Emotion Dysregulation (DERS Guide)
The DERS-16 (Difficulties in Emotion Regulation Scale, 16-item version) is a 16-item self-report questionnaire that measures overall difficulty with emotion regulation, scored 16 to 80. Emotion dysregulation appears across BPD, ADHD, PTSD and depression; the DERS-16 has no published severity cutoffs, so scores are read against reference groups or a person's own baseline.
For professional reference, research, and education only. Not for diagnosis or medical advice.
The DERS-16 (Difficulties in Emotion Regulation Scale, 16-item version) is a 16-item self-report questionnaire that measures overall difficulty managing emotional responses, scored 16 to 80 [2]. It is the short form of the 36-item DERS [1].
Emotion dysregulation is difficulty managing emotional responses in intensity, duration, or expression, and it appears across BPD, ADHD, PTSD, and depression.
What does the DERS-16 measure?
Emotion dysregulation refers to difficulties in modulating the experience, expression, and intensity of emotions. While all people occasionally struggle to manage their emotional reactions, emotion dysregulation as a clinical construct involves persistent and significant difficulties that interfere with daily functioning and goal-directed behaviour. It encompasses multiple dimensions: being aware of and accepting emotions, controlling behaviour when emotionally distressed, effectively using emotion regulation strategies, and accessing strategies when needed.
Emotion dysregulation is considered a core transdiagnostic feature — it is not limited to one condition but appears prominently across many conditions: borderline personality disorder (BPD) (the defining feature), ADHD (especially emotional impulsivity), PTSD (hyperreactivity and emotional numbing), major depression (difficulty modulating sadness and anhedonia), bipolar disorder (mood lability), anxiety disorders (difficulty tolerating distress), and eating disorders (using food to regulate affect).
A widely used assessment tool is the DERS (Difficulties in Emotion Regulation Scale), developed by Gratz and Roemer [1]. The DERS measures six specific dimensions of emotion dysregulation: non-acceptance of emotional responses, difficulty engaging in goal-directed behaviour, impulse control difficulties, lack of emotional awareness, limited access to regulation strategies, and lack of emotional clarity. A validated 16-item short form, the DERS-16, gives an overall score [2].
How do you give the DERS-16?
The DERS-16 is a self-report questionnaire: the person rates 16 statements about how they respond to their emotions on a 5-point scale from 1 to 5. In its validation study the median completion time was 100 seconds, against 269 seconds for the full 36-item DERS [2], which makes it practical for repeated use during treatment.
Educational reference only. Scores must be derived from formal assessment. Consult a mental health professional for evaluation.
How do you score and interpret the DERS-16?
The 16 item ratings (1–5) are summed. Total scores range from 16 to 80. Higher scores indicate greater emotion dysregulation.
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.
The DERS-16 was validated by comparing it against the original 36-item DERS and a range of clinical constructs, not by setting diagnostic thresholds [2]. DERS scores are therefore best interpreted relative to clinical reference groups or as a continuous index of treatment progress over time.
DERS subscales (6 dimensions)
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.
| Subscale | Abbreviation | Items (DERS-36) | What it Measures |
|---|---|---|---|
| Non-Acceptance of Emotional Responses | NONACCEPTANCE | 6 | Tendency to have negative secondary reactions to distress — feeling guilty, ashamed, or angry about one's own emotional responses |
| Difficulties Engaging in Goal-Directed Behaviour | GOALS | 5 | Difficulty concentrating or accomplishing tasks when experiencing negative emotions |
| Impulse Control Difficulties | IMPULSE | 6 | Difficulty controlling behaviour when experiencing negative emotions; tendency toward impulsive action |
| Lack of Emotional Awareness | AWARENESS | 6 | Tendency to not attend to or acknowledge emotions; failure to recognize emotional states (reverse-scored) |
| Limited Access to Emotion Regulation Strategies | STRATEGIES | 8 | Belief that one has few effective strategies available to reduce or modulate emotional distress |
| Lack of Emotional Clarity | CLARITY | 5 | Difficulty identifying and describing the emotions one is experiencing |
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 [4]. The DERS-16 omits Awareness items entirely, which its authors found did not reduce overall construct validity [2]. Clinicians using the full DERS-36 should interpret Awareness scores with this limitation in mind.
Psychometric properties
- Clinical sample. In its validation study, the DERS-16 showed excellent internal consistency (α = .92) and good test-retest reliability (ρI = .85) [2].
- Community samples. In two community samples, internal consistency of the 16- and 36-item versions was comparable (α .92 to .95), and the DERS-16 correlated with related measures almost as strongly as the full DERS, supporting convergent and discriminant validity [2].
- Factor structure. Factor-analytic work on the full DERS in three undergraduate samples (N = 840) found the Awareness items performed inconsistently; a model without them fit adequately across samples [4].
Limitations
- Not a diagnostic test. The DERS-16 gives a continuous index of emotion regulation difficulty; it does not diagnose BPD, PTSD or any other condition.
- No validated cut-point. Interpret scores against reference groups or a person's own baseline, not a fixed threshold.
- Overall score only. The DERS-16 does not yield the six subscale scores of the full DERS, and it omits emotional awareness, which may matter for some presentations such as autism spectrum disorders [2].
- Validation samples. Two of the three validation samples were women only, so generalization to men needs further study [2].
- Self-report. Scores depend on the respondent's insight into their own emotional responses.
Conditions involving emotion dysregulation
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.
| Condition | Notes |
|---|---|
| Borderline Personality Disorder (BPD) | Emotion dysregulation is the defining feature of BPD; people with BPD showed more emotion dysregulation than people with bipolar disorder in a 2023 meta-analysis [3] |
| Post-Traumatic Stress Disorder (PTSD) | Both emotional hyperreactivity and numbing/avoidance reflect disrupted regulation; the DERS is used as an outcome measure in trauma-focused therapies |
| ADHD | Emotional impulsivity is a core but underrecognized feature of ADHD; impaired impulse control under emotional distress is particularly salient |
| Major Depressive Disorder | Difficulty modulating low mood, anhedonia, and rumination; a 2023 meta-analysis found bipolar disorder and MDD did not differ on most adaptive and maladaptive emotion regulation strategies [3] |
| Bipolar Disorder | Mood lability and maladaptive regulation strategies elevated; BPD showed more emotion dysregulation overall than bipolar disorder in cross-diagnostic comparisons [3] |
| Eating Disorders | Food-related behaviour as a primary emotion regulation strategy; DERS scores are elevated across eating disorder diagnoses and often decrease with effective treatment |
| Anxiety Disorders | Difficulty tolerating emotional distress and difficulty concentrating or completing tasks while emotionally activated are commonly elevated |
| Substance Use Disorders | Using substances as an emotion regulation strategy is a recognized pattern; elevated DERS scores are found across substance use populations |
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.
For individuals: This page is a clinical reference, not a diagnostic tool. If you have concerns about your own symptoms, bring this information to a qualified mental health professional.
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Billing
In the US, the Emotion Dysregulation (DERS Guide) is usually billed under these CPT codes. Payer rules vary.
Assessments
FAQ
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.
What is the difference between the DERS-36 and the DERS-16?
The original DERS (Difficulties in Emotion Regulation Scale), developed by Gratz and Roemer, 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 and colleagues, 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.
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 supports it being a transdiagnostic construct spanning a continuum across different psychiatric diagnoses.
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.
References
- 1.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.
- 2.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.
- 3.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.
- 4.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.
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