Difficulties in Emotion Regulation Scale – 16 item version (DERS-16)

Deficits in emotion regulation have been identified as a transdiagnostic factor underlying various psychological conditions (Murray et al., 2024). The Difficulties in Emotion Regulation Scale 16 (DERS-16) is a 16-item self-report measure designed to briefly assess clinically-relevant difficulties in emotion regulation (Bjureberg et al., 2016).  

Emotion regulation broadly refers to the intrinsic and extrinsic processes involved in monitoring, evaluating, and modulating emotional reactions in order to accomplish one’s goals (Thompson, 1994). Inherent within this definition of emotion regulation is the idea that emotions are functional, providing information about our environment and motivating behaviours that may facilitate adaptation to situational demands (Izard & Ackerman, 2000). Conversely, difficulties in the awareness, understanding, or modulation of emotion may interfere with adaptation and contribute to a wide range of negative outcomes. A growing body of research offers support for the role of emotion regulation difficulties in multiple forms of psychopathology and maladaptive behaviours (Cichetti, Ackerman, & Izard, 1995; Gratz & Tull, 2010; Gross & Jazaieri, 2014; Sheppes, Suri, & Gross, 2015).

The DERS-16 is derived from the longer DERS-36 (Gratz and Roemer, 2004) and omits the ‘Awareness’ subscale, evaluating five key aspects of emotion regulation:

• Nonacceptance of Emotional Responses: assesses negative secondary emotional responses to one’s negative emotions, or nonaccepting reactions to one’s distress
• Difficulties Engaging in Goal-Directed Behavior: measures difficulties concentrating and accomplishing tasks when experiencing negative emotions
• Impulse Control Difficulties: looks at difficulties remaining in control of one’s behavior when experiencing negative emotions
• Limited Access to Emotion Regulation Strategies: refers to the belief that there is little that can be done to regulate emotions effectively once an individual is upset.
• Lack of Emotional Clarity: focuses on the extent to which individuals know and are clear about the emotions they are experiencing

The DERS-16 can be particularly useful in helping patients identify areas for growth in how they respond to their emotions, or for formulation and treatment planning transdiagnostically where emotion regulation difficulties feature, such as in borderline personality disorder, generalised anxiety disorder or substance use disorder.

The 16-item scale has been shown to perform on-par to the full 36-item DERS, capturing a similar amount of variance in psychiatric symptoms (Hallion et al., 2018). Given its brevity while maintaining clinical validity, clinicians should consider using the DERS-16 in settings where assessment time is limited. Indeed, researchers have suggested its use in community and clinical assessment to reduce respondent burden and for outcome monitoring (Sörman et al., 2022).

Research findings have demonstrated that difficulties in emotion regulation as measured by the DERS-16 are related to a range of other clinically relevant psychological constructs assessed by measures such as the AAQ, ASI-3, DASS, AUDIT, and FFMQ among others. To briefly summarise these associations, higher DERS-16 scores are correlated with higher levels of psychological inflexibility, negative emotional intensity, anxiety sensitivity, emotional impulsivity, borderline personality traits, general distress (depression, anxiety, and stress), alcohol use problems, disordered eating and self-harm behaviours. Further, those with higher DERS-16 scores tend to show lower levels of mindful awareness, descriptive emotional abilities, and capacity to reduce negative emotions (Bjureberg et al., 2016; Skutch et al., 2019; Sörman et al., 2022).

The total score ranges from 16-80 with higher scores indicating more difficulties with emotion regulation. Subscale raw scores have several ranges listed below:

•   Non-acceptance (3 items: 9, 10, 13): The Nonacceptance of Emotional Responses subscale assesses negative secondary responses to negative emotions and non-accepting reactions to distress (range 3-15)
•   Goals (3 items: 3, 7, 15): The Difficulties Engaging in Goal-Directed Behavior subscale measures difficulties concentrating and accomplishing tasks when experiencing negative emotions (range 3-15)
•   Impulse (3 items: 4, 8, 11): The Impulse Control Difficulties subscale reflects difficulties remaining in control of behavior when experiencing negative emotions (range 3-15)
•   Strategies (5 items: 5, 6, 12, 14, 16): The Limited Access to Emotional Regulation Strategies subscale assesses the belief that little can be done to regulate emotions effectively when upset (range 5-25)
•   Clarity (2 items: 1, 2): The Lack of Emotional Clarity subscale reflects the degree to which individuals know and understand the emotions they experience (range 2-10)

On first administration, a stacked bar graph shows the total and each of the six subscale scores in clinical percentiles. Percentiles give context to a client’s score, showing how they compare to their peers. For example, a percentile of 50 represents the typical level of difficulties with emotional regulation among treatment seeking adults.

