Adolescent Dissociative Experiences Scale-
II (A-DES) - Self-Report Questionnaire
Patient Information
Name:
Date of Birth:
Date of Assessment:
Instructions
Please carefully read each statement and indicate how much you have experienced each
sensation or feeling over the past six months. There are no right or wrong answers; respond
based on your experiences. Circle the appropriate number for each statement.
Scoring
0 = Never
1 = Rarely
2 = Sometimes
3 = Often
4 = Almost Always
A-DES Questionnaire
Statements Score
0 1 2 3 4
I feel as though the things around me are not real.
I feel as though my body does not belong to me.
I feel like I am watching myself from a distance.
I feel like different parts of my body don't belong to each
other.
I feel like I am not really here.
I hear voices that others do not hear.
I feel like I am not in control of my own actions.
I have gaps in my memory for things that I have done.
I sometimes find myself in places and don't know how I
got there.
I have periods of time when I feel as though I am
someone else.
I find items among my belongings that I do not remember
buying.
I suddenly become aware of myself doing something but
have no recollection of starting to do it.
I have trouble remembering how I got somewhere.
I have found evidence that I have done things I don't
remember.
People tell me about things I did but I don't remember.
I find myself in places and do not know how I got there.
I have memories of events that I can't be sure really
happened.
I sometimes hear voices in my head that tell me to do
things.
I often find myself in a place with no idea of how I got
there.
I feel like I am in a dream or trance.
I sometimes hear voices that argue with each other.
I find myself in a place and have no idea of how I got
there.
I feel like I am living in a dream.
I often feel like a spectator in my own life.
I have memories of things that I'm not sure really
happened.
I feel like I am someone else.
I feel like I am in a daze.
I sometimes have trouble recognizing myself in a mirror.
I find objects that I don't remember buying.
I often have difficulty remembering the day or date.
Scoring Key
Total Score:
Interpretation
0-10: Low level of dissociation
11-20: Moderate level of dissociation
21-30: High level of dissociation
31 or above: Very high level of dissociation
Additional Comments/Notes
Clinician's Signature:
Date:
