Development and Psychometric Characteristics of the Dissociation Tension Scale
Abstract
The newly developed Dissoziations-Spannungs-Skala (Dissociation Tension Scale; DSS) is a self-rating instrument for the assessment of psychological and somatoform dissociative features (ranging from normal up to pathological) as well as aversive inner tension occurring within the past 7 days. The DSS contains 21 items assessing dissociative symptoms and 1 additional item assessing aversive inner tension. Ratings are made on a time-oriented scale ranging from 0% (never) to 100% (constantly). We measured the psychometric qualities of the DSS in a total of 294 patients and healthy controls. Internal consistency of the DSS was high (Cronbach's alpha = .92; Gutmann's split-half r = .92). We found good support for convergent, discriminant, and differential validity. There was clear evidence for the DSS being a sensitive instrument for the assessment of changing symptomatology. Assessment of dissociation and other psychopathological features over the same period of time are now possible.
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Most studies summarized used well-established psychometric scales of dissociation (e.g., DES or DSS), showing excellent internal consistency, reliability, and high specificity and sensitivity to change in symptomatology.
“Most studies, summarized in this article, used well-established psychometric scales of dissociation (e.g., DES or DSS), showing excellent internal consistency, reliability, and high specificity and sensitivity to change in symptomatology [53].”
From Dissociation and Alterations in Brain Function and Structure: Implications for Borderline Personality Disorder (2017) · cites this paper as [53]
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“It consists of 21 items assessing dissociative symptoms such as derealization, depersonalization, altered pain perception, and altered hearing as well as 1 additional item assessing the subjective experience of acute stress (all 22 items between 0, not at all, and 9, extremely; Stiglmayr et al., 2010).”
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“Frontiers in Human Neuroscience www.frontiersin.org October 2014 | Volume 8 | Article 848 | 12 FIGURE 9 | Results of the whole-brain regression analysis with self-reported increase of dissociation (DSS-4 scores) as regressor of interest for connectivity of the bilateral amygdala seed (depicted in green) during present…”
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“Correlations between CBF and clinical symptom clusters For the patient group, Spearman correlations were calculated between CBF values and psychometric scores obtained by the DTS, BDI, BIS total score and the BIS subscales (BIS-A, BIS-M, BIS-N).”
MethodInfluentialReactive dissociative experiences in response to acute increases in shame feelings
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“The Dissociation Tension Scale (DSS; Stiglmayr et al., 2010) is a 21-item self-rating instrument assessing psychological (10 items) and somatoform (9 items) dissociative experiences.”
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“The primary outcome is the Dissociation Tension Scale (DTS; Stiglmayr et al., 2010), assessing psycho-form and somatoform dissociative symptoms in the past week.”
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“For depression the Beck-DepressionInventory (BDI; [40]) and the Hamilton-DepressionScale were applied (HAM-D; [41]); the level of dissociative symptoms was assessed with the Dissociation-TensionScale (DSS; [42]).”
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“Potential covariates that might influence physiology were assessed, including medical factors (e.g., age, height, weight, medications; Beauchaine, 1993) and dissociation (Dissociation-Tension Scale; DSS; Stiglmayr et al., 2010; αs = .28-.89).”
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“After the MRI scan, the dissociative state symptom scale – short form (DSS; Stiglmayr et al. 2010) was used to examine the presence of dissociative symptoms during the MRI scan.”
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“…Carleton, Abrams, & Asmundson, 2010; The Dissociative Disorders Interview Schedule [DDIS], Ross et al., 1989; Dissociation Tension Scale [DTS], Stiglmayr et al., 2010; Dissociation Symptom Scale [DSS], Carlson et al., 2018; Traumatic Dissociation Scale [TDS], Carlson & Waelde, 1999; Curious…”
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“All participants filled in the Dissociation Tension Scale (DSS) (Stiglmayr et al., 2010).”
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“…of Depressive Symptoms, QIDS-SR) [32], global symptom severity (Brief Symptom Inventory, BSI) [33], dissociation (Dissociation Tension Scale, DSS) [34], psychosocial functioning and participation (World Health Organization Disability Assessment Schedule 2.0, WHODAS 2.0 [35] and Work and Social…”
InfluentialSelf-citationSmith-Apeldoorn, S. Y., Veraart, J. K. E., Kamphuis, J., Spijker, J., van der Meij, A., van Asselt, A. D. I., Rot, M. A. H., & Schoevers, R. A. (2024) · Molecular Psychiatry · doi:10.1038/s41380-024-02478-9 · Cited by 29 · see citing works
“Dissociative effects were assessed with the Dissociation Tension Scale (DSS) [28], psychotic experiences with the Questionnaire for Psychotic Experiences (QPE) [29], and sleep disturbances with the Iowa Sleep Disturbance Inventory (ISDI) [30].”
