DERS Scoring: Reverse-Scored Items, Subscales and Totals
Most DERS scoring errors come from one place: the eleven reverse-scored items. Miss them and the total inflates by up to 44 points, which is the difference between a patient looking mildly affected and looking severely dysregulated.
This page shows the reverse-scoring rule applied to real responses, then how to build the six subscale scores that actually drive the treatment plan.
Step-by-step scoring
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.
A worked example
| Item | Response and score |
|---|---|
| Reverse-scored items | Items 1, 2, 6, 7, 8, 10, 17, 20, 22, 24 and 34. Flip each response: 1 becomes 5, 2 becomes 4, 3 stays 3, 4 becomes 2, 5 becomes 1. |
| Example: item 1 answered 'almost always' (5) | Reversed to 1 — because the item describes a strength, not a difficulty. |
| Example: item 34 answered 'almost never' (1) | Reversed to 5 — this contributes heavily to the difficulty total. |
| Subscale: Impulse (items 3, 14, 25, 29, 32, 35) | Sum of six scored items, range 6-30. Interpret first when self-harm, bingeing or substance use is present. |
| Subscale: Clarity (items 1, 2, 4, 5, 7, 9) | Sum of six scored items, four of which are reverse-scored. Range 6-30. |
| Total | Sum of all 36 scored items after reversal, range 36-180. |
A patient scoring 118 sits in the severe band, but the plan comes from the profile: Impulse 26 and Strategies 32 with Awareness 11 means start with distress tolerance and concrete regulation skills, not emotion-labelling work.
Score ranges and what to do next
| Score | Severity | Next step |
|---|---|---|
| 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. |
Scoring mistakes to avoid
- Forgetting the 11 reverse-scored items — the single most common DERS error, and it makes progress look like deterioration.
- Reporting only the total, which hides the subscale profile that determines what you actually teach.
- Mixing the 36-item DERS with the DERS-16 or DERS-18 across time points, which makes the trend uninterpretable.
- Expecting PHQ-9-speed movement. The DERS reflects skill acquisition; 8-12 week intervals are more realistic.
- Reading a high Awareness subscale as denial rather than as genuine inattention to internal state.
What individual 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.
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Scoring reference for clinicians and patients. Not medical advice, and no score is a diagnosis. See our medical disclaimer.