📝 What is it?
The PTSD Checklist for DSM-5 (PCL-5) assesses the presence and severity of symptoms of post-traumatic stress disorder (PTSD).
There are two versions, a weekly version that asks about symptoms over the past 7 days, and a monthly version that asks about symptoms over the past 30 days. Both are available on Blueprint.
Both measures contains 20 questions scored on a 5-point Likert scale from 0-4 with "Not at all" for 0 and "Extremely" for 4.
📸 Sample screenshot:
🚨 What is post-traumatic stress disorder (PTSD)?
PTSD is a disorder where a person has disturbing thoughts, feelings, and reactions after experiencing or witnessing a traumatic event.
Symptoms fall into four categories: 1. Intrusion (memories, nightmares, flashbacks, etc.), 2. Avoidance (avoiding thoughts, feelings, situations, or triggers, etc.), 3. Alterations in cognition and mood (memory loss, low self-esteem, fear, anger, etc.), and 4. Alterations in arousal and reactivity (angry outbursts, trouble sleeping, hyper-arousal). These categories of symptoms are taken directly from the DSM-5 and the PCL-5 questions match them exactly. See the section below for each question in each category.
A traumatic event may be war, violence, rape, a natural disaster, a car crash, or the threat of harm. Exposure could also be indirect instead of first hand. For example, a person may learn about the violent death of a family member and subsequently experience PTSD.
PTSD may last months or years. In order to meet diagnostic criteria, problems need to last at least 1 month.
People with PTSD may have triggers that remind them of the trauma or cause distress. It could be fireworks, driving, or being touched unexpectedly. These triggers may lead people to avoid situations or people.
PTSD can be treated with various types of trauma-focused talk therapy and/or medication to help manage symptoms.
It has gone by many different names including "shell shock," "combat fatigue," or "soldier's heart."
⚖️ Categories of symptoms // Subscales
There are four categories of symptoms of PTSD. These categories come directly from the DSM-5-- criteria B, C, D, and E. Under each category/criteria there are symptoms. There are 20 symptoms total in the four categories/criteria. These 20 symptoms make up the 20 questions of the PCL-5. See below for a breakdown of the four categories/criteria and the symptoms/questions from the PCL-5.
Intrusion:
Repeated, disturbing, and unwanted memories of the stressful experience?
Repeated, disturbing dreams of the stressful experience?
Suddenly feeling or acting as if the stressful experience were actually happening again (as if you were actually back there reliving it)?
Feeling very upset when something reminded you of the stressful experience?
Having strong physical reactions when something reminded you of the stressful experience (for example, heart pounding, trouble breathing, sweating)?
Avoidance:
Avoiding memories, thoughts, or feelings related to the
stressful experience?
Avoiding external reminders of the stressful experience (for
example, people, places, conversations, activities, objects, or
situations)?
Alterations in cognition and mood:
Trouble remembering important parts of the stressful experience?
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)?
Blaming yourself or someone else for the stressful experience or what happened after it?
Having strong negative feelings such as fear, horror, anger, guilt, or shame?
Loss of interest in activities that you used to enjoy?
Feeling distant or cut off from other people?
Trouble experiencing positive feelings (for example, being unable to feel happiness or have loving feelings for people close to you)?
Alterations in arousal and reactivity:
Irritable behavior, angry outbursts, or acting aggressively?
Taking too many risks or doing things that could cause you harm?
Being “superalert” or watchful or on guard?
Feeling jumpy or easily startled?
Having difficulty concentrating?
Trouble falling or staying asleep?
📉 Scoring:
The PCL-5 is a 20 question self-report measure scored on a 5-point Likert scale with values from 0 ("Not at all") to 4 ("Extremely"). Total scores range from 0-80 with higher scores being associated with higher levels of PTSD.
Scores can be interpreted by 1. summing the total score or 2. averaging the subscale scores.
1️⃣ Sum total score:
There is no one specified cut-off for the total score of the PCL-5. The cut-off point may vary depending on the client and the situation. But research suggests that a score of 31-33 is indicative of PTSD. In Blueprint, we set the cut-off as 32. Scores below 32 are interpreted as "Sub-clinical" and scores of 32 and above are interpreted as "Clinical."
Score | Interpretation |
0-31 | Sub-clinical-- PTSD is unlikely |
32-80 | Clinical-- PTSD is likely |
2️⃣ Mean subscales score:
There are four subscales: 1. Intrusion (questions #1-5), 2. Avoidance (questions #6-7), 3. Alterations in cognition and mood (questions #8-14), and 4. Alterations in arousal and reactivity (questions #15-20). See the "Categories of symptoms // Subscales" section above for every symptom/question from the PCL-5.
Mean scores range from 0-4 with. High scores are associated with more severe symptoms.
➕ Measuring change:
The PCL-5 can also be used to track symptoms over time. In this situation, a 10-point change is considered significant change.
👍 Benefits:
This is the standard measure for PTSD screening and treatment monitoring used across all Veteran Affairs (VA) treatment facilities.
Captures all of the symptomatic criteria of PTSD from the DSM-5.
It is widely used and well-validated.
Can be used to help provide a provisional diagnosis (see "Best practices" section below).
Blueprint also has a Spanish version of the PCL-5
Can be used in many ways: 1. tracking progress over time, 2. screening for symptoms of PTSD, and 3. making a provisional PTSD diagnosis.
ℹ️ Summary:
Focus Area: Post Traumatic Stress Disorder (PTSD)
Overview: The PTSD Checklist for DSM-5 (PCL-5) is a 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 can be used to quantify and monitor symptoms over time, to screen individuals for PTSD, and to assist in making a provisional or temporary diagnosis of PTSD.
Overview: The PTSD Checklist for DSM-5 (PCL-5) looks at the presence and severity of PTSD symptoms. It is most useful for tracking symptoms over time but can also be useful as a quick screener.
Total number of items: 20
Standardized cadence: One month
Estimated completion time: 5-10 minutes
Supported subscales: DSM-5 cluster A, B, C, D, and E
Age range: 18+
Scoring and interpretation: Evidence for the PCL-5 suggested 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. A PCL-5 cut-point of 33 appears to be a reasonable value to use for provisional PTSD diagnosis.
Reliability/Validity: The PCL-5 administered to an outpatient sample (N = 278) resulted in a Cronbach’s alpha of 0.94, test-retest reliability of r = 0.82, and convergent validity of rs = 0.74 to 0.85.
Original paper: 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.
Additional information: Document detailing how to use the PCL-5. For more info, check out the National Center for PTSD: https://www.ptsd.va.gov/