PTSD Checklist for DSM-5

The PTSD Checklist for DSM-5 (PCL-5) is a robust, widely validated 20-item self-report measure developed by the National Center for PTSD.

Questions: 20
Duration: 10 min
Original title: PCL-5 — Posttraumatic Stress Disorder Checklist for DSM-5
Adaptation: PTSD Checklist for DSM-5
Authors: Weathers, F. W., Litz, B. T., Keane, T. M., Palmieri, P. A., Marx, B. P., & Schnurr, P. P.
Created: 2013

The PTSD Checklist for DSM-5 (PCL-5) is a robust, widely validated 20-item self-report measure developed by the National Center for PTSD. It maps directly to the DSM-5 diagnostic criteria for post-traumatic stress disorder. Clinicians rely on this instrument as an efficient way to quantify trauma-related symptoms, establish a baseline, and monitor clinical progress throughout treatment.

Rather than serving as a standalone diagnostic tool, the PCL-5 provides a detailed symptomatic snapshot across four core clusters: intrusion, avoidance, negative alterations in cognitions and mood, and hyperarousal. Incorporating this measure alongside a structured PTSD symptoms checklist helps to clarify the clinical picture early in the assessment phase. Tracking these specific symptom clusters over time enables clinicians to target therapeutic interventions effectively, recognize common post-traumatic reactions, and visually validate the patient's recovery trajectory.

Example result

Fictitious result, computed from a sample set of answers.

Overall score

40/ 80

A 20-item self-report questionnaire assessing the presence and severity of posttraumatic stress disorder (PTSD) symptoms according to DSM-5 diagnostic criteria over the past month. It covers the four symptom clusters: intrusion/re-experiencing (Criterion B, items 1–5), avoidance (Criterion C, items 6–7), negative alterations in cognitions and mood (Criterion D, items 8–14), and alterations in arousal and reactivity (Criterion E, items 15–20). Used in adults for screening, severity assessment, and symptom monitoring of PTSD in both clinical and research settings.

0–24

Within normal limits

25–32

Mild

33–49

Moderate

50–65

Severe

66–80

Extremely severe

Mean item score from 1.64 (exclusive) to 2.455.

généralemixed · community sample · non-clinical — mix of individuals exposed or not exposed to trauma (without PTSD) · United States · n = 166 · 2016 · Renyer (2016)

080

M = 16.47 ± 16.29

cliniquemixed · pathology: PTSD · military veterans receiving care for PTSD · United States · n = 468 · 2016 · Bovin et al. (2016)

080

M = 36.97 ± 21.16

For information

Cut-off≥ 33Clinical significance

Alternative threshold for identifying significant PTSD symptoms that interfere with daily functioning.

Bovin et al. (2016) · Krüger-Gottschalk et al. (2017) · Rosendahl et al. (2019)

Scoring

Total sum + subscale sums, total score from 0 to 80, each item is scored on a 5-point scale (from 0 to 4).

Re-experiencing (intrusion)

10/ 20

This subscale measures the persistent re-experiencing of the traumatic event(s) through intrusive thoughts, nightmares, flashbacks, or distressing memories. Individuals may feel as if the traumatic event is recurring, leading to significant psychological distress. Re-experiencing symptoms can be triggered by internal or external cues related to the traumatic event.

items 1, 2, 3, 4, 5

0–6

Within normal limits

7–8

Mild

9–12

Moderate

13–16

Severe

17–20

Extremely severe

Mean item score from 1.64 (exclusive) to 2.455.

Avoidance

1/ 8

This subscale assesses efforts to avoid thoughts, feelings, or reminders associated with the traumatic event. Avoidance behaviours may include avoiding places, people, activities, or conversations that remind the individual of the trauma. Avoidance serves as a coping mechanism to reduce distress but can interfere with the individual’s ability to process and heal from the trauma.

items 6, 7

0–2

Within normal limits

3–3

Mild

4–4

Moderate

5–6

Severe

7–8

Extremely severe

Mean item score ≤ 1.23 (Severity descriptors based on distance from the normative mean (mean item score 0–4), applied to the total score and each subscale.)

