Chapter 4 122 changes in cognition, behavior, feelings, and physical symptoms related to depression. Participants are required to respond by means of a 4-point Likert-scale (0-3). Total scores in the scale vary between 0 and 63. Reliability and validity of the BDI-II have been established and scoring norms for the Dutch population are available [108]. In our sample, internal consistency of the BDI-II was excellent (Cronbach’s = .91). Dissociative experiences The Dutch version of the Dissociative Experiences Scale (DES) [109-111] was used to assess the frequency or level of dissociative experiences. The DES is the most used scale world-wide for assessing dissociation, both for research and clinical purposes [111]. The DES has been developed to offer a means of reliably measuring dissociation in normal and clinical populations. The scale is a 28-item self-report questionnaire. Subjects are asked to make slashes on 100-mm lines to indicate where they fall on a continuum for each question. The total score, which also falls anywhere between 0 and 100, is calculated as the mean of all item scores. A higher score on the DES implicates more dissociative experiences. The DES was found to have good psychometric properties [109, 112]. In our sample, internal consistency of the DES was excellent (Cronbach’s = .95). Self-injurious Behaviors Direct SIB was assessed by three separate items: item 1 from the supplement scale of the BSL-23 and item 4 and item 5 of the Dutch, shortened version of the NonSuicidal Self-Injury assessment tool (NSSI-AT; Dutch version: “Screeningsvragenlijst Opzettelijk Zelfverwondend Gedrag” SOZG) [113]. Item 1 of the BSL-23 supplement scale assesses the frequency of direct SIB in the past week; item 4 of the SOZG assesses the total number of days (N.B. not times) someone engaged in direct SIB in the past year; item 5 from the SOZG assesses the total number of times a person has ever engaged in direct SIB. Items use multiple choice answering. Answering options represent an ordinally ranked continuum. For example, on item 5 of the SOZG, participants are required to choose from the options ‘zero times’, ‘once’, ‘2 or 3 times’, ‘4 or 5 times’, ‘6 to 10 times’, ’11 to 20 times’, ’21 to 50 times’, and ‘more than 50 times’) Indirect SIB was assessed by a scale construed by the authors for the purposes of this study. It contains items of the BSL-23 Supplement scale. The BSL-23 Supplement scale consists of 11 items about risky, harmful and suicidal behaviors. Participants are requested to rate on an ordinal 5-point Likert scale if, and if so, how many times they engaged in the described behavior per item in the past week.
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