Dissociative Disorders Interview Schedule
DSM-IV Version
Questions in the Dissociative Disorders Interview Schedule must
be asked in the order they occur in the Schedule. All the items
in the Schedule, including all the items in the DSM-IV diagnostic
criteria for dissociative disorders, somatization disorder, and
borderline personality disorder must be inquired about. The wording
of the questions should be exactly as written in order to standardize
the information gathered by different interviewers. The interviewer
should not read the section headings aloud. The interviewer should
open the interview by thanking the subject for his/her participation
and then should say:
"Most of the questions I will ask can be answered Yes, No, or Unsure. A few of the questions have different answers and I will explain those as we go along."
| I. Somatic Complaints |
| 1. |
[ ] |
Do you suffer from headaches? Yes = 1, No = 2, Unsure = 3
If subject answers No to question 1, go to question
3. |
| 2. |
[ ] |
Have you been told by a doctor that you have migraine headaches?
Yes = 1, No = 2, Unsure = 3 |
Interviewer should read the following to the subject: |
|
"I am going to ask you about a series of physical symptoms
now. To count a symptom as present and to answer yes to these questions, the
following must be met:
a) no physical disorder or medical condition has been found to
account for the symptom.
b) if there is a related general medical condition, the problems
the symptom causes in terms of occupational or social impairment
are more than would be expected.
c) the symptom is not caused by a street drug or medication."
Interviewer should now ask the subject, "Have you
ever had the following physical symptoms for which doctors could find no physical explanation?"
The interviewer should review criteria a-c for the subject
immediately following the first positive response to ensure that
the subject has understood.
|
3. Abdominal pain (other than when menstruating)
Yes=1 No=2 Unsure=3 [ ]
4. Nausea (other than motion sickness)
Yes=1 No=2 Unsure=3 [ ]
5. Vomiting (other than motion sickness)
Yes=1 No=2 Unsure=3 [ ]
6. Bloating (gassy)
Yes=1 No=2 Unsure=3 [ ]
7. Diarrhea
Yes=1 No=2 Unsure=3 [ ]
8. Intolerance of (gets sick on) several different foods
Yes=1 No=2 Unsure=3 [ ]
9. Back pain
Yes=1 No=2 Unsure=3 [ ]
10. Joint pain
Yes=1 No=2 Unsure=3 [ ]
11. Pain in extremities (the hands and feet)
Yes=1 No=2 Unsure=3 [ ]
12. Pain in genitals other than during intercourse
Yes=1 No=2 Unsure=3 [ ]
13. Pain during urination
Yes=1 No=2 Unsure=3 [ ]
14. Other pain (other than headaches)
Yes=1 No=2 Unsure=3 [ ]
15. Shortness of breath when not exerting oneself
Yes=1 No=2 Unsure=3 [ ]
16. Palpitations (a feeling that your heart is beating very
strongly)
Yes=1 No=2 Unsure=3 [ ]
17. Chest pain
Yes=1 No=2 Unsure=3 [ ]
18. Dizziness
Yes=1 No=2 Unsure=3 [ ]
19. Difficulty swallowing
Yes=1 No=2 Unsure=3 [ ]
20. Loss of voice
Yes=1 No=2 Unsure=3 [ ]
21. Deafness
Yes=1 No=2 Unsure=3 [ ]
22. Double vision
Yes=1 No=2 Unsure=3 [ ]
23. Blurred vision
Yes=1 No=2 Unsure=3 [ ]
24. Blindness
Yes=1 No=2 Unsure=3 [ ]
25. Fainting or loss of consciousness
Yes=1 No=2 Unsure=3 [ ]
26. Amnesia
Yes=1 No=2 Unsure=3 [ ]
27. Seizure or convulsion
Yes=1 No=2 Unsure=3 [ ]
28. Trouble walking
Yes=1 No=2 Unsure=3 [ ]
29. Paralysis or muscle weakness
Yes=1 No=2 Unsure=3 [ ]
30. Urinary retention or difficulty urinating
Yes=1 No=2 Unsure=3 [ ]
31. Long periods with no sexual desire
Yes=1 No=2 Unsure=3 [ ]
32. Pain during intercourse
Yes=1 No=2 Unsure=3 [ ]
Note: If subject is male ask question 33 and then go to question
38. If female, go to question 34.
33. Impotence
Yes=1 No=2 Unsure=3 [ ]
34. Irregular menstrual periods
Yes=1 No=2 Unsure=3 [ ]
35. Painful menstruation
Yes=1 No=2 Unsure=3 [ ]
36. Excessive menstrual bleeding
Yes=1 No=2 Unsure=3 [ ]
37. Vomiting throughout pregnancy
Yes=1 No=2 Unsure=3 [ ]
38. Have you had many physical symptoms over a period of several years
beginning before the age of 30 that resulted in your seeking treatment or
which caused occupational or social impairment?
