Nov 16, 2020  |   2 minute read

PCL-5 | Post Traumatic Stress Disorder

PTSD Checklist for DSM-V (PCL-5)

Recommended frequency: Every 4 weeks

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Summary

The PTSD Checklist for DSM-V (PCL-5) is a self-report measure that assesses the 20 DSM-V symptoms of Post-Traumatic Stress Disorder (PTSD). The assessment has been validated for use with adults (18+), as a means of monitoring symptom change during treatment. The PCL-5 can also serve as a tool for screening individuals for PTSD or for making provisional diagnoses. Official PTSD diagnosis should be done through a structured clinical interview, but a provisional diagnosis with the PCL-5 can help indicate if an interview or external referral for diagnoses is needed.

We want to thank Dr. Michelle Bovin for sharing her expertise with us in the creation of this Assessment Guide. Dr. Bovin is a staff psychologist at the Behavioral Science Division of the National Center for PTSD and an Associate Professor of Psychiatry at Boston University Chobanian & Avedisian School of Medicine. She has worked to develop many evidence-based assessments and has led studies to validate several others, including the PTSD Checklist for DSM-5 (PCL-5). The views presented by Dr. Michelle Bovin are her own and do not represent those of any institution or the US government.

About the PCL-5 Measure

The PCL-5 is one of the most widely used self-report measures for PTSD. It’s well regarded for its ability to consistently demonstrate strong psychometric properties, such as internal consistency, test-retest reliability, and convergent and discriminant validity.

This version of the PCL was updated to correspond with the latest edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-V), which includes adjustments to previously identified symptoms, as well as the addition of new symptoms included in the DSM-V. The assessment has a total of 20 questions that are each associated with an item under clusters B-E of PTSD diagnosis.

PCL-5 formats

There are three formats of the PCL-5 available. They each vary in the level of detail collected on Criterion A, which measures trauma exposure. The versions include:

  1. No Criterion A component.
  2. A brief Criterion A component
  3. Including the Life Events Checklist for DSM-5 (LEC-5) and extended Criterion A component.

Considerations to the PCL-5

The PCL-5 has a few limitations related to the fact that it’s a self-report measure:

  1. As mentioned, the PCL-5 should not be used to determine diagnostic status without the assistance of a clinical interview.
  2. The PCL-5 only offers information about the traumatic event if you use a version that has a Criterion A component.
  3. The PCL-5 does not provide information about the course of PTSD— meaning how it has or will progress— nor about the functional impairments caused by the PTSD.

It’s recommended that assessment scores be reviewed and discussed in session with the client. This can be a great opportunity to uncover information that may not have been captured within the assessment or to dive into particular responses where more information is needed, including when specific results may be surprising for the client or clinician.

When treating clients with PTSD, Dr. Michell Bovin shares that self-report measures like the PCL-5 are very powerful, “as they allow patients to check a box, rather than talk to someone— often a stranger— about what’s going on with them.”

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Who is the PCL-5 for?

Review the list below to determine if this assessment should be used with your client. If you answer YES to both questions, the PCL-5 is likely a good fit to use with your client.

  1. Is your client 18 years of age or older?
  2. Has your client received a PTSD diagnosis or are you using this assessment to make a provisional diagnosis?

The PCL-5 Scale

The PCL-5 is a self-report measure, which means clients can fill it out independently before session or with the assistance of their clinician. The measure takes approximately 5-10 minutes to complete and asks clients to indicate the level to which each symptom has impacted them in the last month. The PCL-5 uses a 5 point likert scale to measure symptom severity, with options “Not at all,” “A little bit,” Moderately,” “Quite a bit,” and “Extremely,” that correspond to scores of 1-5.

Below is a list of problems that people often have in response to a stressful or traumatic experience. Clients should read each experience and then choose one of the numbers to indicate the level to which **they have been experienced that symptom in the past month.

Not at all A little bit Moderately Quite a bit Extremely
1. Repeated, disturbing, and unwanted memories of the stressful experience? 0 1 2 3 4
2. Repeated, disturbing dreams of the stressful experience? 0 1 2 3 4
3. Suddenly feeling or acting as if the stressful experience were actually happening again (as if you were actually back there reliving it)? 0 1 2 3 4
4. Feeling very upset when something reminded you of the stressful experience? 0 1 2 3 4
5. Having strong physical reactions when something reminded you of the stressful experience (for example, heart pounding, trouble breathing, sweating)? 0 1 2 3 4
6. Avoiding memories, thoughts, or feelings related to the stressful experience? 0 1 2 3 4
7. Avoiding external reminders of the stressful experience (for example, people, places, conversations, activities, objects, or situations)? 0 1 2 3 4
8. Trouble remembering important parts of the stressful experience? 0 1 2 3 4
9. Having strong negative beliefs about yourself, other people, or the world (for example, having thoughts such as: I am bad, there is something seriously wrong with me, no one can be trusted, the world is completely dangerous)? 0 1 2 3 4
10. Blaming yourself or someone else for the stressful experience or what happened after it? 0 1 2 3 4
11. Having strong negative feelings such as fear, horror, anger, guilt, or shame? 0 1 2 3 4
12. Loss of interest in activities that you used to enjoy? 0 1 2 3 4
13. Feeling distant or cut off from other people? 0 1 2 3 4
14. Trouble experiencing positive feelings (for example, being unable to feel happiness or have loving feelings for people close to you)? 0 1 2 3 4
15. Irritable behavior, angry outbursts, or acting aggressively? 0 1 2 3 4
16. Taking too many risks or doing things that could cause you harm? 0 1 2 3 4
17. Being “superalert” or watchful or on guard? 0 1 2 3 4
18. Feeling jumpy or easily startled? 0 1 2 3 4
19. Having difficulty concentrating? 0 1 2 3 4
20. Trouble falling or staying asleep? 0 1 2 3 4

Tip: If you notice that a client has skipped an item on the PCL-5, Dr. Michelle Bovin recommends asking the client if that was intentional. If they did so purposefully, she advises against asking them to complete it during that time, as this represents a boundary or topic they may not be able to discuss in that moment.

