Difficulties in Emotion Regulation Scale (DERS): Subscales, Scoring and Interpretation

A 36-item measure of six distinct emotion-regulation difficulties — the standard outcome measure for DBT and emotion-focused treatment.

Download the DERS PDF DERS scoring guide Track DERS scores over time

What the DERS measures

The Difficulties in Emotion Regulation Scale (DERS) measures how well a person can notice, accept, understand and act on their own emotions. It is not a symptom checklist; it is a measure of the process that sits underneath self-harm, binge eating, substance use, impulsive anger and much of what gets labelled treatment-resistant.

The full DERS has 36 items rated 1 to 5, producing a total score from 36 to 180 plus six subscale scores. Higher scores mean more difficulty. Eleven items are reverse-scored, which is the single most common source of error when practices score it by hand.

Because the six subscales point to different interventions, the subscale profile is usually more clinically useful than the total. Two patients with identical totals can need completely different treatment plans.

How to score the DERS

Score range: 36-180 total (36 items scored 1-5, 11 items reverse-scored)

1Reverse-score items 1, 2, 6, 7, 8, 10, 17, 20, 22, 24 and 34 (1 becomes 5, 2 becomes 4, 3 stays 3, 4 becomes 2, 5 becomes 1).
2Sum the six subscales: Nonacceptance of emotional responses, Difficulty engaging in goal-directed behaviour, Impulse control difficulties, Lack of emotional awareness, Limited access to emotion regulation strategies, and Lack of emotional clarity.
3Add all 36 scored items for the total, which ranges from 36 to 180.
4Report both the total and the six subscale scores. Interpret subscales relative to each other rather than against a single fixed cut-off.

DERS score interpretation

DERS score ranges and their clinical meaning
Score	Severity	What it means clinically
36-64	Low difficulty	Emotion regulation is broadly intact. Emotional distress, if present, is likely situational rather than a skills deficit.
65-89	Mild difficulty	Some regulation difficulty, often concentrated in one or two subscales. Targeted skills work — usually clarity or strategies — is more efficient than a full skills curriculum.
90-114	Moderate difficulty	Clinically meaningful regulation difficulty across several domains. Structured skills training (DBT emotion regulation and distress tolerance modules) is indicated.
115-180	Severe difficulty	Pervasive emotion-regulation difficulty typical of samples with self-harm, borderline features, or severe eating-disorder or substance-use presentations. Expect a longer course and prioritise impulse control and strategies first.

What specific DERS scores mean

What is a high DERS score?

Totals above roughly 115 are high and typical of clinical samples with self-harm or borderline features. Non-clinical adult means usually fall in the 75-85 range, so anything above about 100 is meaningfully elevated.

Which DERS subscale matters most clinically?

Impulse control difficulties and Limited access to strategies predict behavioural risk most directly — self-harm, binge episodes, substance use. Lack of emotional clarity and awareness predict how hard early skills work will be, because a patient who cannot name an emotion cannot yet regulate it.

How much DERS change counts as progress?

Because the DERS tracks skill acquisition rather than symptoms, expect slower movement than on PHQ-9 or GAD-7. A 10 to 15 point total reduction over a treatment episode, with the largest movement in the subscales you targeted, is a good result.

The six subscales and what each one asks you to do

Nonacceptance — the patient judges themselves for having feelings. Target with validation, acceptance work, and reducing secondary shame.
Goals — emotions derail task completion. Target with behavioural activation, opposite action, and structure.
Impulse — behaviour escapes control when emotions spike. Target first when there is self-harm, bingeing, or substance use; safety before insight.
Awareness — the patient does not attend to emotions at all. Target with mindfulness of current emotion and body-based noticing.
Strategies — the patient believes nothing will help. Target with concrete distress-tolerance and regulation skills plus mastery experiences.
Clarity — the patient cannot tell which emotion they are having. Target with emotion labelling and diary cards before higher-order skills.

Common scoring errors

Forgetting the 11 reverse-scored items, which inflates totals substantially and makes progress look like deterioration.
Reporting only the total, losing the subscale profile that determines the treatment plan.
Mixing the 36-item version with the DERS-16 or DERS-18 across time points, making the trend meaningless.
Treating a high Awareness subscale as denial. It usually reflects genuine inattention to internal state, which is a teachable skill.

Reading the DERS alongside symptom measures

A pattern worth watching for: symptom scores improve while the DERS stays flat. That often means the environment got calmer rather than the patient getting more skilled, and relapse risk on discharge remains high.

The reverse pattern — DERS improving while symptoms lag — is common and usually encouraging, because skill gains typically precede symptom change by weeks.

Who the DERS is for

DBT programmes tracking emotion-regulation change across a course of treatment
Patients with self-harm, chronic suicidality, or borderline personality features
Substance-use and eating-disorder programmes where affect regulation drives relapse
Adolescent and young-adult services assessing impulse control and distress tolerance
Any clinician whose patient describes emotions as overwhelming, confusing, or unbearable

Administration and re-testing

Self-report, 36 items, rated 1 (almost never) to 5 (almost always) for how often each statement applies.
Read the reverse-scored items carefully when scoring by hand: items 1, 2, 6, 7, 8, 10, 17, 20, 22, 24 and 34 are reverse-scored in the standard version.
Score the six subscales as well as the total. The profile drives treatment selection.
Re-administer every 8 to 12 weeks. The DERS reflects skill acquisition, which moves more slowly than symptom scores.
Where the full 36 items are too long, the DERS-16 and DERS-18 short forms are validated alternatives; do not mix versions within one patient's timeline.

Reliability and validity

The original validation reported high internal consistency for the total scale (Cronbach's alpha above 0.90) and adequate to good alpha for each of the six subscales.
Test-retest reliability over four to eight weeks has been reported around 0.88 for the total score.
The DERS shows expected associations with self-harm, experiential avoidance, and borderline personality features, and discriminates clinical from non-clinical samples.
The DERS-16 and DERS-18 short forms retain strong psychometric properties and are appropriate where response burden matters.

Licensing and use

The DERS was developed by Kim Gratz and Lizabeth Roemer and is made available free for research and clinical use. Cite the original 2004 paper when reporting results.

Frequently asked questions

How is the DERS scored?

Reverse-score items 1, 2, 6, 7, 8, 10, 17, 20, 22, 24 and 34, then sum all 36 items for a total from 36 to 180. Also compute the six subscale scores; higher scores mean more difficulty.

What are the six DERS subscales?

Nonacceptance of emotional responses, difficulty engaging in goal-directed behaviour, impulse control difficulties, lack of emotional awareness, limited access to emotion regulation strategies, and lack of emotional clarity.

What is a normal DERS score?

Non-clinical adult samples typically average in the mid-70s to mid-80s. Totals above roughly 100 are elevated and above 115 are consistent with clinical samples.

Is the DERS free to use?

Yes. The authors make the DERS available at no cost for research and clinical use; cite Gratz and Roemer (2004) when reporting results.

How long is the DERS?

The full version has 36 items and takes 8 to 10 minutes. Validated short forms exist with 16 and 18 items.

Should I use the total or the subscales?

Use both, but plan treatment from the subscales. Two patients with the same total can need completely different interventions depending on whether the difficulty is awareness, clarity, impulse control, or access to strategies.

References

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This page is clinical reference information for professionals and the public. It is not medical advice, and no assessment score is a diagnosis. Discuss any result with a licensed clinician. Read our medical disclaimer.