Yes=1 No=2 Unsure=3 [ ]
39. Were the physical symptoms you described deliberately produced by you?
Yes=1 No=2 Unsure=3 [ ]
II. Substance Abuse
40. Have you ever had a drinking problem?
Yes=1 No=2 Unsure=3 [ ]
41. Have you ever used street drugs extensively?
Yes=1 No=2 Unsure=3 [ ]
42. Have you ever injected drugs intravenously?
Yes=1 No=2 Unsure=3 [ ]
43. Have you ever had treatment for a drug or alcohol problem?
Yes=1 No=2 Unsure=3 [ ]
III. Psychiatric History
44. Have you ever had treatment for an emotional problem or mental disorder?
Yes=1 No=2 Unsure=3 [ ]
45. Do you know what psychiatric diagnoses, if any, you have been given in the past?
Yes=1 No=2 Unsure=3 [ ]
46. Have you ever been diagnosed as having:
a) depression [ ]
b) mania [ ]
c) schizophrenia [ ]
d) anxiety disorder [ ]
e) other psychiatric disorder (specify) [ ]
__________________________________
Yes=1 No=2 Unsure=3
If subject did not volunteer a diagnosis for 46 (e) go to
question 48.
47. If the subject volunteered diagnoses for (e), did the subject volunteer
any of the following:
a) dissociative amnesia [ ]
b) dissociative fugue [ ]
c) dissociative identity disorder (multiple personality disorder) [ ]
d) depersonalization disorder [ ]
e) dissociative disorder not otherwise specified [ ]
Yes=1 No=2 Unsure=3
48. Have you ever been prescribed psychiatric medication?
Yes=1 No=2 Unsure=3 [ ]
49. Have you ever been prescribed one of the following medications?
a) antipsychotic [ ]
b) antidepressant [ ]
c) lithium [ ]
d) anti-anxiety or sleeping medication [ ]
e) other (specify) ________________________________ [ ]
Yes=1 No=2 Unsure=3
50. Have you ever received ECT, also know as electroshock treatment?
Yes=1 No=2 Unsure=3 [ ]
51. Have you ever had therapy for emotional, family, or psychological problems,
for more than 5 sessions in one course of treatment?
Yes=1 No=2 Unsure=3 [ ]
52. How many therapists, if any, have you seen for emotional
problems or mental illness in your life.
Unsure=89 [ ]
If subject answered No to both questions 51 and 52, go to
question 54.
53. Have you ever had a treatment for an emotional problem or
mental illness which was ineffective?
Yes=1 No=2 Unsure=3 [ ]
IV. Major Depressive Episode
The purpose of this section is to determine whether the subject
has ever had or currently has a major depressive episode.
54. Have you ever had a period of depressed mood lasting at
least two weeks in which you felt depressed, blue, hopeless, low, or down in
the dumps?
Yes=1 No=2 Unsure=3 [ ]
If subject answered No to question 54, go to question 62.
If subject answered Yes or Unsure, interviewer should ask,
"During this period did you experience the following symptoms nearly every
day for at least two weeks?"
