What is the PCL-5 measure? A quick guide

About the PCL-5 Assessment

Recommended Frequency: At least once a month

The Post-Traumatic Stress Disorder Checklist for DSM-5, or PCL-5, is a self-report measure designed to assess the presence and severity of PTSD symptoms. Each of the assessment’s 20 items corresponds with DSM-5 criteria for post-traumatic stress disorder.

Its primary use is to monitor symptom changes that take place during and after PTSD treatment. The PCL-5 can also be used to screen individuals for PTSD and assist providers in making a provisional PTSD diagnosis.

Respondents are asked to rate how bothered they have been by each of the assessment items throughout the past month. Their answers are measured using a 5-point scale that ranges from 0 (“Not at all”) to 4 (“Extremely”). Then, the scores from each item are summed to provide a total symptom severity score that ranges from 0 to 80.

While the PCL-5 questionnaire may not be a standalone diagnostic tool, it can be used alongside other evaluation methods – like structured clinical interviews with patients – to measure the efficacy of PTSD treatment. Coupled with other mental health and psychological assessments, the PCL-5 can also aid providers in diagnosing PTSD by providing clear, specific examples of symptoms outlined by the DSM-5

PCL-5 Confidence Intervals

The PCL-5 has been shown to demonstrate strong internal consistency, test-retest reliability, and convergent and discriminant validity. As a result, the PCL-5 is considered a psychometrically sound measure of PTSD symptoms. A 2023 meta-analysis of the literature on the PCL-5 likewise found that the questionnaire has the ability to index sensitivity to clinical change.

Who is the PCL-5 for?

The PCL-5 may be useful for any patient currently undergoing or about to begin PTSD treatment. It might also be helpful for patients who exhibit symptoms of PTSD, but have not yet received an official diagnosis. In other words, the PCL-5 is best utilized by providers looking to:

• Monitor PTSD symptom changes during and after a treatment
• Screen an individual for PTSD
• Make a provisional diagnosis for PTSD

PCL-5 Interpretation & Administration

Since the PCL-5 assessment is a self-report measure, patients can complete it in a waiting room prior to treatment sessions. They may also be sent the assessment digitally to complete in between sessions.

The questionnaire only takes about five to 10 minutes to complete. It can be administered with or without a criterion A questionnaire that measures exposure to trauma. In cases where no other tool is used to assess trauma, the PCL-5 may be accompanied by a brief criterion A assessment.

Example Item

Below is an example of an item found on the PCL-5, as listed by the National Center for PTSD. A preview of the full questionnaire can be found here: PCL-5 (PDF)

After a patient completes each item on the questionnaire, their scores are tallied together. Interpretation of PCL-5 scores should always be made by a clinician.

PCL-5 Scoring

A patient’s total symptom severity score is calculated by adding together their score from each individual item. A score of 31 or higher is typically considered indicative of probable PTSD. However, some professionals may use a higher cutoff score – 33 is also a common benchmark, but clinicians can adjust their cutoffs for their patient populations.

Regardless of the cutoff score chosen, using a total severity score to assist in making a provisional PTSD diagnosis tends to produce more reliable results than diagnoses based on DSM-5 criteria alone.

However, when it comes to PCL-5 scoring, severity of symptoms isn’t the only factor clinicians should consider. It’s also necessary to calculate symptom cluster scores, which help providers evaluate patient symptoms against specific diagnostic criteria from the DSM-5.

The clusters and their related symptoms are as follows:

• Cluster B: Re-experiencing stressful events or trauma
• Cluster C: Avoidance of trauma triggers and stressful situations
• Cluster D: Negative alterations in mood and cognition
• Cluster E: Hyper-arousal

Certain items on the PCL-5 correspond with each cluster. Adding up the scores for these items gives clinicians additional insight into potential PTSD symptoms and their frequency.

In addition to aiding clinicians in the diagnostic process, the PCL-5 test also enables regular monitoring of patient progress and treatment efficacy. While change scores for the PCL-5 are still being determined, clinicians can look to the previous version of the PCL (for the DSM-IV) to get an idea of how changes in PCL-5 assessment scores might reflect on patient progress:

• A 5-10 point change represents reliable change, or change that is not simply due to chance.
• A 10-20 point change typically represents a clinically significant change in symptoms.

As a result, a 5-point change may be considered the minimum threshold for determining whether a patient has responded to treatment. Meanwhile, a 10-point change can be used as a threshold for determining whether patient improvements are clinically significant.

Access the PCL-5 & More Clinical Assessments

The PCL-5 is one of many clinical assessments providers can use to engage with patients, monitor their progress, and gain access to important metrics that can shape the treatment experience.

With the help of Linear Health, your team can create, distribute, and collect information from PCL-5 and other assessments with just a few clicks. Skip the hassle of managing physical paperwork and streamline workflows by sending digital PCL-5 assessments to patients on your schedule.

Digitizing your assessments also allows you to automate parts of the process – patients can be sent routine assessments on a set schedule without any additional work on your end.

Linear Health is here to offer behavioral healthcare providers an intuitive system for boosting the quality of care they offer patients. To learn more about how our technology solutions can help you spend less time on administrative work (and more time with patients), schedule a demo with us today!