PTSD Checklist for DSM-5 PCL-5
PTSD Checklist for DSM-5 PCL-5 overview
Creator and Context
The PTSD Checklist for DSM-5 (PCL-5) is a 20 item self report measure of the severity of post traumatic stress symptoms. Each item corresponds directly to one of the 20 PTSD symptoms defined in the DSM-5.
It was developed in 2013 by Weathers, Litz, Keane, Palmieri, Marx and Schnurr at the US National Center for PTSD, replacing the earlier DSM-IV version of the checklist. It is in the public domain and is one of the most widely used trauma measures in the world.
Presenting Conditions
The PCL-5 measures the four DSM-5 symptom clusters:
Intrusion (items 1 to 5), including unwanted memories, nightmares and flashbacks
Avoidance (items 6 to 7) of trauma related thoughts, feelings and reminders
Negative alterations in cognitions and mood (items 8 to 14)
Alterations in arousal and reactivity (items 15 to 20), including hypervigilance and sleep disturbance
Administration
Self administered. The person rates how much they have been bothered by each symptom over the past month on a 5 point scale from 0 (Not at all) to 4 (Extremely). A past week version is also published. It takes approximately 5 to 10 minutes to complete.
Desired Audience
Adults who have experienced a traumatic event. Validated extensively in veteran, serving military and civilian trauma exposed populations, and used across primary care, specialist trauma services and research.
The PCL-5 supports three distinct jobs: screening for probable PTSD, quantifying symptom severity, and tracking change across a course of trauma focused therapy. Because it maps one to one onto DSM-5 criteria, it also helps structure a diagnostic conversation.
Considerations
The PCL-5 is not a diagnostic instrument. The reference standard remains a structured clinical interview such as the CAPS-5.
The National Center for PTSD is explicit that cut off scores depend on the population and the purpose. Published validation studies have recommended thresholds ranging from 28 to 37. Use a lower cut point when you want to maximise detection and a higher one when you want to minimise false positives.
Scores can be elevated by depression, grief and other conditions that share symptoms with PTSD.
How to score the PTSD Checklist for DSM-5 PCL-5
Conducting the assessment
The person rates all 20 items for the past month on a 0 to 4 scale. Cluster scores are produced by summing the items within each DSM-5 cluster.
Interpretation
Items are summed to give a total severity score from 0 to 80.
Initial research suggests a cut off between 31 and 33 is indicative of probable PTSD across samples (National Center for PTSD).
A provisional DSM-5 diagnosis can be made by treating any item rated 2 (Moderately) or higher as endorsed, then requiring at least 1 intrusion item, 1 avoidance item, 2 negative cognition and mood items, and 2 arousal items.
A change of 10 points is suggested as an indicator of treatment response.
Clinical Considerations
Use the PCL-5 to inform, not replace, clinical judgement. A positive screen should lead to further assessment.
Repeat administration at consistent intervals gives the most useful picture of change. The 10 point response threshold is more informative than a single score.
Pay attention to individual item endorsement, particularly around avoidance, which often explains why a person disengages from treatment.
PTSD Checklist for DSM-5 PCL-5 use cases
Screening for probable PTSD in adults after trauma exposure
Measuring symptom severity at intake and at review
Monitoring response to trauma focused treatment
Research and service level outcome reporting
Category
Trauma
Research Summary
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 to 498.
Bovin, M. J., Marx, B. P., Weathers, F. W., et al. (2016). Psychometric properties of the PTSD Checklist for DSM-5 (PCL-5) in Veterans. Psychological Assessment, 28(11), 1379 to 1391.
Marx, B. P., Lee, D. J., Norman, S. B., et al. (2022). Reliable and clinically significant change in the CAPS-5 and PCL-5 among male Veterans. Psychological Assessment, 34(2), 197 to 203.
Other Assessment Guides
Adverse Childhood Experience (ACE)
Explore the Adverse Childhood Experience (ACE) Assessment, its development, significance, and application in psychological practice. Understand how to calculate ACE scores and interpret results.
Primary Care PTSD Screen for DSM-5 PC-PTSD-5
A guide to the PC-PTSD-5, the five item primary care screen for PTSD. Covers administration, the cut point of 4, sex differences in performance and when to escalate to a full assessment.
Impact of Event Scale Revised IES-R
A guide to the Impact of Event Scale Revised (IES-R), the 22 item measure of event related distress across intrusion, avoidance and hyperarousal. Covers scoring, the 33 threshold and its DSM-IV limitations.
Note on Assessment licensing
Some assessments are copyright protected and require a licence or the copyright holder's permission for clinical, commercial or digital use. Where that applies, obtaining and maintaining that permission is the responsibility of the practice or organisation using the assessment. Tacklit provides the digital administration, scoring and reporting. We do not grant, transfer or supply rights to the underlying instrument.
