Using the PTSD Checklist for
DSM-5 (PCL-5)
www.ptsd.va.gov
Using the PTSD Checklist for DSM-5
What is the PCL-5?
The PTSD Checklist for DSM-5 is a 20-item self-report measure that assesses
the presence and severity of PTSD symptoms. Items on the PCL-5 correspond
with DSM-5 criteria for PTSD. The PCL-5 has a variety of purposes, including:
• Quantifying and monitoring symptoms over time
• Screening individuals for PTSD
• Assisting in making a provisional diagnosis of PTSD
The PCL-5 should not be used as a stand-alone diagnostic tool. When
considering a diagnosis, the clinician will still need to use clinical interviewing
skills, and a recommended structured interview (e.g., Clinician-Administered
PTSD Scale for DSM-5, CAPS-5) to determine a diagnosis.
Three formats of the PCL-5 measure are available:
• PCL-5 without Criterion A component
• PCL-5 with extended Criterion A assessment
• PCL-5 with LEC-5 and extended Criterion A assessment
How is the PCL-5 administered?
The PCL-5 is a self-report measure that can be read by respondents
themselves or read to them either in person or over the telephone. It can be
completed in approximately 5-10 minutes.
The preferred administration is for the patient to self-administer the PCL-5.
Patients can complete the measure: in the waiting area prior to a session,
at the beginning of a session, at the close of a session, or at home prior to
an appointment.
The PCL-5 is intended to assess patient symptoms in the past month.
Versions of the PCL-5 that assess symptoms over a different timeframe (e.g.,
past day, past week, past 3 months) have not been validated. For various
reasons it often makes sense to administer the PCL-5 more or less frequently
than once a month, and in those cases the timeframe in the directions may be
changed to meet the purpose of the assessment, though providers should be
aware that such changes may alter the psychometric properties of the measure.
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NOTE:
The PCL for DSM-IV was
revised in accordance with DSM- 5
(PCL-5). Several important
revisions were made to the PCL-
5, including changes to existing
symptoms and the addition of
three new symptoms of PTSD.
The self-report rating scale for
PCL-5 was also changed to 0-4.
Therefore, 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.
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.
How is the PCL-5 scored and interpreted?
Respondents are asked to rate how bothered they have been by each of 20 items in the past month on a 5- point
Likert scale ranging from 0-4. Items are summed to provide a total severity score (range = 0-80).
0 = Not at all 1 = A little bit 2 = Moderately 3 = Quite a bit 4 = Extremely
The PCL-5 can determine a provisional diagnosis in two ways:
• Summing all 20 items (range 0-80) and using a cut-point score of 31-33 appears to be reasonable based
upon current psychometric work. However, when choosing a cutoff score, it is essential to consider the goals
of the assessment and the population being assessed. The lower the cutoff score, the more lenient the
criteria for inclusion, increasing the possible number of false-positives. The higher the cutoff score, the more
stringent the inclusion criteria and the more potential for false-negatives.
• 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 Criterion B item (questions 1-5), 1 Criterion C item (questions 6-7),
2 Criterion D items (questions 8-14), 2 Criterion E items (questions 15-20). In general, use of a cutoff score
tends to produce more reliable results than the DSM-5 diagnostic rule.
If a patient meets a provisional diagnosis using either of the methods above, he or she needs further assessment
(e.g., CAPS-5) to conrm a diagnosis of PTSD.
There are currently no empirically derived severity ranges for the PCL-5.
How might the PCL-5 help my patients?
Treatment Planning
When given at an intake or assessment session, the PCL-5 may be used to help determine the appropriate next steps
or treatment options. For example:
• A total score of 31-33 or higher suggests the patient may benet from PTSD treatment. The patient can
either be referred to a PTSD specialty clinic or be offered an evidence-based treatment for PTSD such as
Prolonged Exposure (PE), Cognitive Processing Therapy (CPT), or Eye Movement Desensitization and
Reprocessing (EMDR).
• Scores lower than 31-33 may indicate the patient either has subthreshold symptoms of PTSD or does not
meet criteria for PTSD, and this information should be incorporated into treatment planning.
