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PTSD Checklist for DSM-5 (PCL-5)

 

PTSD Checklist for DSM-5 (PCL-5)

Frank W. Weathers, PhD; Brett T. Litz, PhD; Terence M. Keane, PhD; Patrick A. Palmieri, PhD; Brian P. Marx, PhD; & Paula P. Schnurr, PhD

Description

The PCL-5 is a 20-item self-report measure that assesses the 20 DSM-5 symptoms of PTSD. The PCL-5 has a variety of purposes, including:

  • Monitoring symptom change during and after treatment
  • Screening individuals for PTSD
  • Making a provisional PTSD diagnosis

The gold standard for diagnosing PTSD is a structured clinical interview such as the Clinician-Administered PTSD Scale (CAPS-5). When necessary, the PCL-5 can be scored to provide a provisional PTSD diagnosis.

The PCL-5 can be administered in one of three formats:

  • without Criterion A (brief instructions and items only), which is appropriate when trauma exposure is measured by some other method
  • with a brief Criterion A assessment
  • with the revised Life Events Checklist for DSM-5 (LEC-5) and extended Criterion A assessment

Changes from previous PCL for DSM-IV

Several important revisions were made to the PCL in updating it for DSM-5:

  • PCL for DSM-IV has three versions, PCL-M (military), PCL-C (civilian), and PCL-S (specific), which vary slightly in the instructions and wording of the phrase referring to the index event. PCL-5 is most similar to the PCL-S (specific) version. There are no corresponding PCL-M or PCL-C versions of PCL-5.
  • Although there is only one version of the PCL-5 items, there are three formats of the PCL-5 measure, including one without a Criterion A component, one with a Criterion A component, and one with the LEC-5 and extended Criterion A component.
  • The PCL-5 is a 20-item questionnaire, corresponding to the DSM-5 symptom criteria for PTSD. The wording of PCL-5 items reflects both changes to existing symptoms and the addition of new symptoms in DSM-5.
  • The self-report rating scale is 0-4 for each symptom, reflecting a change from 1-5 in the DSM-IV version. Rating scale descriptors are the same: "Not at all," "A little bit," Moderately," "Quite a bit," and "Extremely."
  • The change in the rating scale, combined with the increase from 17 to 20 items means that PCL-5 scores are not compatible with PCL for DSM-IV scores and cannot be used interchangeably.

Administration and Scoring

The PCL-5 is a self-report measure that can be completed by patients in a waiting room prior to a session or by participants as part of a research study. It takes approximately 5-10 minutes to complete. Interpretation of the PCL-5 should be made by a clinician.

The PCL-5 can be scored in different ways:

  • A total symptom severity score (rang - 0-80) can be obtained by summing the scores for each of the 20 items.
  • DSM-5 symptom cluster severity scores can be obtained by summing the scores for the items within a given cluster, i.e., cluster B (items 1-5), cluster C (items 6-7), cluster D (items 8-14), and cluster E (items 15-20).
  • A provisional PTSD diagnosis can be made by treating each item rated as 2 = "Moderately" or higher as a symptom endorsed, then following the DSM-5 diagnostic rule which requires at least: 1 B item (questions 1-5), 1 C item (questions 6-7), 2 D items (questions 8-14), 2 E items (questions 15-20).
  • Preliminary validation work is sufficient to make initial cut-point suggestions, but this information may be subject to change. Overall, optimal PCL-5 cut-points appear to be 11-14 points lower than PCL for DSM-IV cut-points, with closer to an 11-point difference for more stringent cutoffs and closer to a 14-point difference for more lenient cutoffs. A PCL-5 cut-point of 38 appears to be a reasonable value to propose until further psychometric work is available.

Interpretation

Characteristics of a respondent's setting should be considered when using PCL-5 severity scores to make a provisional diagnosis. The goal of assessment also should be considered. A lower cutoff should be considered when screening or when it is desirable to maximize detection of possible cases. A higher cutoff should be considered when attempting to make a provisional diagnosis or to minimize false positives.

Measuring Change

Good clinical care requires that clinicians monitor patient progress. Evidence for the PCL for DSM-IV suggests that a 5-10 point change represents reliable change (i.e., change not due to chance) and a 10-20 point change represents clinically significant change. Therefore, it was recommended to use 5 points as a minimum threshold for determining whether an individual has responded to treatment and 10 points as a minimum threshold for determining whether the improvement is clinically meaningful using the PCL for DSM-IV.

