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Synopsis of the Derogatis Stress Profile

Derogatis, Leonard R.

Derogatis Stress Profile (DSP®)

Clinical Psychometric Research Inc.,          
1228 Wine Spring Lane, Towson, MD 21204

Instrument Development
	Year Developed: 1980
	Primary Measurement Constructs: Stress, based on an interactional stress theory 
paradigm which holds stress to be a phenomenon arising from a dynamic interaction 
between environmental events, personality characteristics and emotional responses.

The DSP® is a 77-item self-report inventory derived from interactional stress theory.   
According to this model, stress is comprised of three interactional components: 
environmental events, personality mediators, and emotional responses.  These three 
components are the specific referents in interactional theory for the more general categories 
of environmental stimuli, person mediating characteristics, and individual responses.  Some 
stress researchers have attempted to operationally define stress in terms of only one of 
these components (e.g., life events, Type A personality, psychological symptoms); however, 
 interactional theorists have effectively argued that these domains must be appreciated and 
measured interactively to achieve a meaningful definition of the stress construct. 

The design of the DSP® uses a hierarchical model to represent stress as an interactive 
construct: eleven primary stress vectors (dimensions) are subsumed under three principal 
stress components (domains), which cumulatively provide a quantitative overall summary 
estimate (global stress score) of the respondent's current stress level.  Figure 1 provides a 
graphic representation of the DSP®'s hierarchical construct structure.

The DSP® paradigm holds that stress vectors from the three primary stress-inducing life 
event areas (i.e., domestic, vocational and health) are mediated by five critical personality 
characteristics and the quality of the individual's emotional response, which itself becomes 
an aspect of the stimulus environment, to result in the phenomenologic experience of 
stress.  Stress vector burdens arising from the environment are either magnified and 
enhanced or deflected and diminished by personality mediators and the nature and 
magnitude of the emotional response (i.e., affective, cognitive and physiologic) that they 
ultimately elicit.

Although the precise nature of the relationships between the principal stress domains has 
not been definitively established, it is conservatively represented as additive in the DSP®.  
This strategy enables, after appropriate statistical scaling, summation across appropriate 
stress dimensions to achieve the three principal DSP® domain scores, and subsequently to 
sum across domain scores to achieve a single global definition of stress-- the Total Stress 
Score (TSS).  The DSP® also features a Subjective Stress Score (SSS), measured in 
analogue fashion, to provide an estimate of the respondent's conscious appreciation of 
his/her current stress level.

	A distinct advantage associated with the DSP® is that it operationally defines stress 
at three distinct but related construct levels: primary stress dimensions, secondary stress 
domains and as a tertiary global stress construct.  The secondary domain constructs are 
those specified by interactional theory, and represent the fundamental dynamic  elements 
comprising the DSP®'s interactional definition of stress.  The 11 primary stress vectors all 
represent constructs consistently identified as stress-inducers, stress-mediators or stress- 
indicators, and were developed based on comprehensive research in the areas of life 
events, personality and psychopathology (Derogatis, 1987; Derogatis & Coons, 1993).

Definition of the Primary DSP® Dimensions

	Environmental Events:

	Vocational Environment-	Vocational environment focuses on the individual's work 
environment as one of the three primary stress-inducing areas of life.  Although typically a 
significant source of self-worth and self-esteem, the work environment is a frequent source 
of stressful life events which may be of an acute or chronic nature.  Success or failure in the 
work role plays a significant part in most individual's feelings of well-being.  

	Domestic Environment-	The Domestic Environment represents the second 
principal life experience that is critical to healthy psychological adjustment and feelings of 
well-being.  Like the vocational sphere, domestic life carries the potential for extremely 
disruptive interpersonal conflicts and high stress-induction.  Relationships with spouses, 
parents, children, neighbors and extended family all possess the capacity for significant 
conflict, and resultant high levels of stress.  Specific developmental epochs tend to share 
common difficulties e.g.,"adolescent rebellion", "midlife crisis", "geriatric decline", as well as 
those that are specific to the particular epoch at hand.

	Health Environment-	The Health Environment probably possesses the potential for 
the most profound and pervasive influence on our psychological adjustment and sense of 
well-being than any other aspect of life experience.  Disease and illness carry with them 
significant burdens for coping and adjustment, since all serious illnesses degrade quality of 
life and have high potential for stress-induction.  Although we do not possess definitive 
knowledge of health-optimizing behaviors, evidence does exist concerning the impact of 
some behaviors and attitudes on health.  By assessing an individual relative to these 
behaviors, postures and practices the Health Environment dimension is designed to 
measure stress arising from this important and central aspect of life.

