Description
The PCL-5 is a 20-item self-report measure that assesses the 20 DSM-5 symptoms of PTSD. The PCL-5 has a variety of purposes, including:
- Monitoring symptom change during and after treatment
- Screening individuals for PTSD
- Making a provisional PTSD diagnosis
The gold standard for diagnosing PTSD is a structured clinical interview such as the Clinician-Administered PTSD Scale (CAPS-5). When necessary, the PCL-5 can be scored to provide a provisional PTSD diagnosis.
Changes from Previous PCL for DSM-IV
Several important revisions were made to the PCL in updating it for DSM-5:
- PCL for DSM-IV has 3 versions, PCL-M (military), PCL-C (civilian), and PCL-S (specific), which vary slightly in the instructions and wording of the phrase referring to the index event. PCL-5 is most similar to the PCL-S (specific) version. There are no corresponding PCL-M or PCL-C versions of PCL-5.
- Although there is only one version of the PCL-5 items, there are 3 formats of the PCL-5 measure, including one without a Criterion A component, one with a Criterion A component, and one with the Life Events Checklist for DSM-5 (LEC-5) and extended Criterion A component.
- The PCL-5 is a 20-item questionnaire, corresponding to the DSM-5 symptom criteria for PTSD. The wording of PCL-5 items reflects both changes to existing symptoms and the addition of new symptoms in DSM-5.
- The self-report rating scale is 0-4 for each symptom, reflecting a change from 1-5 in the DSM-IV version. Rating scale descriptors are the same: "Not at all," "A little bit," Moderately," "Quite a bit," and "Extremely."
- 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.
Administration and Scoring
The PCL-5 is a self-report measure that can be completed by patients in a waiting room prior to a session or by participants as part of a research study. It takes approximately 5-10 minutes to complete. The PCL-5 can be administered in one of three formats:
- Without Criterion A (brief instructions and items only), which is appropriate when trauma exposure is measured by some other method
- With a brief Criterion A assessment
- With the revised Life Events Checklist for DSM-5 (LEC-5) and extended Criterion A assessment
Interpretation of the PCL-5 should be made by a clinician. The PCL-5 can be scored in different ways:
- A total symptom severity score (range - 0-80) can be obtained by summing the scores for each of the 20 items.
- 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).
- A provisional PTSD diagnosis can be made by 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 B item (questions 1-5), 1 C item (questions 6-7), 2 D items (questions 8-14), 2 E items (questions 15-20).
- 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.
Interpretation
Characteristics of a respondent's setting should be considered when using PCL-5 severity scores to make a provisional diagnosis. The goal of assessment also should be considered. A lower cut-point score should be considered when screening or when it is desirable to maximize detection of possible cases. A higher cut-point score should be considered when attempting to make a provisional diagnosis or to minimize false positives.
Measuring Change
Good clinical care requires that clinicians monitor patient progress. Evidence for the PCL for DSM-IV suggests that a 5-10 point change represents reliable change (i.e., change not due to chance) and a 10-20 point change represents clinically significant change. Therefore, it was recommended to use 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 using the PCL for DSM-IV.
Change scores for PCL-5 are currently being determined. It is expected that reliable and clinically meaningful change will be in a similar range. We recommend following the DSM-IV recommendations until new information is available.
Sample Item
- Item: In the past month, how much were you been bothered by: "Repeated, disturbing, and unwanted memories of the stressful experience?"
- Response: 5-point Likert (0 = "Not at all" to 4 = "Extremely")