PTSD Checklist (PCL-5)

DSM-5 PTSD Assessment — Validated 20-Item Self-Report

✓ VA Validated ⚗ DSM-5 Aligned 🔒 100% Private
20 Items 4 Symptom Clusters
6% US Adults Lifetime PTSD Prevalence
Score 0–80 Cutoff ≥33 Probable PTSD
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PCL-5 Questionnaire

Below is a list of problems that people sometimes have in response to a very stressful experience. Please read each problem carefully and then select one of the numbers to indicate how much you have been bothered by that problem in the past month.

0 — Not at all 1 — A little bit 2 — Moderately 3 — Quite a bit 4 — Extremely
Cluster B — Intrusion Symptoms (Items 1–5)

1. Repeated, disturbing, and unwanted memories of the stressful experience?

2. Repeated, disturbing dreams of the stressful experience?

3. Suddenly feeling or acting as if the stressful experience were actually happening again (as if you were actually back there reliving it)?

4. Feeling very upset when something reminded you of the stressful experience?

5. Having strong physical reactions when something reminded you of the stressful experience (for example, heart pounding, trouble breathing, sweating)?

Cluster C — Avoidance Symptoms (Items 6–7)

6. Avoiding memories, thoughts, or feelings related to the stressful experience?

7. Avoiding external reminders of the stressful experience (for example, people, places, conversations, activities, objects, or situations)?

Cluster D — Negative Cognitions & Mood (Items 8–14)

8. Trouble remembering important parts of the stressful experience?

9. Having strong negative beliefs about yourself, other people, or the world (for example, having thoughts such as: I am bad, there is something seriously wrong with me, no one can be trusted, the world is completely dangerous)?

10. Blaming yourself or someone else for the stressful experience or what happened after it?

11. Having strong negative feelings such as fear, horror, anger, guilt, or shame?

12. Loss of interest in activities that you used to enjoy?

13. Feeling distant or cut off from other people?

14. Trouble experiencing positive feelings (for example, being unable to feel happiness or have loving feelings for people close to you)?

Cluster E — Arousal & Reactivity (Items 15–20)

15. Irritable behavior, angry outbursts, or acting aggressively?

16. Taking too many risks or doing things that could cause you harm?

17. Being “superalert” or watchful or on guard?

18. Feeling jumpy or easily startled?

19. Having difficulty concentrating?

20. Trouble falling or staying asleep?

Understanding PTSD

Post-Traumatic Stress Disorder (PTSD) is a mental health condition that can develop after exposure to a traumatic event. The DSM-5 classifies PTSD under “Trauma- and Stressor-Related Disorders” and requires exposure to actual or threatened death, serious injury, or sexual violence through direct experience, witnessing, learning about it happening to a close person, or repeated professional exposure.

DSM-5 Diagnostic Criteria:

  • Criterion A: Exposure to a traumatic event (direct, witnessed, learned about, or repeated exposure to details)
  • Criterion B: Intrusion symptoms (at least 1 required) — intrusive memories, nightmares, flashbacks, psychological distress, or physiological reactions to reminders
  • Criterion C: Avoidance (at least 1 required) — avoidance of trauma-related thoughts/feelings or external reminders
  • Criterion D: Negative alterations in cognitions and mood (at least 2 required) — memory gaps, negative beliefs, distorted blame, persistent negative emotions, diminished interest, detachment, inability to experience positive emotions
  • Criterion E: Alterations in arousal and reactivity (at least 2 required) — irritability, reckless behavior, hypervigilance, exaggerated startle, concentration problems, sleep disturbance
  • Symptoms must last more than 1 month and cause significant distress or functional impairment

Prevalence:

  • Approximately 6% of U.S. adults will have PTSD at some point in their lifetime
  • About 12 million adults in the U.S. have PTSD during any given year
  • Women are about twice as likely as men to develop PTSD
  • Veterans experience higher rates, with estimates of 11–20% for Iraq/Afghanistan veterans

Common trauma types:

  • Combat and military exposure
  • Sexual assault or abuse
  • Physical assault or violence
  • Serious accidents (motor vehicle, workplace)
  • Natural disasters (earthquakes, hurricanes, floods)
  • Childhood abuse or neglect
  • Witnessing violence or death
  • Medical trauma (life-threatening illness, ICU stays)

The 4 DSM-5 Symptom Clusters

PTSD symptoms are organized into four distinct clusters in the DSM-5. Understanding these clusters helps clarify the full picture of how PTSD affects a person:

Cluster B — Intrusion Symptoms (Items 1–5):

  • Intrusive memories: Recurrent, involuntary, and distressing memories of the traumatic event that seem to come out of nowhere
  • Nightmares: Disturbing dreams related to the trauma that may cause sleep disruption and fear of going to sleep
  • Flashbacks: Feeling or acting as if the traumatic event is happening again; can range from brief episodes to complete loss of awareness of present surroundings
  • Emotional distress: Intense or prolonged psychological distress when exposed to reminders of the trauma
  • Physical reactivity: Physiological reactions (racing heart, sweating, nausea) to trauma reminders

At least 1 intrusion symptom is required for DSM-5 diagnosis.

