxiety disorders. A 2023 systematic review and meta-analysis (De Prisco et al.) confirmed it is a transdiagnostic construct spanning a continuum across different psychiatric diagnoses.",{"question":291,"answer":292},"Which DERS subscales are most clinically relevant?","The Impulse Control (IMPULSE) and Limited Access to Emotion Regulation Strategies (STRATEGIES) subscales are particularly emphasized in treatment research as they map directly onto skills targeted in dialectical behaviour therapy (DBT). The Awareness subscale has shown inconsistent psychometric performance across studies and is omitted from the DERS-16 without loss of overall validity. All subscales provide clinically useful information about where a person's regulation difficulties are concentrated.",{"question":294,"answer":295},"Can the DERS be used to track treatment progress in DBT?","Yes. The DERS is widely used as an outcome measure in DBT research to track improvements in emotion regulation skills. A reduction in total DERS score reflects acquisition of effective emotion regulation capacities, and the original 36-item version's subscale scores can help identify which specific dimensions have improved. Serial administration during treatment provides a continuous, quantitative index of therapeutic progress.",{"question":297,"answer":298},"Is the DERS-16 free to use clinically?","The DERS-16 is freely available for non-commercial clinical and research use. The short form was developed and validated with open-access intent by Bjureberg et al. (2016). Clinicians should cite the original development articles when using the scale (Gratz & Roemer, 2004, for the full scale; Bjureberg et al., 2016, for the DERS-16).",false,"2026-06-03",{},true,"\u002Fassessments\u002Femotion-dysregulation",{"title":5,"description":278},"emotion-dysregulation","assessments\u002Femotion-dysregulation","Guide to emotion dysregulation and the DERS-16 (Difficulties in Emotion Regulation Scale). Transdiagnostic feature of BPD, ADHD, PTSD, and depression. DERS-16 scores 16–80. Gratz & Roemer (2004); Bjureberg et al. 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