Posttraumatic Stress Disorder Checklist (PCL) Jocelyn Williams Wake Forest University

Background 3 versions for the DSM-IV One of the most commonly used self-report measurements for PTSD First introduced in 1993 by the National Center for PTSD 3 versions for the DSM-IV Civilian (PCL-C) – “stressful experiences” Military (PCL-M) – “stressful military experiences” Specific (PCL-S) – anchored to a specific, identified traumatic event Current version – PCL-5 for DSM-5 Translated into Chinese, Spanish, and Bosnian PTSD Explanation: https://www.youtube.com/watch?v=tqxiEe0RH-Y

Purpose Screening individuals for PTSD Aiding in the diagnostic assessment of PTSD Gold standard for diagnosing PTSD is a structured clinical interview, such as the Clinician-Administered PTSD Scale (CAPS-5) Can be used for provisional diagnosis Monitoring change in PTSD symptoms Evidence for the PCL for DSM-IV suggests that a 5-10 point change represents reliable change (not due to chance); 10-20 point change is clinically significant (U.S. Department of Veteran Affairs, 2014)

Description PCL for DSM-IV (PCL-C, PCL-M, PCL-S) 17 questions; DSM-IV Likert scale rating how bothered client has been by the symptom in the past month 1 – not at all, 5 – extremely PCL-5 for DSM-5 20 questions; DSM-5 Likert scale: 0 – 4 3 formats: without Criterion A with Criterion A with the Life Events Checklist for DSM-5 (LEC-5) and extended Criterion A component Scores not compatible with PCL for DSM-IV scores and cannot be used interchangeably (U.S. Department of Veteran Affairs, 2014)

Administration/ Scoring (PCL-5) Completion time: 5-10 minutes Sum item scores for a “Total Symptom Severity Score” (0-80) Symptom cluster severity score Each item rated 2 or higher is an endorsed symptom Diagnostic rule: 1 B item (questions 1-5), 1 C item (6-7), 2 D items (8-14), 2 E items (15-20) Cut off of 38 appears to be reasonable (U.S. Department of Veteran Affairs, 2014)

Psychometrics (Wilkins, Lang, & Norman, 2011) PCL-S Test-retest Immediate – 0.92 One week – 0.87-0.88 2 weeks – 0.66-0.68 Internal consistency Cronbach’s Alpha = 0.85-0.95 Convergent validity PCL-S correlated significantly more highly with measures of PTSD than with measures assessing depression, other domains of psychopathology, or physical pain Overall correlation between total PCL-S and CAPS scores – 0.93 (Norris & Hamblen, 2004) Discriminant validity PCL-S correlated significantly more highly with the CAPS than PTSD measures that were not anchored to DSM-IV PTSD symptom criteria Structural validity Support for a 4 factor model of re-experiencing, avoidance, hyperarousal, and dysphoria/numbing vs current 3 factor model Cut point 44 showed sensitivity of 0.94-0.97, a specificity of 0.86-0.87, and an overall diagnostic efficacy of 0.90-0.94 (Norris & Hamblen, 2004) with individuals in France who had experienced a variety of events. PCL-S has a 3 factor structure (re-experiencing, avoidance/numbing, and hyperarousal). (Wilkins, Lang, & Norman, 2011)

Strengths Can be used as an outcome instrument to help measure symptom change Useful as a guide for diagnostic assessment Easy to administer and score Only takes 5-10 minutes to complete In the public domain - easy to obtain M and S versions correlate highly with clinician- administered measures PCL-5 has option to assess for Criterion A

Limitations Limited to no research available on current version’s (PCL-5) psychometrics No definitive cut off Dependent on the prevalence of PTSD in that population and the needs of a given setting Published cutpoints should be used with caution as many were derived from samples with high prevalence rates of current PTSD. May not be appropriate for samples with lower rates (Norris & Hamblen, 2011). Reading level – 10 – 13.2 years of schooling (Wilkins, Lang & Norman, 2011)

Selected REFERENCES U.S. Department of Veteran Affairs. (2014, May 2). PTSD Checklist for DSM-5 (PCL-5). Retrieved November 13, 2014, from U.S. Department of Veteran Affairs: National Center for PTSD website: http://www.ptsd.va.gov/professional/assessment/adult-sr/ptsd-checklist.asp Norris, F. H., & Hamblen, J. L. (2004). Standardized self-report measures of civilian trauma and PTSD. In J. P. Wilson & T. M. Keane (Eds.), Assessing Psychological Trauma and PTSD: A Practitioner's Handbook (2nd ed.). New York, NY: The Guilford Press. Wilkins, K. C., Lang, A. J., & Norman, S. B. (2011). Synthesis of the psychometric properties of the PTSD Checklist (PCL) military, civilian, and specific versions. Depression and Anxiety, 28, 596-606. Posttraumatic Stress Disorder Checklist (PCL). (n.d.). Retrieved November 13, 2014, from International Society for Traumatic Stress Studies website: http://www.istss.org/PosttraumaticStressDisorderChecklist.htm