	Personality Mediators:

	Time Pressure-	The concept of "time pressure" has become synonymous in 
contemporary culture with performance, evaluation and task deadlines, and thereby, with 
stress.   Time pressure induces stress by functioning as a multiplier for the demand 
characteristic of the situation:  Not only must the individual accomplish the task accurately, 
but must do so in a conspicuously limited, perhaps insufficient, amount of time.  The 
imposition of a time constraint "ups the ante" in terms of the physical, psychological and 
emotional resources that must be brought to bear to accomplish a task. 

	Driven Behavior-	Frequently seen as a concomitant personality characteristic of 
time pressure, driven behavior is nonetheless a distinct personality trait.  Driven behavior 
represents a compulsive need to be involved in activities that the individual views as broadly 
constructive, and the pattern of behaviors which he/she employs to satisfy that need.  The 
self-imposed, demanding criterion of constant, tangible accomplishment is required by these 
individuals to achieve feelings of consistent well-being and self-worth.

	Attitude Posture-	  Attitude posture is highly related to the "achievement ethic".  
The idea that "good" members of our society achieve tangible accomplishments is 
interwoven throughout our social fabric.   Some individuals extend the concept further, 
however, behaving as though if tangible accomplishment is equated with "good", then more 
 accomplishment must make them "better".  For these people there can never be enough 
productivity. Unfortunately, these individuals can rarely enjoy the fruits of their labors, having 
to quickly focus on the next set of potential achievements.  This characteristic promotes the 
feeling of being "caught in a ratrace", from which the person can never seem to escape. 

	Relaxation Potential-	As the label implies, Relaxation Potential refers to the 
individual's capacity to become involved in healthy diversions from the daily demands of 
work, family and community.  Sometimes referred to as "hedonic potential", this 
characteristic captures a person's capacity to engage in stress-deflecting activities that are 
perceived as "fun".  Contemporary research has consistently shown that the greater and 
varied the number of activities an individual enjoys participating in, the more resistant to 
cumulative stress burdens that individual will be.  

	Role Definition-	Role Definition, as the intrapsychic and interpersonal 
representation of self-concept, is a personality characteristic comprised of both private and 
public components.  Role-defining personal characterizations probably exist on a stress-
related continuum; however, a number of consistently stress-inducing definitions have been 
identified.  Of these, the most clearly defined is the "atlas syndrome".  These individuals 
define themselves as the maximum "can do" person; they delegate little authority to others 
and represent themselves as "indispensable".  They are "all business" and  rarely request 
help from others, perceiving such actions as a sign of personal weakness and a 
fundamental betrayal of their identity.  Individuals high on this personality trait tend to be 
lonely, alienated, chronically fatigued and unhappy, having never learned how to share 
either life's demands or life's pleasures.

	Emotional Response:

	Hostility-	The Hostility dimension is the first of the three affect/symptom stress 
vectors that define the Emotional Response domain.  Like all of the emotional response 
dimensions, Hostility reflects affective experiences arising from one of the fundamental 
human emotions--in this case anger.  The items comprising the Hostility dimension were 
selected to measure thoughts, feelings and behaviors that are characteristic expressions of 
anger, and items were developed to reflect all three modalities of expression.  In addition to 
explicit experiences of anger, the Hostility dimension is designed to capture other shadings 
of this emotional complex such as irritability, resentment and aggression.

	Anxiety-	The Anxiety dimension represents the second in the DSP®'s triad of 
Emotional Response measures.  Its items are designed to reflect mild-to-moderate  
manifestations of anxiety.  Items reflect characteristics such as tension, free-floating anxiety, 
worry, nervousness and apprehension.  These expressions of anxiety were chosen 
because they represent relatively moderate, less clinically remarkable, manifestations.  This 
strategy is consistent with our view of stress as a transitional phenomenon which can 
progress to more dramatic clinical states (e.g., formal anxiety disorders).  Thus elevations 
on the emotional response vectors can signal an "at riskness" for the possibility of more 
serious emotional problems.