55. Poor appetite or significant weight loss (when not dieting) or increased appetite or significant weight gain.
Yes=1 No=2 Unsure=3 [ ]
56. Sleeping too little or too much.
Yes=1 No=2 Unsure=3 [ ]
57. Being physically and mentally slowed down, or agitated to the point where it was noticeable to other people.
Yes=1 No=2 Unsure=3 [ ]
58. Loss of interest or pleasure in usual activities, or decrease in sexual drive.
Yes=1 No=2 Unsure=3 [ ]
59. Loss of energy or fatigue nearly every day.
Yes=1 No=2 Unsure=3 [ ]
60. Feelings of worthlessness, self-reproach, or excessive or inappropriate guilt nearly every day.
Yes=1 No=2 Unsure=3 [ ]
61. Difficulty concentrating or difficulty making decisions.
Yes=1 No=2 Unsure=3 [ ]
62. Recurrent thoughts of death, suicidal thoughts, wishes to be dead, or attempted suicide.
Yes=1 No=2 Unsure=3 [ ]
If you have made a suicide attempt, did you:
a) take an overdose [ ]
b) slash your wrists or other body areas [ ]
c) inflict cigarette burns or other self injuries [ ]
d) use a gun, knife, or other weapons [ ]
e) attempt hanging [ ]
f) use another method [ ]
Yes=1 No=2 Unsure=3
63. If you have had an episode of depression as described above, is it: [ ]
currently active, first occurrence =1
currently in remission =2
currently active, recurrence =3
uncertain =4
due to a specific organic cause =5
V. Positive Symptoms of Schizophrenia (Schneiderian First Rank Symptoms)
64. Have you ever experienced the following
Yes=1 No=2 Unsure=3
a) voices arguing in your head [ ]
b) voices commenting on your actions [ ]
c) having your feelings made or controlled by someone or something outside you [ ]
d) having your thoughts made or controlled by someone or something outside you [ ]
e) having your actions made or controlled by someone or something outside you [ ]
f) Influences from outside you playing on or affecting your body such as some external force or power. [ ]
g) having thoughts taken out of your mind [ ]
h) thinking thoughts which seemed to be someone else's [ ]
i) hearing your thoughts out loud [ ]
j) other people being able to hear your thoughts as if they're out loud [ ]
k) thoughts of a delusional nature that were very out of touch with reality [ ]
If subject answered No to all schizophrenia symptoms, go to
question 67, otherwise, interviewer should ask:
"If you have experienced any of the above symptoms
are they clearly limited to one of the following:"
65. Occurred only under the influence of drugs, or alcohol.
Yes=1 No=2 Unsure= 3 [ ]
66. Occurred only during a major depressive episode.
Yes=1 No=2 Unsure= 3 [ ]
VI. Trances, Sleepwalking, Childhood Companions
67. Have you ever walked in your sleep?
Yes=1 No=2 Unsure= 3 [ ]
If subject answered No to question 67, go to question 69.
68. If you have walked in your sleep, how many times roughly?
1-10=1 ; 11-50=2 ; >50= 4 ; Unsure=3 [ ]
69. Have you ever had a trance-like episode where you stare off
into space, lose awareness of what is going on around you
and lose track of time?
Yes=1 No=2 Unsure= 3 [ ]
If subject answered No to question 69, go to question 71.
70. If you have had this experience, how many times, roughly?
1-10=1 ; 11-50=2 ; >50=3 ; Unsure=4 [ ]
71. Did you have imaginary playmates as a child?
Yes=1 No=2 Unsure= 3 [ ]
If subject answered No to question 71, go to question 73.
72. If you had imaginary playmates, how old were you when they stopped. Unsure=0 [ ]
If subject still has imaginary companions score subject's current age.
VIII. Childhood Abuse
73. Were you physically abused as a child or adolescent?
Yes=1 No=2 Unsure= 3 [ ]
If subject answered No to question 73, go to question 78.
74. Was the physical abuse independent of episodes of
sexual abuse?
Yes=1 No=2 Unsure= 3 [ ]
75. If you were physically abused, was it by:
a) father [ ]
b) mother [ ]
c) stepfather [ ]
d) stepmother [ ]
e) brother [ ]
f) sister [ ]
g) male relative [ ]
h) female relative [ ]
i) other male [ ]
j) other female [ ]
Yes=1 No=2 Unsure= 3
76. If you were physically abused, how old were you when it started?
Unsure=89. If less than 1 year, score 0. [ ]
77. If you were physically abused how old were you when it stopped?
Unsure=89 If less than 1 year, score 0. If ongoing score subject's current age. [ ]
78. Were you sexually abused as a child or adolescent? Sexual
abuse includes rape, or any type of unwanted sexual touching or fondling
that you may have experienced.
