Item 29(1): Depersonalization: Persistent or recurrent experiences of feeling detached from, and as if one were an outside observer of, one’s mental processes or body (e.g., feeling as though one were in a dream; feeling a sense of unreality of self or body or of time moving slowly).

In the past month, have there been times when you felt as if you were separated from yourself, like you were watching yourself from the outside or observing your thoughts and feelings as if you were another person?

[If no:] (What about feeling as if you were in a dream, even though you were awake? Feeling as if something about you wasn’t real? Feeling as if time was moving more slowly?)

Tell me more about that.

How strong is this feeling? (Do you lose track of where you actually are or what’s actually going on?)

What do you do while this is happening? (Do other people notice your behavior? What do they say?)

How long does it last?

Circle: Dissociation = Minimal, Clearly Present, Pronounced, Extreme. (No items circled)

[If not clear:] (Was this due to the effects of alcohol or drugs? What about a medical condition like seizures?) [Rate 0=Absent if due to the effects of a substance or another medical condition]

How often has this happened in the past month? # of times: ______

Did this feeling start or get worse after (EVENT)? (Do you think it’s related to (EVENT)? How so?)

Circle: Trauma-relatedness: Definite, Probable, Unlikely. (none circled)

0. Absent (circled)
1. Mild / subthreshold
2. Moderate / threshold
3. Severe / markedly elevated
4. Extreme/ incapacitating

Key rating dimensions = frequency / intensity of dissociation

Moderate = at least 2 X month / dissociative quality clearly present but transient, retains some realistic sense of self and awareness of environment

Severe = at least 2 X week / pronounced dissociative quality, marked sense of detachment and unreality