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“During the experiment, parallelized with the collection of saliva (see below), participants provided self-reports on the computerized Positive and Negative Affect Schedule (PANAS [53]) the Dissociation–Tension Scale (DSS-4; [54]) and a single item on current stress rated on a visual analog scale [VAS; 100 mm].”
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“Partial correlations were similar for ITT analyses (r part ( Δ 16 CAPS, DSS dur,pre ) = 0.2206, r part ( Δ 16 CAPS, DSS int,pre ) = 0.1488) and ATP analyses (r part ( Δ 16 CAPS, DSS dur,pre ) = 0.2297, r part ( Δ 16 CAPS, DSS int,pre ) = 0.1370).”
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“The Dissociation Tension Scale (DSS; Stiglmayr et al., 2010) assesses psychological and somatoform dissociative experiences with 21 items and aversive inner tension with 1 item.”
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“Scores on the DSS are correlated with BPD symptoms and other measures of trait dissociation, but not correlated with other personality measures (Stiglmayr et al., 2010).”
BackgroundMethodInfluentialGraumann, L., Heekerens, J. B., Duesenberg, M., Metz, S., Spitzer, C., Otte, C., Roepke, S., & Wingenfeld, K. (2023) · Borderline Personality Disorder and Emotion Dysregulation · doi:10.1186/s40479-023-00215-2 · Cited by 18 · see citing works
“For the present analysis, we included all participants who provided answers on the Dissociation Tension Scale (DSS-7) [8] as a measure of baseline or trait-like dissociation, as well as the Dissociation Tension Scale acute (DSS-4) [5] as a measure of state dissociation.”
BackgroundMethodInfluentialMaking EGMs Accountable: Can an Informative and Dynamic Interface Help Players Self-regulate?
Byrne, C. A., & Russell, A. M. T. (2019) · Journal of Gambling Studies · doi:10.1007/s10899-019-09889-2 · Cited by 13 · see citing works
Veraart, J. K. E., Smith-Apeldoorn, S. Y., van der Meij, A., Spijker, J., Schoevers, R. A., & Kamphuis, J. (2025) · Journal of Psychopharmacology · doi:10.1177/02698811251332831 · Cited by 8 · see citing works
Covers, M. L. V., de Jongh, A., Huntjens, R. J. C., de Roos, C., van den Hout, M., & Bicanic, I. (2019) · European Journal of Psychotraumatology · doi:10.1080/20008198.2019.1632021 · Cited by 7 · see citing works
“and good convergent, discriminant, and differential validity (Stiglmayr et al., 2010).”
BackgroundInfluentialResearching Shame, Dissociation, and Their Relationship Using Latent Change Modeling
Kulla, P., Braun, T., Reichenberger, T., & Kruse, J. (2023) · Journal of Experimental Psychopathology · doi:10.1177/20438087231162756 · Cited by 5 · see citing works
“It is reliable and satisfactorily valid and has a high sensitivity to change (Stiglmayr et al., 2010).”
BackgroundHöper, S., Kröller, F., Heinze, A.-L., Bardtke, K. F., Kaess, M., & Koenig, J. (2024) · BJPsych Open · doi:10.1192/bjo.2024.728 · Cited by 5 · see citing works
Malejko, K., Huss, A. M., Schönfeldt‐Lecuona, C., Braun, M., & Graf, H. (2020) · Brain Sciences · doi:10.3390/brainsci10120905 · Cited by 5 · see citing works
“Psychological and somatoform dissociative features were assessed before and after rPMS procedures by the Dissociation Tension Scale-acute (DSS-acute) [22,23].”
MethodVonderlin, R., Priebe, K., Müller‐Engelmann, M., Fydrich, T., Steil, R., Resick, P. A., Schmahl, C. G., Lindauer, P., Kleindienst, N., & Bohus, M. (2024) · European Journal of Psychotraumatology · doi:10.1080/20008066.2024.2393061 · Cited by 4 · see citing works
“Because individuals with a history of CA often report elevated levels of dissociative symptoms, we used the Dissocia-tive Symptom Scale (DSS; Stiglmayr et al., 2010).”