Yes=1 No=2 Unsure= 3 [ ]
If the subject answered No to question 78, go to question
85. If the
subject answered Yes or Unsure to question 78, the interviewer should
state the following before asking further questions on sexual abuse:
"The following questions concern detailed examples of the
types of sexual abuse you may or may not have experienced. Because
of the explicit nature of these questions, you have the option not to answer
any or all of them. The reason I am asking these questions is to try to
determine the severity of the abuse that you experienced. You may
answer Yes, No, Unsure or not give an answer to each question."
79. If you were sexually abused, was it by:
a) father [ ]
b) mother [ ]
c) stepfather [ ]
d) stepmother [ ]
e) brother [ ]
f) sister [ ]
g) male relative [ ]
h) female relative [ ]
i) other male [ ]
j) other female [ ]
Yes=1 No=2 Unsure= 3 No Answer=4
If subject is female skip question 80. If male skip question 81.
80. If you are male and were sexually abused, did the abuse involve:
a) hand to genital touching [ ]
b) other types of fondling [ ]
c) intercourse with a female [ ]
d) anal intercourse with a male - you active [ ]
e) you performing oral sex on a male [ ]
f) you performing oral sex on a female [ ]
g) oral sex done to you by a male [ ]
h) oral sex done to you by a female [ ]
i) anal intercourse - you passive [ ]
j) enforced sex with animals [ ]
k) pornographic photography [ ]
l.) other (specify) ___________________________ [ ]
Yes=1 No=2 Unsure=3 No Answer=4
81. If you are female and were sexually abused, did the abuse
involve:
a) hand to genital touching [ ]
b) other types of fondling [ ]
c) intercourse with a male [ ]
d) simulated intercourse with a female [ ]
e) you performing oral sex on a male [ ]
f) you performing oral sex on a female [ ]
g) oral sex done to you by a male [ ]
h) oral sex done to you by a female [ ]
i) anal intercourse with a male [ ]
j) enforced sex with animals [ ]
k) pornographic photography [ ]
l) other (specify) ____________________________ [ ]
Yes=1 No=2 Unsure=3 No Answer=4
82. If you were sexually abused, how old were you when it started?
Unsure=89. If less than 1 year, score 0. [ ]
83. If you were sexually abused, how old were you when it stopped?
Unsure=89 If less than 1 year, score 0. If ongoing
score subject's current age. [ ]
84. How many separate incidents of sexual abuse were you subjected
to up until the age of 18?
1-5=1 ; 6-10=2 ; 11-50=3 ; >50=4 ; Unsure=5 ; [ ]
85. How many separate incidents of sexual abuse were you subjected
to after the age of 18?
0=1 ; 1-5=2 ; 6-10=3 ; 11-50=4 ; >50=5 ; Unsure=6 [ ]
VIII. Features Associated with Dissociative Identity Disorder
For questions 86-95, if subject answers Yes, ask subject
to specify whether it is occasionally, fairly often or frequently,
excluding question 93.
86. Have you ever noticed that things are missing from your personal possessions or where you live?
Never=1 ; Occasionally=2 ; Fairly Often=3 ; Frequently=4 ; Unsure=5 ; [ ]
87. Have you ever noticed that there are things present where
you live, and you don't know where they came from or how
they got there? e.g. clothes jewelry, books, furniture.
Never=1 Occasionally=2 Fairly Often=3 Frequently=4 Unsure=5 [ ]
88. Have you ever noticed that your handwriting changes drastically
or that there are things around in handwriting you don't recognize?
Never=1 Occasionally=2 Fairly Often=3 Frequently=4 Unsure=5 [ ]
89. Do people ever come up and talk to you as if they know you
but you don't know them, or only know them faintly?
Never=1 Occasionally=2 Fairly Often=3 Frequently=4 Unsure=5 [ ]
90. Do people ever tell you about things you've done or said, that you can't
remember, not counting times you have been using drugs or alcohol?
Never=1 Occasionally=2 Fairly Often=3 Frequently=4 Unsure=5 [ ]
91. Do you ever have blank spells or periods of missing time that you can't
remember, not counting times you have been using drugs or alcohol?
Never=1 Occasionally=2 Fairly Often=3 Frequently=4 Unsure=5 [ ]
92. Do you ever find yourself coming to in an unfamiliar place,
wide awake, not sure how you got there, and not sure what has been happening
for the past while, not counting times when you have been using drugs or alcohol?