Negative alterations in cognitions and mood

15/ 28

This subscale measures the negative impact on thoughts and feelings that began or worsened after the traumatic event. Symptoms may include persistent negative beliefs about oneself, others, or the world; distorted blame of oneself or others for causing the traumatic event; persistent negative emotions such as fear, anger, guilt, or shame; diminished interest in activities once enjoyed; feeling detached from others; and an inability to experience positive emotions.

items 8, 9, 10, 11, 12, 13, 14

0–8

Within normal limits

9–11

Mild

12–17

Moderate

18–22

Severe

23–28

Extremely severe

Mean item score from 1.64 (exclusive) to 2.455.

Alterations in arousal and reactivity

14/ 24

This subscale measures heightened arousal and reactivity that may present as difficulty sleeping, irritability, angry outbursts, difficulty concentrating, hypervigilance, and an exaggerated startle response. Individuals with hyperarousal symptoms may feel constantly on edge, as if they are in a state of heightened alertness or danger.

items 15, 16, 17, 18, 19, 20

0–7

Within normal limits

8–9

Mild

10–14

Moderate

15–19

Severe

20–24

Extremely severe

Mean item score from 1.64 (exclusive) to 2.455.

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What the test measures

The PCL-5 evaluates the severity of trauma symptoms experienced over the past month, capturing clinical phenomena often conceptualized through the Ehlers & Clark cognitive model of PTSD. It assesses four primary dimensions:

Intrusion: Recurrent, involuntary memories, traumatic nightmares, flashbacks, and physiological or psychological distress upon exposure to reminders.
Avoidance: Active efforts to avoid internal triggers (thoughts, memories) or external reminders (people, places, conversations) associated with the trauma.
Negative alterations in cognitions and mood: Dissociative amnesia, exaggerated negative beliefs (highly relevant when identifying negative and positive cognitions for targeted reprocessing), distorted blame, persistent negative emotions, alienation, and anhedonia.
Alterations in arousal and reactivity: Irritability, reckless behavior, hypervigilance, exaggerated startle response, and difficulties with concentration or sleep.

This measure is appropriate for adults who have been exposed to a significantly stressful or traumatic event.

When and why to use it

Clinicians typically administer the PCL-5 during the initial intake phase and periodically throughout trauma-focused therapy to guide clinical decision-making.

Intake screening: Identifies probable cases and warrants deeper diagnostic evaluation, serving as a critical first step when recognizing PTSD in a new patient.
Symptom profiling: Maps which specific symptom clusters dominate the clinical presentation, offering valuable context whether assessing acute trauma or complex presentations like PTSD after critical illness.
Monitoring progress: Tracks the efficacy of interventions over time, helping clinicians and patients see concrete data on symptom reduction.
Treatment outcome: Provides an objective measure of recovery at discharge, supplementing the clinician's global impression with standardized metrics.

Using a validated score adds a reliable, quantifiable dimension to the clinician's initial impression, ensuring that subtle shifts in symptom severity are accurately captured.