MethodSelf-citationPieper, A., Bermpohl, F., Meyer, K., Bathe-Peters, R., Trobisch, V., Schulte, A., Grummt, M., Wolfarth, B., Ströhle, A., Schoofs, N., et al. (2024) · Journal of Sleep Research · doi:10.1111/jsr.14299 · Cited by 4 · see citing works
“The Dissociation Tension Scale (DSS) was administered for measuring dissociative symptoms (Stiglmayr et al., 2010), the Beck-Depression Inventory for depression (BDI-II; Kühner et al., 2007), and the Mini-Symptom-Checklist for psychological distress (Mini-SCL; Franke, 2016).”
Schoofs, N., Pieper, A., Meyer, K., Herrmann, S., Jäger, A., Wülfing, F., Grummt, M., Wolfarth, B., Ströhle, A., & Priebe, K. (2024) · Mental health and physical activity · doi:10.1016/j.mhpa.2024.100579 · Cited by 4 · see citing works
How-To Study Dissociative Symptoms in a Broad Range of Mental Disorders: A Methodological Primer
Danböck, S. K., Mertens, Y. L., Kulla, P., Seitz, K. I., & Schalinski, I. (2025) · Journal of Trauma & Dissociation · doi:10.1080/15299732.2025.2481474 · Cited by 4 · see citing works
Steil, R., Weiss, J., Müller‐Engelmann, M., Dittmann, C., Priebe, K., Kleindienst, N., Fydrich, T., & Stangier, U. (2023) · European Journal of Psychotraumatology · doi:10.1080/20008066.2023.2260293 · Cited by 4 · see citing works
“Concerning the reduction of the outcome measures, the mean reduction from intake to end of treatment in the PCL-5, BSL, and the DSS was higher in the DBT-PTSD than in the CPT group.”
MethodInfluentialSelf-citationCavelti, M., Kaeser, J. M., Lerch, S., Bauer, S., Moessner, M., Berger, T., Hayward, M., & Kaess, M. (2022) · Trials · doi:10.1186/s13063-022-06846-0 · Cited by 3 · see citing works
“Dissociation Tension Scale (DSS) [75] The DSS is a selfrating instrument for the assessment of psychological and somatoform dissociative features (ranging from normal up to pathological) as well as of aversive inner tension, occurring within the past 7 days.”
BackgroundInfluentialKleszewski, E., Wehrt, W., Otto, K., Matick, E., & Kottwitz, M. (2025) · Journal of business and psychology · doi:10.1007/s10869-025-10033-8 · Cited by 1 · see citing works
“To measure tension, we used a single item by Stiglmayr et al. (2010).”
The role of the precuneus in dissociative seizures: A structural neuroimaging study
Helmstaedter, L., Popkirov, S., Wellmer, J., Seliger, C., & Jungilligens, J. (2025) · NeuroImage Clinical · doi:10.1016/j.nicl.2025.103872 · Cited by 2 · see citing works
“To characterize and quantify the diverse dissociative phenomena described in the casefiles, we relied on descriptive dissociation scores developed based on the Dissociation Tension Scale (Stiglmayr et al., 2010) and additional clinical observations.”
Schmitz, S. E., Ebner‐Priemer, U., Kleindienst, N., Friedmann, F., Bohus, M., Steil, R., Müller‐Engelmann, M., Limberger, M. F., Hartnagel, L., Santangelo, P., et al. (2025) · JMIR Mental Health · doi:10.2196/81081 · Cited by 2 · see citing works
“Supporting this interpretation, findings from the parent trial demonstrated greater reductions in dissociation-related tension (Dissociation Tension Scale [27]) and borderline symptoms (Borderline Symptom List 23 [28]) in the DBT-PTSD group compared with the CPT group [14].”