	Depression-	Clinical depression is well-established as the most prevalent 
manifestation of psychiatric disorder (Derogatis & DellaPietra, 1994; Derogatis & Wise, 
1989), and depressed affect (i.e., "feeling down") is a very common occurrence.  The items 
comprising the Depression dimension reflect a broad spectrum of depressive 
manifestations, and like the other Emotional Response dimensions, are drawn from the 
"mild-to-moderate" range of symptoms.  The Depression dimension assesses such 
experiences as fatigue, loss of interest, feelings of loneliness and lowered self-esteem.  
Suicidal ideation is included because of its paramount importance; however, more dramatic 
signs and symptoms of profound clinical depression (e.g., vegetative signs) are absent.  
The Depression dimension is not designed to enable clinical diagnosis; however, like the 
Anxiety subscale, high scores do signal a potential "at riskness" for more formal psychiatric 

DSP® Norms
Fundamentally, norms provide interpretive points of reference regarding the meaning of 
psychological test scores.  They deliver information on an individual's relative standing in 
comparison to the standardization sample, and in the case of multidimensional tests, enable 
a meaningful comparison of a respondent's scores on multiple attributes (e.g., levels of 
depression vs anxiety).  Norms for the DSP® are based on approximately 1,000 community 
respondents who ranged in age from 18 to over 70.  Slightly more men than women 
contributed to the sample, and all were employed at the time of evaluation.  All DSP® 
norms have been developed in terms of Area T-scores, which represent normalizing area 
transformations.  Area T-scores, unlike their linear counterparts, deliver accurate centile 
equivalents, and thereby enable precise actuarial representation and meaningful clinical 
interpretation of score profiles.

Instrument Type
Clinical/Research Instrument, Self-Report

Languages Available
Arabic, Dutch, English, French, Greek, Italian and Spanish.

Item Format
The DSP® is comprised of 77 items, seven (7) items for each of the 11 primary dimensions. 
 The scale takes approximately 12 to 13 minutes to complete under normal conditions, 
although some individuals make require a few minutes longer.  Each item of the DSP® is 
rated on a 5-point scale ranging from 0="not-at-all true of me", to 4 ="extremely true of me".

Reliability of the DSP®
In the self-report modality of measurement, the two most indicators of reliability are 
measures involving consistency of items (homogeneity) and stability through time (repeated 
measures).  The DSP® has been evaluated concerning both forms of reliability and has 
demonstrated very acceptable reliability coefficients.  Test-retest coefficients are based on a 
small sample of employees (N=34) who presented to a corporate medical office with what 
were judged by the physician in charge to be stress-related disorders.  The nature of 
presenting complaints ranged from general anxiety to headaches and gastrointestinal 
disorders.  Patients were medically evaluated and assessed with the DSP® twice, 7 days 
apart.  Test-retest coefficients ranged from a high of .92 for Time Pressure, to a low of .72 
for Hostility, with the majority of values falling in the mid to high .80's.  The Total Stress 
Score (TSS) had a coefficient of .90.

Internal consistency coefficients for the DSP® were established on a large sample of 867 
individuals, who were employed by twelve commercial companies.  The majority of 
respondents held middle management positions, although individuals' positions ranged from 
clerical staff to several CEO's.  Item homogeneity was demonstrated to be at acceptable 
levels for all DSP® primary stress dimensions, ranging from a high of .93 for Time Pressure 
to a low of .79 for Vocational Environment.  Internal consistency for the three principal 
domain scores was also quite good , ranging from .83 to .88.  

Validity of the DSP®

	Internal Relationships Among DSP® Scales:  An ideal of multidimensional 
measurement is an instrument which demonstrates relative orthogonality among primary 
measurement dimensions, while simultaneously revealing moderate-to-high correlations 
between the dimensions and the test's total score.  Such a pattern of relationships among 
test subscales is highly desirable because it confirms the goal of designing relatively unique, 
uncorrelated components of the superordinate construct being assessed (e.g., stress).  It 
also helps insure minimum measurement redundancy while increasing measurement 
breadth and sensitivity.  In the case of the DSP®, we have approached such a pattern.  
Interscale correlations are relatively high between primary stress dimensions and their 
corresponding domains, and much more modest between dimensions and non-
corresponding domains.  As examples, the average r among the 5 Personality Mediator 
dimensions with the domain score was .71, while the average correlation of this set of 
measures with non-corresponding domains was .41 .  The mean coefficient for 
Environmental Events dimensions was .70 with the corresponding domain, but only .39 with 
divergent domains.  Dimensions comprising the Emotional Response domain showed a 
mean correlation of .80 with the Emotional Response score, but only .41 with other 
domains.  At each level of the measurement hierarchy a reasonably non-redundant pattern 
of relationships was observed.

