Somatoform Dissociation
Questionnaire
The SDQ-20 is a 20-item questionnaire that measures how severe somatoform dissociation is: dissociation that shows itself in the body. It has very good psychometric qualities and takes only a few minutes to complete.
The SDQ-20 and helpful literature are
available for free in our Open Library.
In which languages is the SDQ-20 available?
The SDQ-20 has been translated to a variety of languages. All versions can be downloaded via our free eLibrary. The SDQ-5 consists of the SDQ-20 items 4, 8, 13, 15, and 18.
Danish: SDQ-5 på dansk (ikke SDQ-20)
Dutch: SDQ-20 en SDQ-5 in het Nederlands
English: SDQ-20 and SDQ-5 in English
French: SDQ-20 et SDQ-5 en français
German: SDQ-20 und SDQ-5 in deutsch
Hebrew: SDQ-5 בעברית, ה-sdq-20 בעברית עדיין לא אושר
Hindi: एसडीक्यू-20 और एसडीक्यू-5 हिंदी में।
Italian: SDQ-20 e SDQ-5 in Italiano
Mandarin: 普通话的 SDQ-20 和 SDQ-5。
Norwegian: SDQ-20 og SDQ-5 på norsk.
Polish: SDQ-20 i SDQ-5 w języku polskim.
Portuguese: SDQ-20 e SDQ-5 em português.
Spanish: SDQ-20 y SDQ-5 en español.
Swedish: SDQ-20 och SDQ-5 på svenska.
Turkish: Türkçe SDQ-20 ve SDQ-5.
Urdu: SDQ-20 اور SDQ-5 اردو میں۔
What is the SDQ-5?
The five item SDQ-5 is a screener for dissociative disorders. The instrument performed well in some studies, but less well in other studies. We advice you to you the SDQ-20 when time permits.
What is the SDQ-20 based on?
Normally, we bring everything we experience together into one whole: what we feel in our body, what we see and hear, how we move, our emotions, what we know and what we remember. Mind and body work as one. We don't just think about what happens to us; we live it with our whole body. When life brings too much pain, this bringing together can fail. This is especially true when it happens early in life, and when it comes from the very people a child depends on. The experience is then not lived as one whole, but divided among different parts of the person. One part may go on with daily life as if nothing happened, while another part still carries the fear, the pain or the memories of what happened. These parts each have their own way of feeling, thinking and acting, and they don't fully share their experiences with one another. This division of the person into parts that don't fully know each other is what we call dissociation.
What is somatoform dissociation?
Dissociation is not only mental (“psychoform”). It can show just as much in the body: for example, numbness, pain without a medical cause or not being able to move. This bodily expression of dissociation is called somatoform dissociation. It is dissociation expressed physically. The SDQ-20 assesses these signs and symptoms.
What is structural dissociation?
In chronic traumatisation in childhood, there is often a deep conflict of longings. To survive, a child must attach to their parents: they depend on them for food, shelter, safety and love. But when those same parents abuse the child, the child also needs to protect themselves against them. The child must move towards the very people they also need to escape from.
When abuse from caregivers comes together with emotional neglect, this conflict becomes impossible to hold together. Life becomes unbearable as one whole person. The way to survive the unsurvivable is division: the child's divides into different parts.
This division often involves at least three prototypical parts:
• A part that keeps daily life going: it goes to school or work, looks after others and tries to carry on as if nothing happened. This is called the apparently normal part (ANP).
• A part that defends itself in the face of threat and may also long for care and attachment. It is often feels like a small, frightened child. This is called the fragile emotional part (EPF).
• A part that hungers for autonomy. It can be angry, controlling or hostile, even towards the therapist. Being needy is dangerous. This is called the controlling emotional part (EPC).
The emotional parts (EPF and EPC) remain caught in traumatic experiences, as if it were still happening. The everyday part (ANP) often avoids them, because facing them is overwhelming.
What kind of somatoform dissociative symptoms exist?
As early as the 1890s, the French psychologist Pierre Janet observed that dissociation shows itself in two ways. Today, Ellert Nijenhuis call these negative and positive dissociative symptoms.
An important point: a bodily symptom is only dissociative if it belongs to one or some dissociative parts, but not to all of them. For example, the everyday part may feel no pain at all, while an emotional part feels intense pain in the same place. It is this difference between the parts that makes a symptom dissociative.
Negative dissociative symptoms: something is missing
The person feels, senses or can do less than usual. For example:
• little awareness of the body, or not feeling the body at all
• not feeling pain
• numbness in part of the body
• not being able to move, or freezing
The everyday part often has these symptoms. The emotional parts can have them too, as old survival reactions to danger.
Positive dissociative symptoms: something is added
The person experiences something that isn't actually happening now.
For example:
• pain in part of the body without a medical cause
• the feeling of being touched
• smelling or tasting something that isn't there
• movements the person doesn't control
These symptoms often come from the emotional parts and are part of the traumatic memories they carry.
References
Nijenhuis, E.R.S., Spinhoven, P., Van Dyck, R., Van der Hart, O., & Vanderlinden, J. (1996). The development and the psychometric characteristics of the Somatoform Dissociation Questionnaire (SDQ-20). Journal of Nervous and Mental Disease, 184, 688-694.
Nijenhuis, E.R.S. (2009). Somatoform dissociation and somatoform dissociative disorders. In P.F. Dell, & J. O’Neil (Eds.), Dissociation and dissociative disorders: DSM-IV and beyond (pp. 259-277). New York: Routledge.
Add SDQ-20 to your own database
Would you like to make the SDQ-20 available to your healthcare workers through your organisation’s own digital system or database?
We offer this option in combination with an in-house training by Ellert Nijenhuis or one of our appointed Associates. This ensures that clinicians not only have convenient access to the SDQ-20 within their working environment, but also receive training in its appropriate clinical use and interpretation.
Interested? Please contact Kirande Nijenhuis (kirande [at] enijenhuis.nl) to discuss an in-house training and the use of the SDQ-20 within your organisation.