Keeping the goal of the assessment in mind, it may make sense to lower the cut-point score to maximize the
detection of possible cases needing additional services or treatment. A higher cut-point score should be considered
when attempting to minimize false positives.
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Measuring Change
Good clinical care requires that clinicians monitor patient progress. Evidence for the PCL for DSM-IV suggested 5
points as a minimum threshold for determining whether an individual has responded to treatment and 10 points as a
m
inimum threshold for determining whether the improvement is clinically meaningful. Change scores for the PCL-5
are currently being determined. It is expected that reliable and clinically meaningful change will be in a similar
range. We recommend following DSM-IV recommendations until new information is available.
Addressing Lack of Improvement
If repeated administrations of the PCL-5 suggest little movement or worsening in your patient’s overall score during
treatment, you can:
•
Refer back to the protocol and/or recommended supplemental treatment materials
•
Work to identify possible therapy-interfering behaviors while also reviewing application and response to
interventions
•
Explore and process the lack of improvement with the patient
•
If seeing the patient less frequently than once a week, consider seeing them weekly to increase the dose of
treatment while using the PCL-5 to track symptom change
•
If an adequate dose of the current treatment has been given (e.g. typically 10-15 sessions), and scores
remain high or are getting higher, consider switching to another evidence-based treatment for PTSD
•
Seek consultation with an experienced provider or contact the PTSD Consultation Program (866- 948-7880
Is the PCL-5 psychometrically sound?
The PCL-5 is a psychometrically sound measure of DSM-5 PTSD. (See Studies that Informed Our Recommendations
below for references.) It is valid and reliable, useful in quantifying PTSD symptom severity, and sensitive to change
over time in military Servicemembers and undergraduate students.
Questions?
If you have any questions about the use of the PCL-5 or PTSD assessment more broadly, we recommend seeking
consultation with a supervisor or experienced provider, or contacting the PTSD Consultation Program (866-948-7880
or [email protected]).
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Studies that Informed Our Recommendations
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, 489–498.
doi: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, 1379-1391. doi:10.1037/pas0000254
Clapp, J. D., Kemp, J. J., Cox, K. S., & Tuerk, P. W. (2016). Patterns of change in response to prolonged exposure:
Implications for treatment outcome. Depression and Anxiety, 33, 807-815. doi: 10.1002/da.22534
Cohen, J., Kanuri, N., Kieschnick, D., Blasey, C., Taylor, C. B., Kuhn, E., Lavoie, C., Ryu, D., Gibbs, E., Ruzek, J., &
Newman, M. (2014). Preliminary evaluation of the psychometric properties of the PTSD Checklist for DSM-5. Paper
presented at the 48th Annual Convention of the Association of Behavior and Cognitive Therapies, Philadelphia, PA.
doi:10.13140/2.1.4448.5444
Galovski, T. E., Harik, J. M., Blain, L. M., Farmer, C., Turner, D., & Houle, T. (2016). Identifying patterns and predictors of
PTSD and depressive symptom change during cognitive processing therapy. Cognitive Therapy and Research, 40, 617-626.
doi 10.1007/s10608-016-9770-4
National Center for PTSD. (2016). PTSD Checklist for DSM-5 (PCL-5). Retrieved from www.ptsd.va.gov/professional/
assessment/adult-sr/ptsd-checklist.asp
Valenstein, M., Adler, D. A., Berlant, J., Dixon, L. B., Dulit, R. A., Goldman, B., Hackman, A., Oslin, D. W., & Sonis, W. A.
(2009). Implementing standardized assessments in clinical care: Now’s the time. Psychiatric Services, 60, 1372-1375.
doi:10.1176/ps.2009.60.10.1372
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) – Standard [Measurement instrument]. Available from www.ptsd.va.gov
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. S., Hembree, E. A., Mintz, J., Peterson, A., & Litz, B. T. (2016). Psychometric analysis of the
PTSD Checklist-5 (PCL-5) among treatment-seeking military service members. Psychological Assessment, 28, 1392-1403.
doi:10.1037/pas0000260
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