Never=1 Occasionally=2 Fairly Often=3 Frequently=4 Unsure=5 [ ]
93. Are there large parts of your childhood after age 5 which you can't remember?
Yes=1 No=2 Unsure=3 [ ]
94. Do you ever have memories come back to you all of a sudden,
in a flood or like flashbacks?
Never=1 Occasionally=2 Fairly Often=3 Frequently=4 Unsure=5 [ ]
95. Do you ever have long periods when you feel unreal, as if
in a dream, or as if you're not really there, not counting when you are using
drugs or alcohol?
Never=1 Occasionally=2 Fairly Often=3 Frequently=4 Unsure=5 [ ]
96. Do you hear voices talking to you sometimes or talking inside your head?
Yes=1 No=2 Unsure=3 [ ]
If subject answered No to question 96, go to question 98.
97. If you hear voices, do they seem to come from inside you?
Yes=1 No=2 Unsure=3 [ ]
98. Do you ever speak about yourself as "we" or "us"?
Yes=1 No=2 Unsure=3 [ ]
99. Do you ever feel that there is another person or persons inside you?
Yes=1 No=2 Unsure=3 [ ]
If subject answered No to question 99, go to question 102.
100. Is there another person or person inside you that has a name?
Yes=1 No=2 Unsure=3 [ ]
101. If there is another person inside you, does he or she ever
come out and take control of your body?
Yes=1 No=2 Unsure=3 [ ]
IX. Supernatural/Possession/ESP Experiences/Cults
102. Have you ever had any kind of supernatural experience?
Yes=1 No=2 Unsure=3 [ ]
103. Have you ever had any extrasensory perception experiences such as:
a) mental telepathy [ ]
b) seeing the future while awake [ ]
c) moving objects with your mind [ ]
d) seeing the future in dreams [ ]
e) deja vu (the feeling that what is happening to you has happened before) [ ]
f) other (specify) _______________________________ [ ]
Yes=1 No=2 Unsure=3
104. Have you ever felt you were possessed by a:
a) demon [ ]
b) dead person [ ]
c) living person [ ]
d) some other power or force [ ]
Yes=1 No=2 Unsure=3
105. Have you ever had any contact with:
a) ghosts [ ]
b} poltergeists (cause noises or objects to move around) [ ]
c) spirits of any kind [ ]
Yes=1 No=2 Unsure=3
106. Have you ever felt you know something about past lives or incarnations of yours?
Yes=1 No=2 Unsure=3 [ ]
107. Have you ever been involved in cult activities?
Yes=1 No=2 Unsure=3 [ ]
X. Borderline Personality Disorder
Interviewer should state, "For the following nine questions, please answer
Yes only if you have been this way much of the time for much of your life."
Have you experienced:
108. Impulsive or unpredictable behavior in at least two areas
that are potentially self-damaging, e.g., spending, sex, substance use, reckless
driving, binge eating.
Yes=1 No=2 Unsure=3 [ ]
109. A pattern of intense, unstable personal relationships characterized
by your alternating between extremes of positive and negative feelings.
Yes=1 No=2 Unsure=3 [ ]
110. Intense anger or lack of control of anger, e.g., frequent
displays of temper, constant anger, recurrent physical fights.
Yes=1 No=2 Unsure=3 [ ]
111. Unstable identity, self-image, or sense of self.
Yes=1 No=2 Unsure=3 [ ]
112. Frequent mood swings: noticeable shifts from normal mood
to depression, irritability or anxiety, usually lasting only a
few hours and rarely more than a few days.
Yes=1 No=2 Unsure=3 [ ]
113. Frantic efforts to avoid real or imagined abandonment.
Yes=1 No=2 Unsure=3 [ ]
114. Recurrent suicidal behavior, e.g., suicidal attempts, self-mutilation,
or threats of suicide.
Yes=1 No=2 Unsure=3 [ ]
115. Chronic feelings of emptiness.
Yes=1 No=2 Unsure=3 [ ]
116. Transient, stress-related paranoia or severe dissociative
symptoms. [ ]
Yes=1 No=2 Unsure=3 [ ]
If subject answered No or Unsure to question 116, go to 118.
