Clinician Administered Dissociative States Scale CADSS
Clinician Administered Dissociative States Scale CADSS overview
Creator and Context
The Clinician Administered Dissociative States Scale (CADSS) measures acute, state dissociation during a defined period of time, rather than dissociation as a trait.
It was developed by Douglas Bremner, John Krystal, Frank Putnam, Steven Southwick, Charles Marmar, Dennis Charney and Carolyn Mazure, and published in 1998. A revised version is now in general use, with 23 interview items and five observer items.
Presenting Conditions
The CADSS covers three areas of acute dissociation:
Depersonalisation
Derealisation
Amnesia
The interview items are completed with the person. A small number of observer items are rated by the clinician.
Administration
Clinician administered as a structured interview. Each item is rated from 0 (not at all) to 4 (extremely).
The critical feature is the recall frame: the CADSS asks about dissociation during a circumscribed, defined interval, such as the therapy session that has just finished or a specific procedure. It is designed for repeated administration.
Desired Audience
Adults, in psychiatric, trauma and anaesthetic or ketamine treatment populations. No paediatric validation was located.
Most dissociation measures ask about the last month or about life in general. The CADSS asks about the last hour, which is what you need if you want to know whether a person dissociated during the session, during the exposure, or during the infusion. That is a different and often more actionable question.
Considerations
There is no validated diagnostic cut off. It is a severity and change measure.
Version ambiguity is the biggest source of implementation error. The original had 19 interview and 8 observer items. The revised version has 23 interview and 5 observer items. The phrase 23 item CADSS usually refers to the interview portion only.
The original observer items had poor inter rater reliability, which is why the revision reduced them. Do not present observer items as validated.
The factor structure is contested.
No open licence was located. Confirm permission before commercial deployment.
How to score the Clinician Administered Dissociative States Scale CADSS
Conducting the assessment
The clinician works through the interview items with the person, rating each 0 to 4 in relation to the defined interval, and separately rates the observer items.
Interpretation
The interview items are summed. On the 23 item interview version this gives a total from 0 to 92. Observer items are scored separately.
There is no validated cut off. Higher scores indicate more severe acute dissociation, and interpretation is against the person's own baseline and prior readings.
Clinical Considerations
Define the interval explicitly before administering it, and keep that interval consistent across administrations.
Use it to detect dissociation during trauma work. A person who dissociates through an exposure session is not processing anything, and the CADSS is how you find out.
Track change from the person's own baseline. There is no threshold to apply.
Clinician Administered Dissociative States Scale CADSS use cases
Measuring acute dissociation during a defined interval
Detecting dissociation during therapy sessions or procedures
Monitoring dissociative side effects during ketamine treatment
Research into state dissociation
Category
Trauma
Research Summary
Bremner, J. D., Krystal, J. H., Putnam, F. W., Southwick, S. M., Marmar, C., Charney, D. S., & Mazure, C. M. (1998). Measurement of dissociative states with the Clinician-Administered Dissociative States Scale (CADSS). Journal of Traumatic Stress, 11(1), 125 to 136.
Mertens, Y. L., & Daniels, J. K. (2022). The Clinician-Administered Dissociative States Scale (CADSS): Validation of the German version. Journal of Trauma and Dissociation.
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