	Confirmation of Dimensional Structure:  An essential step in the construct 
validation of a multidimensional psychological measure is confirmation of its proposed 
dimensional structure.  Such confirmation is generally achieved through factor analysis.  For 
the DSP®, Derogatis (1987) reported a factor analysis of the instrument, at the level of the 
primary stress dimensions, based on a sample of 867 respondents.  Hypothesized structure 
called for three factors, corresponding to the three principal stress domains of the 
instrument. Four factors were identified accounting for approximately 70% of the variance in 
the matrix.  The initial factor was loaded almost exclusively by the five dimensions of the 
Personality Mediators domain, while the second factor clearly represented the Emotional 
Response domain.  Hostility, Anxiety and Depression all showed substantial loadings on 
Factor II.  The third factor identified had significant correlations with Vocational Environment 
and Domestic Environment.  The third Environmental Event measure, Health Environment, 
did not correlate with this factor, instead, forming a unique, separate factor on which it 
revealed a highly saturated loading and accounted for approximately 8% of the variance in 
the matrix.  In general, this analysis provides a substantial degree of corroboration for the 
hypothesized dimensional structure of the DSP®: 10 of the 11 dimensions conform to the 
designed structure of the test.  It remains unclear as to why the Health Environment 
dimension did not load with the other Environmental Event measures.  However, theorists 
currently posit health status to be one of the seven major dimensions of outcomes 
assessment (Docherty & Streeter, 1996), and it may turn out that elements of the perception 
of health are more orthogonal to other dimensions of life experience than previously 

	Criterion Validity:  	Although contemporary validity theory (Messick, 1995) has 
reassigned criterion-oriented validation to the external aspect of construct validity, when 
most investigators and clinicians use the term "validity" it is this aspect of validation they are 
referring to.  Criterion validity refers to the programmatic series of experiments which 
demonstrate patterns of correlations (i.e., empirical relationships) between test scores and 
external criteria (which themselves may be other test scores) that are consistent with and 
confirm the theory of the construct being measured.  In the case of the DSP®, there is a 
growing body of research demonstrating empirical relationships with external criteria which 
confirm the test as a valid interactional measure of stress.  The Principal Citations which 
follow contain references to much of this work.

How to Obtain
The DSP® is distributed exclusively by Clinical Psychometric Research Inc., 1228 Wine 
Spring Lane, Towson, MD 21204.  Phone 1-800-245-0277; 1-(410) 321-6165; FAX 1-(410) 

Copyright & Trademark Owner
Leonard R. Derogatis, Ph.D.

Principal Citations

Derogatis, L.R. (1984). The Derogatis Stress Profile DSP®: Preliminary Administration & 
	Scoring Manual. 	Baltimore, MD, Clinical Psychometric Research.

Derogatis, L.R. (1987). The Derogatis Stress Profile DSP®: Quantification of psychological  
	stress. In G. Fava & T. Wise (Eds.), Research Paradigms in Psychosomatic 
Medicine, 	(pp 30-54). Basel, Karger.

Derogatis, L.R. (1982). Self-report measures of stress. In L. Goldberger & S. Breznitz 
(Eds.), 	Handbook of Stress: Theoretical and Clinical Aspects. (pp 270-294), New 
York, 	MacMillan.

Derogatis, L.R. & Coons, H.L. (1993). Self-report measures of stress. In L. Goldberger & S. 
	Breznitz (Eds.), Handbook of Stress: Theoretical and Clinical Aspects, (Second 
	Edition). New York, Free Press/MacMillan.

Derogatis, L.R. & DellaPietra, L. (1994). Psychological tests in screening for psychiatric 
	disorder. In M. Maruish (Ed.), Psychological Testing in Treatment Planning and 
	Outcomes Assessment. New York, Lawrence Earlbaum Associates.

Dobkin, P.L., Pihl, R.O. & Breault, C. (1991). Validation of the Derogatis Stress Profile using 
	laboratory and real world data. Psychotherapy & Psychosomatics, 56, 185-196.

Duquette, R.L., DuPuis, G. & Perrault, J. (1991). A new approach for quality of life 
	assessment in cardiac patients. Cardiovascular Medicine, 10, 106-112.

Lewandowski, A., Byl, N., Franklin, B., Gordon, S., Timmis, G.C. & Beaumont, W. (1987). 
	Relationship of the Derogatis Stress Profile to staff perceptions of adjustment and 
	prognosis of cardiac patients. Journal of Cardiopulmonary Rehabilitation, 7, 502-506.

Solis, S. (1991). Psychosocial Stress in Marine Corps officers. Military Medicine, 156, 223-

Sturdevant, J.R., George, J.M. & Lundeen, T.F. (1987). An interactional view of dental 
	student stress. Journal of Dental Education, 51, 246-249.
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