PTSD Checklist (PCL)

Weathers, 1993

Description

The PCL is a 17-item self-report measure of the 17 DSM-IV symptoms of PTSD. The PCL has a variety of purposes, including:

• Screening individuals for PTSD
• Diagnosing PTSD
• Monitoring symptom change during and after treatment

There are three versions of the PCL:

1. The PCL-M (military) asks about symptoms in response to "stressful military experiences." It is often used with active service members and Veterans.
2. The PCL-C (civilian) asks about symptoms in relation to "stressful experiences." The PCL-C is useful because it can be used with any population. The symptoms endorsed may not be specific to just one event, which can be helpful when assessing survivors who have symptoms due to multiple events. Typically, it is optimal to assess traumatic event exposure to ensure that a respondent has experienced at least one Criterion A event.
3. The PCL-S (specific) asks about symptoms in relation to an identified "stressful experience." The PCL-S is useful because the symptoms endorsed are clearly linked to a specified event. Typically, it is optimal to assess traumatic event exposure to ensure that the event meets Criterion A. Respondents also may be instructed to complete the PCL-S in reference to a specific type of event.

Administration and Scoring

The PCL 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 a PCL. Interpretation of the PCL should be completed by a clinician.

The PCL can be scored in different ways:

• A total symptom severity score (range = 17-85) can be obtained by summing the scores from each of the 17 items.
• A diagnosis can be made by:
1. Determining whether an individual meets DSM-IV symptom criteria, i.e., at least 1 B item (questions 1-5), 3 C items (questions 6-12), and at least 2 D items (questions 13-17). Symptoms rated as "Moderately" or above (responses 3 through 5) are counted as present.
2. Determining whether the total severity score exceeds a given cutpoint.
3. Combining methods (1) and (2) to ensure that an individual has sufficient severity as well as the necessary pattern of symptoms required by the DSM.

Interpretation

Characteristics of a respondent's setting should be considered when using PCL severity scores to make a 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 definitive diagnosis or to minimize false positives.

Measuring Change

Good clinical care requires that clinicians monitor patient progress. Evidence 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, we recommend using 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 (7).

Sample Items

In the past month, how much have you been bothered by:

• PCL-C. "Repeated, disturbing memories, thoughts or images of a stressful experience from the past?"
• PCL-S. "Repeated, disturbing memories, thoughts or images of the (stressful experience)?"
• PCL-M. "Repeated, disturbing memories, thoughts or images of a stressful military experience?"

1 = Not at all to 5 = Extremely

References

1. Prins, A., Kimerling, R., Yeager, D. E., & Magruder, K. M. (2010). Guidelines for interpreting PCL scores in VA settings: An interval approach. Manuscript in preparation.
2. 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.
3. Harrington, T., & Newman, E. (2007). The psychometric utility of two self-report measures of PTSD among women substance users. Addictive Behaviors, 32, 2788-2798.
4. 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.
5. 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.
6. 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.
7. 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? Psychological Assessment, 20(2), 131-138.
8. 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, 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

Orsillo (2001) (PDF) p. 281.

Orsillo, Susan 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, Fran H. & Hamblen, Jessica 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: Download the PCL (PTSD Checklist) from the Intranet.