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The questions

Below is a list of problems that people sometimes encounter following a very stressful experience. Please read each statement carefully and check the box that best indicates how much that problem has affected you during the past month.
1. Repeated, disturbing, and unwanted memories of the stressful experience?
This item probes the frequency of spontaneous, distressing recollections of the traumatic event.
- Not at all
- A little bit
- Moderately
- Quite a bit
- Extremely
2. Repeated, distressing dreams of the stressful experience?
This item assesses the presence of recurrent nightmares linked to the trauma.
- Not at all
- A little bit
- Moderately
- Quite a bit
- Extremely
3. Suddenly feeling or acting as if the stressful experience were happening again?
This item evaluates dissociative reactions or flashbacks where the individual feels the event is recurring.
- Not at all
- A little bit
- Moderately
- Quite a bit
- Extremely
4. Feeling very upset when something reminded you of the event?
This item captures intense psychological distress triggered by internal or external trauma cues.
- Not at all
- A little bit
- Moderately
- Quite a bit
- Extremely
5. Having strong physical reactions when something reminded you of the event (e.g., heart pounding, trouble breathing, sweating)?
This item measures autonomic physiological reactivity upon exposure to trauma reminders.
- Not at all
- A little bit
- Moderately
- Quite a bit
- Extremely
6. Trying to avoid memories, thoughts, or feelings related to the event?
This item assesses cognitive and emotional avoidance of trauma-related internal experiences.
- Not at all
- A little bit
- Moderately
- Quite a bit
- Extremely
7. Trying to avoid people and things that remind you of the stressful experience (places, people, activities, objects)?
This item evaluates behavioral efforts to steer clear of external trauma triggers.
- Not at all
- A little bit
- Moderately
- Quite a bit
- Extremely
8. Trouble remembering important parts of the event?
This item probes for dissociative amnesia regarding significant aspects of the traumatic event.
- Not at all
- A little bit
- Moderately
- Quite a bit
- Extremely
9. Having strong negative beliefs about yourself, other people, or the world (such as: I am bad, there is something wrong with me, I can't trust anyone, the world is dangerous)?
This item screens for generalized negative cognitive distortions regarding the self, others, or the world.
- Not at all
- A little bit
- Moderately
- Quite a bit
- Extremely
10. Blaming yourself or someone else for the event or what happened afterward?
This item captures distorted attribution of blame toward oneself or others regarding the trauma.
- Not at all
- A little bit
- Moderately
- Quite a bit
- Extremely
11. Having intense negative feelings such as fear, horror, anger, guilt, or shame?
This item evaluates the persistence of pervasive negative emotional states.
- Not at all
- A little bit
- Moderately
- Quite a bit
- Extremely
12. Losing interest in activities you used to enjoy?
This item measures trauma-induced anhedonia and withdrawal from previously enjoyed activities.
- Not at all
- A little bit
- Moderately
- Quite a bit
- Extremely
13. Feeling distant or cut off from other people?
This item assesses feelings of detachment, estrangement, or social alienation.
- Not at all
- A little bit
- Moderately
- Quite a bit
- Extremely
14. Having trouble experiencing positive feelings (for example, being unable to feel happiness or love for those close to you)?
This item probes the restricted capacity to experience positive emotions like joy or affection.
- Not at all
- A little bit
- Moderately
- Quite a bit
- Extremely
15. Irritable behavior, angry outbursts, or acting aggressively?
This item screens for heightened irritability, temper outbursts, and aggressive behavior.
- Not at all
- A little bit
- Moderately
- Quite a bit
- Extremely
16. Taking too many risks or doing things that could cause you harm?
This item assesses engagement in reckless or self-destructive behaviors post-trauma.
- Not at all
- A little bit
- Moderately
- Quite a bit
- Extremely
17. Being 'super-alert' or hypervigilant, or on guard?
This item captures the persistent state of hypervigilance and scanning for threats.
- Not at all
- A little bit
- Moderately
- Quite a bit
- Extremely
18. Being easily startled?
This item measures heightened reactivity through an exaggerated startle response.
- Not at all
- A little bit
- Moderately
- Quite a bit
- Extremely
19. Having trouble concentrating?
This item evaluates trauma-related cognitive impairments, specifically sustained attention difficulties.
- Not at all
- A little bit
- Moderately
- Quite a bit
- Extremely
20. Having trouble falling or staying asleep?
This item assesses disruption in the ability to initiate or maintain restorative sleep.
- Not at all
- A little bit
- Moderately
- Quite a bit
- Extremely