Scoring the PCL-5

Items on the PCL-5 are summed to provide a total score.

Using the PCL-5 for Probable Diagnosis

It’s important to note that the interpretation of the PCL-5 should be determined by a clinician and that the measure cannot provide definitive diagnostic status. A clinical interview must be conducted by a trained PTSD professional for a diagnosis is confirmed.

1. A probable PTSD diagnosis can be made by treating each item within the DSM-V clusters that are rated as 2 or higher (“Moderately” or higher) as a qualifying score under that cluster. Then you may follow the DSM-5 diagnostic rule which requires from each cluster at least:

  • 1 item from B (questions 1-5) which measures re-experiencing symptoms
  • 1 item from C (questions 6-7) which measures avoidance symptoms
  • 2 items from D (questions 8-14) which measure negative change to cognition and mood
  • 2 items from E (questions 15-20) which measure hyper-arousal symptoms.

2. If calculating the total symptom severity score (range of 0-80)—which can be obtained by summing the scores for each of the 20 items— research suggests that a PCL-5 cutoff score between 31-33 can be used for a provisional PTSD diagnosis. There is also reason to believe that different populations or reasons for the screening could warrant different cutoff scores, thus both should be considered when determining if further psychometric work to diagnose and treat PTSD is warranted.

A note about Determining probable PTSD: When using severity scores to make a probable diagnosis, a few other factors should be considered. These include the setting that the client is completing the assessment in and the goal of assessment. If you’re screening for PTSD or interested in maximizing your ability to detect possible cases, a lower cut point should be used. A higher cut-point score should be considered when making a probable diagnosis or when the goal is to minimize false positives.

Using the PCL-5 to Determine PTSD Severity

1. Total symptom severity score

For the purpose of using the PCL-5 for ongoing progress measurement, clinicians may calculate and leverage the total symptom severity score. Severity can be determined adding scores of each item together to determine a total score. A total score of 33 or higher may indicate severe PTSD and suggests the patient needs further assessment to confirm a diagnosis of PTSD.

Score PTSD Severity
0-32 Below clinical threshold
33-80 Above clinical threshold

2. DSM-5 symptom cluster severity scores

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).

This method will help indicate which symptom cluster is impacting the client the most and may help guide treatment plans as cluster scores change overtime. The total symptom severity score can still be obtain by summing the scores of each cluster.

Monitoring symptom change

According to evidence for the PCL from DSM-IV, any change in assessment score between 5-10 points suggests reliable change in symptom severity, while 10-20 points indicates clinically significant change. It is recommended that clinicians administering the PCL-5 treat any change greater than 5 points as a meaningful response to treatment, while 10 points or greater would indicate significant reliable clinical change in symptom severity.

Copyright Information & Disclaimer
PCL-5 (8/14/2013) Weathers, Litz, Keane, Palmieri, Marx, & Schnurr — National Center for PTSD
The information provided above was derived from materials and research developed by the creators and/or licensors of the PCL-5. The information may not be exhaustive and is not a treatment recommendation by Greenspace.
The views presented by Dr. Michell Bovin are her own and do not represent those of any institution or the US government.

Frequently Asked Questions
What are the benefits to using a self-report measure in PTSD treatment and are there any special considerations I should be aware of?

Dr. Michelle Bovin shares insight into the research on this topic and offers tips to help ensure both clinicians and clients are able to draw the most value from the PCL-5 assessment.

How can the PCL-5 be used to monitor symptom change in PTSD treatment and empower clients in the process?

In explaining how the PCL-5 is commonly used in PTSD treatment, Dr. Michelle Bovin shares the importance of educating clients on the measure and walking them through how their scores might change as they progress. By ensuring clients know what they can expect over the course of treatment, you are able to empower them with the tools and language to share what they’re experiencing with you throughout their treatment process.

How should I introduce this measure to my clients and how should it be administered?

Dr. Michelle Bovin offers her recommendation for administering the PCL-5 and how to introduce it to clients to ensure they are knowledgeable partners in their care process.

How and when should I respond to changes in my clients PCL-5 scores?

Dr. Michelle Bovin offers insight into what score changes are clinically significant and may signal the need for a discussion with your client.

How should I respond to significant and unexpected score changes?

Dr. Michell Bovin provides some clarity behind why clients might experience unexpected score changes in their PCL-5 and shares how she may approach a conversation with clients in response.

What is the most important thing to note when administering the PCL-5?

Dr. Michell Bovin shares some of nuance that clinicians should be mindful of when using the PCL-5. She reminds clinicians not to over interpret the PCL-5 and that it’s important to use your training and judgement, engage in collaborative discussion, and leverage other clinical tools when drawing clinical insights from the PCL-5.

How can I ensure I’m being sensitive to my clients with PTSD when using the PCL-5 in treatment?

Dr. Michelle Bovin expresses the importance of being mindful about discussing the traumatic event (Criterion A) when treating clients with PTSD.

How should I respond if my client skipped an item on the PCL-5?

If your client skips an item on the PCL-5 Dr. Michelle Bovin suggests asking them if this was intentional and shares how you might respond accordingly. If clients skip a question intentionally, she advises against asking them to complete it during that time, as this represents a boundary or topic they may not be able to discuss in that moment. The lack of response can also hold a lot of information in itself about what they might be struggling with or avoiding.

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