PTSD: National Center for PTSD

PTSD Checklist for DSM-5 (PCL-5)

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.

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 3 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 3 formats of the PCL-5 measure, including one without a Criterion A component, one with a Criterion A component, and one with the Life Events Checklist for DSM-5 (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. 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

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 (range - 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).
• Initial research suggests that a PCL-5 cutoff score between 31-33 is indicative of probable PTSD across samples. However, additional research is needed. Further, because the population and the purpose of the screening may warrant different cutoff scores, users are encouraged to consider both of these factors when choosing a cutoff score.

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 cut-point score should be considered when screening or when it is desirable to maximize detection of possible cases. A higher cut-point score 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. We recommend following the DSM-IV recommendations until new information is available.

Sample Item

• Item: In the past month, how much were you been bothered by: "Repeated, disturbing, and unwanted memories of the stressful experience?"
• Response: 5-point Likert (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-5)

Blevins, C. A., Weathers, F. W., Davis, M. T., Witte, T. K., & Domino, J. L. (2015). The Posttraumatic Stress Disorder Checklist for DSM-5 (PCL-5): Development and initial psychometric evaluation. Journal of Traumatic Stress, 28(6), 489-498. https://doi.org/10.1002/jts.22059

Bovin, M. J., Marx, B. P., Weathers, F. W., Gallagher, M. W., Rodriguez, P., Schnurr, P. P., & Keane, T. M. (2016). Psychometric properties of the PTSD Checklist for Diagnostic and Statistical Manual of Mental Disorders-Fifth Edition (PCL-5) in Veterans. Psychological Assessment, 28(11), 1379-1391. https://doi.org/10.1037/pas0000254

Marx, B. P., Lee, D. J., Norman, S. B., Bovin, M. J., Sloan, D. M., Weathers, F. W., Keane, T. M., & Schnurr, P. P. (2022). Reliable and clinically significant change in the Clinician-Administered PTSD Scale for DSM-5 and PTSD Checklist for DSM-5 among male Veterans. Psychological Assessment, 34(2), 197-203. https://doi.org/10.037/pas0001098

Marx, B. P., Lee, D. J., Norman, S. B., Bovin, M. J., Sloan, D. M., Weathers, F. W., Keane, T. M., & Schnurr, P. P. (2021). Reliable and clinically significant change in the Clinician-Administered PTSD Scale for DSM-5 and PTSD Checklist for DSM-5 among male Veterans. Psychological Assessment, Advance online publication. https://doi.org/10.1037/pas0001098

Wortmann, J. H., Jordan, A. H., Weathers, F. W., Resick, P. A., Dondanville, K. A., Hall-Clark, B., Foa, E. B., Young-McCaughan, S., Yarvis, J., Hembree, E. A., Mintz, J., Peterson, A. L., & Litz, B. T. (2016). Psychometric analysis of the PTSD Checklist-5 (PCL-5) among treatment-seeking military Service members. Psychological Assessment, 28(11), 1392-1403. https://doi.org/10.1037/pas0000260

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(2), 272-281. https://doi.org/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(12), 2788-2798. https://doi.org/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(6), 375-380. https://doi.org/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(4), 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(8), 669-673. https://doi.org/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? Psychological Assessment, 20(2), 131-138. https://doi.org/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). Kluwer Academic/Plenum. PTSDpubs ID 24368

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). Guilford Press. PTSDpubs ID 18638

To Obtain Scale

This measure was developed by staff at VA's National Center for PTSD and is in the public domain and not copyrighted. In accordance with the American Psychological Association's ethical guidelines, this instrument is intended for use by qualified health professionals and researchers.

Download the PTSD Checklist for DSM-5 (PCL-5):

• PCL-5, Past Month (PDF)
• PCL-5, Past Week (PDF)
• PCL-5 with Criterion A (PDF)
• PCL-5 with LEC-5 and Criterion A (PDF)
• Using the PTSD Checklist for DSM-5 (PCL-5) (PDF)

Download the PTSD Checklist for DSM-IV (PCL):

• PCL-Civilian (PCL-C) for DSM-IV (PDF)
• PCL-Military (PCL-M) for DSM-IV (PDF)
• PCL-Specific (PCL-S) for DSM-IV (PDF)
• PCL Psychometric Information for DSM-IV (PDF)
• PCL Scoring Information for DSM-IV (PDF)
• Using the PTSD Checklist for DSM-IV (PCL) (PDF)

Are you using this measure with U.S. Veterans or Service members?

Our PTSD Consultation Program can answer administration or scoring questions: PTSDconsult@va.gov or 866-948-7880.

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Measure availability: We provide information on a variety of measures assessing trauma and PTSD. These measures are intended for use by qualified mental health professionals and researchers. Measures authored by National Center staff are available as direct downloads or by request. Measures developed outside of the National Center can be requested via contact information available on the information page for the specific measure.