A horizontal comparison graph is also presented showing the respondent’s score in comparison to the normative community and clinical samples.  

When administered more than once, a line graph is presented for the raw total score with clinical percentile labels on the right.

A second line graph is presented plotting each of the five subscales in clinical percentile terms. 

Significant improvements or deterioration in the total score are indicated by shifts of half a standard deviation or greater (approximately 7.5 total score points or more) following the guidelines of the Minimally Important Difference (Turner et al., 2010).

Severity categories were created based on clinical percentiles from NovoPsych (2025) and in consideration of community percentiles derived from Bjureberg et al. (2016):

•   Percentiles 1st-10th = “Very Low”
•   Percentiles 11th-30th = “Low”
•   Percentiles 31st-70th = “Average”
•   Percentiles 71st-94th = “High”
•   Percentiles 95th+ = “Very High”

The DERS-16 demonstrates strong construct validity despite being significantly shorter than the DERS-36 and the removal of the emotional awareness subscale did not significantly diminish the scale’s relationship to awareness-related constructs–suggesting the 16-item version captures this aspect to similar effect (Bjureberg et al., 2016). Furthermore, the measure demonstrates temporal stability, with a 14-day test-retest reliability of ρI = .85 (Bjureberg et al., 2016).

The scale has strong internal consistency, with several investigations reporting high reliability for the total scale score: .90 (Lawlor et al., 2020), .92, .94 (Bjureberg et al., 2016) and .91 (Westerlund & Santtila, 2018). Indeed, the results of a NovoPsych (2025) analysis support these findings, with a PSI of .93 (person separation index; how reliably the scale distinguishes between individuals at different levels of emotional difficulty), in addition to a Cronbach’s alpha and McDonald’s omega of .94.

Several authors direct that the DERS-16 subscale scores should not be computed given the low number of items (Burton et al; Bjureberg et al). However, investigations of both community and clinical samples, found that subscale reliability ranged from acceptable to high .7-.9 (Lawlor et al., 2020; Westerlund & Santtila, 2018). In an analysis of NovoPsych (2025) data, excellent reliability values (alpha, omega) for each subscale were observed, ranging from .83-.88 (full details in table 2). Furthermore, seven CFA studies have replicated the 5-factor structure of the DERS-16, further supporting the use of subscales (Charak et al., 2019; Hallion et al., 2018; Lawlor et al 2020; Miguel et al., 2017; Shahabi et al., 2018; Westerlund & Santtila, 2018; Yiĝit & Yiĝit, 2017). It should also be noted that these CFA results do not invalidate the use of the total score—under a NovoPsych analysis, evidence of unidimensionality was observed via Smith’s (2005) test. Therefore, we encourage the calculation of the DERS-16 subscale and total scores as they are valid, reliable and useful.

The DERS-16 has also demonstrated strong measurement invariance across different populations. Charak et al. (2019) found measurement invariance between adolescent and adult samples, indicating the scale functions similarly across these age groups. A NovoPsych (2025) analysis (n=707) of differential item functioning supports these findings. NovoPsych (2025) looked at measurement invariance across ages ranging from 18-83 and found no evidence of differential item functioning (or “item bias”) by age. Bias testing was also conducted on gender and time taken to complete the assessment, with no bias being observed for these additional variables (NovoPsych, 2025).

Clinical norms have been reported from a sample of treatment-seeking adults (n=707) by NovoPsych (2025), with a mean total score of 45.88 (SD = 15.05). Table 1 provides further details, including subscale scores from this sample. Community norms are reported by Bjurberg et al. (2016) n=482 and Westerlund & Santtila (2018) n=409. 

Severity categories were created based on the percentile ranges of the Clinical sample from NovoPsych (2025) and considering the community sample distribution from Bjurberg et al. (2016): 

•   Percentiles 1st-10th = “Very Low”
•   Percentiles 11th-30th = “Low”
•   Percentiles 31st-70th = “Average”
•   Percentiles 71st-94th = “High”
•   Percentiles 95th+ = “Very High”

For subscales, data is reported for both clinical (Lawlor et al., 2020; NovoPsych, 2025) and community (Westerlund & Santtila, 2018) samples, and are detailed in table 1. 

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