Self-citationSarlon, J., Liwinski, T., Bruehl, A. B., Thomi, D., & Lang, U. E. (2025) · Journal of Affective Disorders Reports · doi:10.1016/j.jadr.2025.100954 · Cited by 2 · see citing works
Schweden, T. L. K., Konrad, A. C., & Hoyer, J. (2019) · Diagnostica · doi:10.1026/0012-1924/a000232 · Cited by 2 · see citing works
Gender and Age Dimensions of Occupational Stress and Dissociative Features among IT Professionals
Rajshekhar, A., & Thomas, T. M. (2015) · International Journal of Indian Psychology · doi:10.25215/0301.051 · Cited by 1 · see citing works
“The studies conducted by Chaturvedi et al (2008) and Subramanian and Vinothkumar (2009) on the detection of stress, anxiety and depression among IT professionals and the reduction of the impact of a stressful situation by enhancing hardiness and self-esteem of individuals are supportive of the present study in the sen…”
ResultInfluentialMills, K. L., Teesson, M., Back, S. E., Barrett, E. L., Cobham, V. E., Bendall, S., Perrin, S. G., Brady, K. T., & Ross, J. E. (2019) · Lund University Publications (Lund University) · doi:10.1080/20008198.2019.1613834
Dissociative and Psychotic Features
Cavelti, M., Thomson, M., & Kaess, M. (2025) · doi:10.1093/9780191964343.003.0015 · Cited by 1 · see citing works
Neurological soft signs in borderline personality disorder and schizophrenia
Otte, M., Schmitgen, M. M., Wolf, N. D., Kubera, K. M., Balcik, Y., Tech, C., Koç, M. İ., Prieult, Y. L., Sambataro, F., Brandt, G. A., et al. (2025) · Borderline Personality Disorder and Emotion Dysregulation · doi:10.1186/s40479-025-00282-7 · Cited by 1 · see citing works
“Dissociative symptoms were self-rated using the Dissociation Tension Scale (DTS) [37, 38].”
Sarlon, J., Thomi, D., Brühl, A. B., Liwinski, T., & Lang, U. E. (2026) · Journal of Affective Disorders · doi:10.1016/j.jad.2026.121208 · Cited by 1 · see citing works
Dissoziative Symptome und Störungen
Spitzer, C., Freyberger, H. J., & Daniels, J. K. (2017) · PiD - Psychotherapie im Dialog · doi:10.1055/s-0043-111270 · Cited by 1 · see citing works
“Trotz der Absicht, ein Verfahren für die Verlaufsmessung zu entwickeln, sind die bisherigen Befunde zur Änderungssensitivität der DSS inkonsistent (Stiglmayr et al. 2003, 2010).”
BackgroundInfluentialSchizophrenie, affektive, Angst- und Zwangsstörungen
Priebe, K., Schmahl, C. G., & Stiglmayr, C. (2013) · Springer eBooks · doi:10.1007/978-3-642-35066-5_7
Self-citationBorderline-Persönlichkeitsstörung und andere Persönlichkeitsstörungen
Priebe, K., Schmahl, C. G., & Stiglmayr, C. (2013) · Springer eBooks · doi:10.1007/978-3-642-35066-5_5
Self-citationDas Kognitive Inventar für Borderline-Persönlichkeitsstörung (KIB)
Braakmann, D., Philipp, A., Gelo, O. C. G., Beisel, S., Hüppe, M., Sipos, V., & Schweiger, U. (2011) · Zeitschrift für Klinische Psychologie und Psychotherapie · doi:10.1026/1616-3443/a000061
Self-citationKlassifikation und Phänomenologie
Priebe, K., Schmahl, C. G., & Stiglmayr, C. (2013) · Springer eBooks · doi:10.1007/978-3-642-35066-5_2
Self-citationEye Gaze Diversion and Dissociation in External and Internal Shame: A script-driven procedure
McKendry, H. B. (2014) · UC Research Repository (University of Canterbury) · doi:10.26021/7409
Dissoziative Symptome und Störungen
Priebe, K., Stiglmayr, C., & Schmahl, C. G. (2018) · PSYCH up2date · doi:10.1055/a-0498-3712
Self-citationPriebe, K., Schmahl, C. G., & Stiglmayr, C. (2013) · Springer eBooks · doi:10.1007/978-3-642-35066-5_3
Self-citationla Rie, D., & Wageningen, S.-V. (2022) · Bohn Stafleu van Loghum eBooks · doi:10.1007/978-90-368-2711-9_4
Das entfremdete Selbst, die entfremdete Umwelt
Macchia, A., Malejko, K., & Abler, B. (2023) · Nervenheilkunde · doi:10.1055/a-2016-2551
Grundlagen der Diagnostik und Therapie
(2024) · Elsevier eBooks · doi:10.1016/b978-3-437-22487-4.16001-0