Change scores for PCL-5 are currently being determined. It is expected that reliable and clinically meaningful change will be in a similar range.

Sample Item

  • Item: In the past month, how much were you been bothered by: "Repeated, disturbing, and unwanted memories of the stressful experience?"
  • Response: 0 = "Not at all" to 4 = "Extremely"

Citation

Weathers, F.W., Litz, B.T., Keane, T.M., Palmieri, P.A., Marx, B.P., & Schnurr, P.P. (2013). The PTSD Checklist for DSM-5 (PCL-5). Scale available from the National Center for PTSD at www.ptsd.va.gov.

References (PCL for DSM-IV)

Bliese, P. D., Wright, K. M., Adler, A. B., Cabrera, O., Castrol, C. A., & Hoge, C. W. (2008). Validating the primary care posttraumatic stress disorder screen and the posttraumatic stress disorder checklist with soldiers returning from combat. Journal of Consulting and Clinical Psychology, 76, 272-281. doi: 10.1037/0022-006X.76.2.272

Harrington, T., & Newman, E. (2007). The psychometric utility of two self-report measures of PTSD among women substance users. Addictive Behaviors, 32, 2788-2798. doi: 10.1016/j.addbeh.2007.04.016

Walker, E. A., Newman, E., Dobie, D. J., Ciechanowski, P., & Katon, W. (2002). Validation of the PTSD checklist in an HMO sample of women. General Hospital Psychiatry, 24, 375-380. doi: 10.1016/S0163-8343(02)00203-7

Sherman, J. J., Carlson, C., Wilson, J. F., Okeson, J., & McCubbin, J. A. (2005). Posttraumatic stress disorder among patients with orofacial pain. Journal of Orofacial Pain, 19, 309-317.

Blanchard, E. B., Jones-Alexander, J., Buckley, T. C., & Forneris, C. A. (1996). Psychometric properties of the PTSD checklist (PCL). Behavioral Research & Therapy, 34, 669-673. doi: 10.1016/0005-7967(96)00033-2

Kimerling, R., Prins, A., Yeager, D. E., & Magruder, K. M. (2010, November). An interval approach to screening for PTSD in primary care. Poster presented at the 44th annual conference of the Association for Behavioral and Cognitive Therapies, San Francisco, CA.

Monson, C. M., Gradus, J. L., Young-Xu, Y., Schnurr, P. P., Price, J. L., & Schumm, J. A. (2008). Change in posttraumatic stress disorder symptoms: Do clinicians and patients agree? (PDF) Psychological Assessment, 20, 131-138. doi: 10.1037/1040-3590.20.2.131

Weathers, F., Litz, B., Herman, D., Huska, J., & Keane, T. (October 1993). The PTSD Checklist (PCL): Reliability, Validity, and Diagnostic Utility. Paper presented at the Annual Convention of the International Society for Traumatic Stress Studies, San Antonio, TX. NOTE: Due to some confusion over versions of the PCL for DSM-IV, some of the published papers state that the PCL-C was used in this study, but the authors have confirmed that the PCL-S was the version actually used.

Additional Reviews (PCL for DSM-IV)

Orsillo (2001) (PDF) p. 281.

Orsillo, S. M. (2001). Measures for acute stress disorder and posttraumatic stress disorder. In M.M. Antony & S.M. Orsillo (Eds.), Practitioner's guide to empirically based measures of anxiety (pp. 255-307). New York: KluwerAcademic/Plenum. PILOTS ID 24368

Norris and Hamblen (2004) (PDF) p. 79.

Norris, F. H. & Hamblen, J. L. (2004). Standardized self-report measures of civilian trauma and PTSD. In J.P. Wilson, T.M. Keane & T. Martin (Eds.), Assessing psychological trauma and PTSD (pp. 63-102). New York: Guilford Press. PILOTS ID 18638

To Obtain Scale

This measure was created by staff at the VA National Center for PTSD. To obtain this scale complete the online request form.

Measure availability: Information on measures is available to everyone. However, the assessment tools themselves can only be distributed to qualified mental health professionals and researchers. We maintain measures developed by affiliated staff of the National Center for PTSD.


VA Providers and Staff can find information on how to download this instrument here: Specifically for VA Providers and Staff. See "Assessment measures."

Date this content was last updated is at the bottom of the page.

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The PILOTS database is the largest electronic index to the world's literature on traumatic stress.

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