XI. Dissociative Amnesia
117. Have you ever experienced inability to recall important
personal information, particularly of a traumatic or stressful nature,
that is too extensive to be explained by ordinary forgetfulness?
Yes=1 No=2 Unsure=3 [ ]
118. If you answered Yes to the previous question was the disturbance
due to known physical disorder (e.g., blackouts during alcohol
intoxication, or stroke), substance abuse, or another psychiatric disorder?
Yes=1 No=2 Unsure=3 [ ]
119. Did the symptoms cause you significant distress or impairment
in social or occupational function?
Yes=1 No=2 Unsure=3 [ ]
XII. Dissociative Fugue
If subject answered No to one or both of questions 118 and
119, go to 121.
120. Have you ever experienced sudden unexpected travel away
from your home or customary place of work, with inability to recall your
past?
Yes=1 No=2 Unsure=3 [ ]
121. During this period did you experience confusion about your identity
or assume a partial or complete new identity?
Yes=1 No=2 Unsure=3 [ ]
122. If you answered Yes to both the previous two questions was
the disturbance due to a known physical disorder? (e.g., blackouts during
alcohol intoxication or stroke)?
Yes=1 No=2 Unsure=3 [ ]
123. Did the symptoms cause you significant distress or impairment in occupational or social function?
Yes=1 No=2 Unsure=3 [ ]
XIII. Depersonalization Disorder
124. Interviewer should say, "I am now going to ask
you a series of questions about depersonalization. Depersonalization
means feeling unreal, feeling as if you're in a dream, seeing yourself
from outside your body or similar experiences."
a) Have you had one or more episodes of depersonalization sufficient
to cause problems in your work or social life?
Yes=1 No=2 Unsure=3 [ ]
b) Have you ever had the feeling that your feet and hands or
other parts of your body have changed in size?
Yes=1 No=2 Unsure=3 [ ]
c) Have you ever experienced seeing yourself from outside your body?
Yes=1 No=2 Unsure=3 [ ]
d) Have you ever had a strong feeling of unreality that lasted for a
period of time, not counting when you are using drugs or alcohol?
Yes=1 No=2 Unsure=3 [ ]
If subject did not answer Yes to any of 124 a-d,
go to question 127.
125. If you answered Yes to any of the previous questions
about depersonalization was the disturbance due to another disorder,
such as Schizophrenia, Anxiety Disorder, or epilepsy, substance
abuse, or a general medical condition?
Yes=1 No=2 Unsure=3 [ ]
126. During the periods of depersonalization, did you stay in
touch with reality and maintain your ability to think rationally?
Yes=1 No=2 Unsure=3 [ ]
XIV. Dissociative Identity Disorder
127. Have you ever felt like there are two or more distinct identities or
personalities within yourself, each of which has its own pattern of perceiving,
thinking, and relating to self and others?
Yes=1 No=2 Unsure=3 [ ]
If subject answered No to question 127, go to question 131.
128. Do at least two of the identities or personalities
recurrently take control of your behavior?
Yes=1 No=2 Unsure=3 [ ]
Interviewer should score question 129 based on the subject's
response to Question 117, and should not read question 129 aloud.
129. Have you experienced inability to recall important personal
information that is too extensive to be explained by ordinary forgetfulness?
Yes=1 No=2 Unsure=3 [ ]
130. Is the problem with different identities or personalities due to
substance abuse (e.g. alcohol blackouts) or a general medical condition?
Yes=1 No=2 Unsure=3 [ ]
INTERVIEWER SHOULD NOT READ THE FOLLOWING 2 QUESTIONS ALOUD
XV. Dissociative Disorder Not Otherwise Specified
131. Subject appears to have a dissociative disorder but does
not satisfy the criteria for a specific dissociative disorder. Examples
include trance-like states, derealization unaccompanied by depersonalization,
and those more prolonged dissociated states that may occur in persons who have been
subjected to periods of prolonged and intense coercive persuasion (brainwashing,
thought reform, and indoctrination while captive).
Yes=1 No=2 Unsure=3 [ ]
XVI. Concluding Item
132. During the interview, did the subject display unusual, illogical,
or idiosyncratic thought processes?
Yes=1 No=2 Unsure=3 [ ]
Interviewer should make a brief concluding statement telling
subject that there are no more questions, and thanking the subject for
his/her participation. |