Dissociative Disorders and the Dissociative Experience Scale (DES)
Tzikos, A., Arvaniti, A., & Samakouri, M. A. (2024) · Springer eBooks · doi:10.1007/978-3-031-32035-4_146-1
Kemmere, B., van Pelt, Y. T., Lommen, M. J. J., Huntjens, R. J. C., Olff, M., Méndez, M. Z., Matthijssen, S. J. M. A., Roijen, L. H., Nijdam, M. J., & ter Heide, F. J. J. (2025) · BMJ Open · doi:10.1136/bmjopen-2025-102530
Schmitz, S. E., Ebner‐Priemer, U., Kleindienst, N., Friedmann, F., Bohus, M., Steil, R., Müller‐Engelmann, M., Limberger, M. F., Hartnagel, L., Santangelo, P., et al. (2025) · doi:10.2196/preprints.81081
Self-citationDissociative Disorders and the Dissociative Experience Scale (DES)
Tzikos, A., Arvaniti, A., & Samakouri, M. A. (2025) · Springer eBooks · doi:10.1007/978-3-031-73368-0_146
Generalization of emotion regulation using conditioned reminders on mobile phones
McMahon, K., Compton, S. N., Neacsiu, A. D., Herr, N. R., LaBar, K. S., Kelley, L., Howard, M., & Rosenthal, M. Z. (2025) · Behaviour Research and Therapy · doi:10.1016/j.brat.2025.104924
Graumann, L., Heekerens, J. B., Duesenberg, M., Metz, S., Spitzer, C., Otte, C., Roepke, S., & Wingenfeld, K. (2024) · Figshare · doi:10.6084/m9.figshare.26579318
Graumann, L., Heekerens, J. B., Duesenberg, M., Metz, S., Spitzer, C., Otte, C., Roepke, S., & Wingenfeld, K. (2024) · Figshare · doi:10.6084/m9.figshare.26579315
Sramko, V. (2014) · Summit (Simon Fraser University)
Rana, A., Otte, M., Fazio, G., Olivio, D., Prieult, Y. L., Schmitgen, M. M., Balcik, Y., Koç, M. İ., Tech, C., Wolf, N. D., et al. (2026) · European Archives of Psychiatry and Clinical Neuroscience · doi:10.1007/s00406-026-02255-5
“…[31], emotion regulation difficulties via the Difficulties in Emo - tion Regulation Scale (DERS) [32], impulsivity through the Barratt Impulsiveness Scale (BIS-11) [33], and dissociation using the German adaptation of the Dissociative Tension Scale, the Dissoziations-Spannungs-Skala (DSS) [34].”
- Authors
- Stiglmayr, C., Schimke, P., Wagner, T., Braakmann, D., Schweiger, U., Sipos, V., Fydrich, T., Schmahl, C., Ebner-Priemer, U., Kleindienst, N., Bischkopf, J., Auckenthaler, A., & Kienast, T.
- Affiliations
- Freie Universität Berlin (DE)
- Humboldt-Universität zu Berlin (DE)
- University of Lübeck (DE)
- Central Institute of Mental Health (DE)
- d Department of Psychosomatic Medicine and Psychotherapy , Central Institute of Mental Health , Mannheim, Germany
- Charité – Universitätsmedizin Berlin (DE)
- Venue
- Journal of Personality Assessment
- Publisher
- Informa UK Limited
- Published
- 2010-04-19
- Volume
- 92
- Issue
- 3
- Pages
- 269-277
- ISSN
- 0022-3891 (ISSN-L)
- 1532-7752
- OpenAlex
- W2047340578
- Cited by
- 80
- References
- 48
- Citations by year
- 2026: 2 · 2025: 13 · 2024: 10 · 2023: 5 · 2022: 4 · 2021: 1 · 2020: 2 · 2019: 9 · 2018: 3 · 2017: 5 · 2016: 4 · 2015: 2 · 2014: 7 · 2013: 7 · 2012: 2
- FWCI
- 2.82
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Journal of Personality Assessment (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Psychiatry and Mental health › Psychosomatic Disorders and Their Treatments
- Social Sciences › Psychology › Clinical Psychology › Psychoanalysis and Psychopathology Research
- Social Sciences › Psychology › Experimental and Cognitive Psychology › Anxiety, Depression, Psychometrics, Treatment, Cognitive Processes
- Keywords
- dissociation, somatoform dissociation, dissociative symptoms, self-report questionnaire, psychometric validation, internal consistency, convergent validity, discriminant validity, differential validity
- MeSH terms
- Adolescent, Adult, Dissociative Disorders, Female, Humans, Male, Middle Aged, Psychiatric Status Rating Scales, Psychometrics, Sensitivity and Specificity, Sex Factors, Somatoform Disorders, Reproducibility of Results, Young Adult
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