The following is a questionnaire designed to help identify and assess the severity of potential dissociative symptoms you are experiencing.
This assessment involves identifying how often you identify with certain types of dissociative experiences that people commonly experience. Based on this, a score is calculated, and if the score is above a certain threshold, this can suggest the potential for a dissociative disorder.
This test is known as the second version of the Dissociative Experiences Scale (DES-II) and is based on the work of Eve Carlson, PhD and Frank W. Putnam, MD.
For each statement, choose the percentage of time it happens to you, when not under the influence of alcohol or drugs.
Question 1 / 28
Some people have the experience of driving or riding in a car or bus or subway and suddenly realizing that they don't remember what has happened during all or part of the trip.
Question 2 / 28
Some people find that sometimes they are listening to someone talk and they suddenly realize that they did not hear part or all of what was said.
Question 3 / 28
Some people have the experience of finding themselves in a place and having no idea how they got there.
Question 4 / 28
Some people have the experience of finding themselves dressed in clothes that they don't remember putting on.
Question 5 / 28
Some people have the experience of finding new things among their belongings that they do not remember buying.
Question 6 / 28
Some people sometimes find that they are approached by people that they do not know who call them by another name or insist that they have met them before.
Question 7 / 28
Some people sometimes have the experience of feeling as though they are standing next to themselves or watching themselves do something and they actually see themselves as if they were looking at another person.
Question 8 / 28
Some people are told that they sometimes do not recognize friends or family members.
Question 9 / 28
Some people find that they have no memory for some important events in their lives (for example, a wedding or graduation).
Question 10 / 28
Some people have the experience of being accused of lying when they do not think that they have lied.
Question 11 / 28
Some people have the experience of looking in a mirror and not recognizing themselves.
Question 12 / 28
Some people have the experience of feeling that other people, objects, and the world around them are not real.
Question 13 / 28
Some people have the experience of feeling that their body does not seem to belong to them.
Question 14 / 28
Some people have the experience of sometimes remembering a past event so vividly that they feel as if they were reliving that event.
Question 15 / 28
Some people have the experience of not being sure whether things that they remember happening really did happen or whether they just dreamed them.
Question 16 / 28
Some people have the experience of being in a familiar place but finding it strange and unfamiliar.
Question 17 / 28
Some people find that when they are watching television or a movie they become so absorbed in the story that they are unaware of other events happening around them.
Question 18 / 28
Some people find that they become so involved in a fantasy or daydream that it feels as though it were really happening to them.
Question 19 / 28
Some people find that they sometimes are able to ignore pain.
Question 20 / 28
Some people find that that they sometimes sit staring off into space, thinking of nothing, and are not aware of the passage of time.
Question 21 / 28
Some people sometimes find that when they are alone they talk out loud to themselves.
Question 22 / 28
Some people find that in one situation they may act so differently compared with another situation that they feel almost as if they were two different people.
Question 23 / 28
Some people sometimes find that in certain situations they are able to do things with amazing ease and spontaneity that would usually be difficult for them (for example, sports, work, social situations, etc.).
Question 24 / 28
Some people sometimes find that they cannot remember whether they have done something or have just thought about doing that this (for example, not knowing whether they have just mailed a letter or have just thought about mailing it).
Question 25 / 28
Some people find evidence that they have done things that they do not remember doing.
Question 26 / 28
Some people sometimes find writings, drawings, or notes among their belongings that they must have done but cannot remember doing.
Question 27 / 28
Some people sometimes find that they hear voices inside their head that tell them to do things or comment on things that they are doing.
Question 28 / 28
Some people sometimes feel as if they are looking at the world through a fog so that people and objects appear far away or unclear.
Source
Carlson, E. B., & Putnam, W. Frank. (1993, March). Dissociation : Vol. 6, No. 1, p. 016-027 : An update on the Dissociative Experience Scale. Handle.net; Ridgeview Institute and the International Society for the Study of Multiple Personality and Dissociation. https://hdl.handle.net/1794/1539
