Beyond the DES-II: Screening for Dissociative Disorders in EMDR Therapy

Abstract

The Dissociative Experiences Scale (DES-II) remains the most widely used brief screening tool for identifying dissociative symptoms despite limitations of the instrument and the training of those who use it. Standard eye movement desensitization and reprocessing (EMDR) therapy procedures require a thorough clinical assessment and formally screening for the presence of a dissociative disorder. This aids development of an accurate case conceptualization prior to the preparation and trauma reprocessing phases of EMDR therapy. Reliance on DES-II mean scores as the sole measure of dissociative features—particularly with persons reporting a history of early childhood neglect or abuse—is insufficient to determine readiness for safely reprocessing traumatic memories. The International Society for the Study of Trauma and Dissociation (ISSTD) Guidelines for Treating Dissociative Identity Disorder in Adults, Third Revision, noted that employing standard EMDR therapy with individuals suffering from an unrecognized dissociative disorder was reported as a risk for significant harm. EMDR-trained clinicians’ standard practice of screening for dissociative disorders must evolve beyond a casual reliance upon the DES-II. Consistent use of a mental status examination and reliable diagnostic tools is needed. Several relevant assessment tools are reviewed with their strengths and limitations. The authors recommend that clinicians apply these approaches even when their intent is to screen out persons whose presenting difficulties lie outside their scope of practice or research design.