TL;DR: Summary

✅ Available on Bravely Connect

The PCL-5 is a self-report measure used to assess the symptoms of PTSD as listed in the DSM-5. It consists of 20 questions which ask clients about the severity of each PTSD symptom they may have experienced in the past month. Total scores are calculated via the summation of each item’s score. Potential scores range from 0 to 80 with higher scores indicating higher PTSD symptom severity. Limitations for the PCL-5 include its inability to definitively diagnose (although it can be used for provisional diagnoses) due to lack of official cutoff score, restricting clients to symptoms experienced only in the past month, and scarcity of cross-cultural research confirming its validity with diverse groups. Even with these limitations, the PCL-5 may be helpful in tracking severity of clients’ PTSD symptoms and can be used to aid diagnosis when used in conjunction with other official diagnostic criteria such as a clinical interview.

Highlights

📏 Lengths: 20 questions

📋 Administration: Self-administered

🎯 Uses: Monitoring PTSD symptoms, screening for PTSD, provisional diagnosis

⚠️ Important Caveats: To be used in conjunction with clinical interviews for a conclusive PTSD diagnosis

✅ Available in Bravely Connect? Yes

🌏 Culturally Applicable? To be determined

💬 Translations? 17 via the Los Angeles County Department of Mental Health

The PCL-5 Question type and length

The client is presented with 20 questions asking how often in the past month they were bothered by PTSD symptoms. The PTSD symptoms described in the PCL-5 come directly from the DSM-5. Each question has the same selection of answers: a 5-point Likert scale ranging from 0 (not at all) to 4 (extremely).

Here’s an example of an item from the PCL-5 and the range of answers:

In the past month, how much were you bothered by: Repeated, disturbing, and unwanted memories of the stressful experience?

• 0. Not at all

• 1. A little bit

• 2. Moderately

• 3. Quite a bit

• 4. Extremely

For the full list of questions check out the measures on Bravely Connect, or follow the following link to the original unautomated version: PCL-5

What does the PCL-5 measure

The PCL-5 is a self-report measure which assesses the severity of each PTSD symptom listed in the DSM-5.

PCL-5 Factor structure

Items of the PCL-5 come from the DSM-5 which proposes a four-factor model of PTSD; however, several studies analyzing the PCL-5’s factor structure find that models of six or seven factors may be more fitting.

A 2014 study by Liu et al. proposed the six-factor “anhedonia” model in which the PTSD symptoms assessed by the PCL-5 could be clustered into intrusion, avoidance, negative affect, anhedonia, dysphoric arousal, and anxious arousal. A seven-factor “hybrid” model was proposed shortly after in 2015 by Armour et al. which included the same factors as the anhedonia model with the addition of an “externalizing behaviors” factor. Both the anhedonia and the hybrid models tend to fare better in confirmatory factor analysis than the DSM’s suggested four-factor model.

The history and theory behind the PCL-5

The first edition of the PTSD Checklist (PCL) was developed in 1990 by the National Center for PTSD. This first edition contained 17 items and spawned three different versions for use with military veterans (PCL-M), civilians with histories of trauma (PCL-C), and individuals who experienced a singular specific traumatic event (PCL-S). As with the PCL-5, the items in the original PCL were congruent with PTSD diagnostic criteria from the contemporary edition of the DSM. The original scale asked respondents to rate the severity of each of their PTSD symptoms as identified in the DSM-IV. Respondents answered on a 5-point Likert scale ranging from 1 (not at all) to 5 (extremely). Scores were then summed with higher numbers reflecting higher severity. The measure was to be used as a screening instrument that indicated severity of PTSD symptoms in conjunction with the DSM-IV diagnostic criteria.

As the DSM was updated in the early 2010s, so was the PCL. The DSM-5 identified three additional symptoms of PTSD which were then reflected in the updated checklist as three new items. With the new items along with updated wording to existing items and a new scoring scale, the PCL became the PTSD Checklist for DSM-5 (PCL-5). Scoring changed from a 1-5 scale to a 0-4 scale; this change allowed for the complete absence of PTSD symptoms to be scored as a 0. As with its previous version, the PCL-5 is intended to measure severity of PTSD symptoms while the DSM-5 diagnostic criteria is used to diagnose.

PCL-5 Scoring Interpretation

PCL-5 scoring is straightfoward via the summation of item scores. Potential scores range from 0 to 80. As part of a continuous measure, a higher sum indicates overall higher PTSD symptom severity. The PCL-5 may also be used as a provisionary diagnostic tool. Items rated 2 (“moderately”) or higher can be considered endorsed symptoms; from there, follow the DSM-5 diagnostic criteria if items corresponding with at least one DSM Criterion B, one Criterion C, two Criterion D, and two Criterion E are endorsed.

Who developed the measures, licensing and how to obtain the PCL-5

The PCL-5 was debuted in 2013 by the National Center for PTSD, part of the US Department of Veteran Affairs. The PCL-5 was a further development of the original PCL developed in the 1990s. The revisions and additions established in the PCL-5 were reviewed by PTSD experts from the National Center for PTSD and the Trauma/Stress-Related and Dissociative Disorders Sub-Work Group (Blevins et al., 2015, p. 490).

The PCL-5 is in the public domain and does not require any type of licensing.

The PCL-5 is available on Bravely Connect as part of our automated measures. See the PCL-5 on Bravely Connect →

There are currently 17 translations of the PCL-5. If you find a version you’d like adding to Bravely Connect then just let us know here.

Limitations, biases and when you should/shouldn’t use the PCL-5

The PCL-5 was created to be used with adults aged 18 and over. Although the PCL-5 may be used to make a preliminary PTSD diagnosis, it lacks an official cut-off score to designate a diagnosis. The PCL-5 also only asks about symptoms experienced in the past month; a client may have experienced different symptoms beyond that timeframe. Given the complexity of trauma and the limited capacity of a 20-question assessment, the PCL-5 is best used in conjunction with clinical interviews for a conclusive PTSD diagnosis. That said, one strength in its brevity is that the PCL-5 may be useful for ongoing monitoring of changes in symptom severity over the course of treatment.

Given the relative newness of the PCL-5 in comparison with other measures, there is still research emerging on its cross-cultural applicability. One study found that the PCL-5 expresses strong internal consistency and adequate convergent validity, yet slightly lower specificity and sensitivity among Kurdish and Arab displaced populations living in Iraq (Ibrahim et al., 2018). A study of the PCL-5 used with Indian women residing in slums yielded similar results with strong convergent validity yet some questions—or the wording of those questions—appeared culturally inapplicable (Patel et al., 2022). Further research is needed to explore the PCL-5’s cross-cultural utility.

As always, if you’ve found a measure you would like adding to Bravely Connect as an automated measure, just drop us a measure request here.