PTSD Checklist for DSM-5

The PCL-5 covers the 20 PTSD symptoms described in the DSM-5, in four areas: re-experiencing, avoidance, negative changes in thoughts and mood, and changes in arousal and reactivity. Each question is rated from 0 to 4, giving a total between 0 and 80. The patient answers with their worst stressful experience in mind.

Use the PCL-5 when the patient has been through a very stressful or frightening experience and is still affected by it, for example by memories that keep coming back, nightmares or feeling constantly on edge. It is also useful when the patient drinks or uses drugs, since substances are sometimes used to numb memories or to sleep. If it is unclear whether the patient is affected, the shorter PC-PTSD-5 can be a first step.

The PCL-5 was developed by Frank W. Weathers, Brett T. Litz, Terence M. Keane, Patrick A. Palmieri, Brian P. Marx and Paula P. Schnurr at the US National Center for PTSD and published in 2013. It is the updated version of the earlier PTSD Checklist, adapted to the PTSD criteria of the DSM-5.

The PCL-5 has been studied in several large samples, including students, veterans and treatment-seeking military service members, and has shown good psychometric properties. Research suggests that a total score between 31 and 33 indicates probable PTSD. For tracking treatment, a change of 10 points is suggested as a sign of response, and one study found that a score below 28 can indicate clinically significant improvement. The German version was translated and back-translated, then tested in 341 trauma-exposed adults, most of them in treatment at specialised centres. It showed very high internal consistency (α = .95) and test-retest reliability (r = .91), and correlated strongly with the clinical interview CAPS-5 (r = .77). Compared with the interview diagnosis, the cutoff of 33 correctly identified 86% of people with PTSD and 68% of those without it (Krüger-Gottschalk et al., 2017).

The PCL-5 is a screening questionnaire and does not replace a diagnosis. The gold standard for diagnosing PTSD is a structured clinical interview, and the developers state that results should be interpreted by a clinician. The appropriate cutoff depends on the setting and purpose: a lower cutoff finds more possible cases, a higher one reduces false alarms. The questionnaire relies on self-report about the past month. Some symptoms, such as sleep problems, trouble concentrating or irritability, can also have other causes – including alcohol or drug use and withdrawal.