Cluster C — Avoidance (Items 6–7):

  • Internal avoidance: Avoiding memories, thoughts, or feelings about the trauma; may use distraction, substance use, or emotional numbing to avoid internal triggers
  • External avoidance: Avoiding people, places, conversations, activities, objects, or situations that serve as reminders; may lead to significant lifestyle restriction

At least 1 avoidance symptom is required for DSM-5 diagnosis.

Cluster D — Negative Alterations in Cognitions and Mood (Items 8–14):

  • Dissociative amnesia: Inability to recall important aspects of the trauma (not due to head injury or substance use)
  • Negative beliefs: Persistent and exaggerated negative beliefs about oneself, others, or the world (“I am permanently damaged,” “No one can be trusted”)
  • Distorted blame: Persistent distorted cognitions about the cause or consequences of the trauma, leading to self-blame or blaming others
  • Persistent negative emotions: Chronic states of fear, horror, anger, guilt, or shame
  • Diminished interest: Markedly decreased interest or participation in previously enjoyed activities
  • Detachment: Feeling alienated, distant, or cut off from others
  • Restricted positive affect: Persistent inability to experience positive emotions (happiness, satisfaction, loving feelings)

At least 2 negative cognition/mood symptoms are required for DSM-5 diagnosis.

Cluster E — Alterations in Arousal and Reactivity (Items 15–20):

  • Irritability/aggression: Angry outbursts, verbal or physical aggression with little or no provocation
  • Reckless behavior: Self-destructive actions such as reckless driving, excessive substance use, or unsafe sexual behavior
  • Hypervigilance: Being constantly on guard, scanning the environment for threats, difficulty feeling safe
  • Exaggerated startle: Heightened startle response to unexpected sounds, movements, or touch
  • Concentration problems: Difficulty focusing, following conversations, or completing tasks
  • Sleep disturbance: Difficulty falling or staying asleep, often due to hyperarousal or nightmares

At least 2 arousal/reactivity symptoms are required for DSM-5 diagnosis.

Evidence-Based Treatment Options

PTSD is one of the most treatable mental health conditions. Several evidence-based therapies have demonstrated strong effectiveness:

First-Line Psychotherapies (Strongly Recommended):

  • Cognitive Processing Therapy (CPT): A 12-session structured therapy that helps patients identify and challenge unhelpful beliefs related to the trauma. CPT teaches patients to evaluate and modify “stuck points” — thoughts that keep them locked in patterns of avoidance and negative beliefs. Highly recommended by VA/DoD clinical guidelines.
  • Prolonged Exposure (PE): A 8–15 session therapy that involves gradually approaching trauma-related memories, feelings, and situations that have been avoided. Includes imaginal exposure (revisiting the trauma memory) and in vivo exposure (confronting avoided situations in daily life). Extensive research base spanning 20+ years.
  • Eye Movement Desensitization and Reprocessing (EMDR): A structured therapy that has patients focus on the trauma memory while simultaneously experiencing bilateral stimulation (typically eye movements). The mechanism involves reprocessing traumatic memories to reduce their emotional intensity. Typically 6–12 sessions. Recommended by WHO, VA/DoD, and APA.

Medication Options (under medical supervision):

  • SSRIs: Sertraline (Zoloft) and paroxetine (Paxil) are FDA-approved for PTSD. They help regulate serotonin and can reduce the intensity of PTSD symptoms across all four clusters.
  • SNRIs: Venlafaxine (Effexor) has strong evidence for PTSD treatment and is recommended by VA/DoD guidelines as a first-line medication option.
  • Prazosin: An alpha-1 blocker that can help reduce trauma-related nightmares and improve sleep quality. Commonly used as an adjunct treatment.

Combination Approaches:

  • Therapy combined with medication often produces the best outcomes, especially for severe PTSD
  • Medication can help reduce symptom severity enough to engage more fully in therapy
  • Treatment should be individualized based on symptom profile, patient preference, and comorbid conditions

Other Approaches with Evidence:

  • Written Exposure Therapy (WET): A brief (5-session) therapy involving writing about the trauma
  • Cognitive Behavioral Therapy (CBT): Broader cognitive-behavioral approaches focusing on thought and behavior patterns
  • Group therapy: Can reduce isolation and provide peer support; often combined with individual therapy
  • Stellate Ganglion Block (SGB): An emerging treatment showing promise in clinical trials

Recovery & Support Resources

Recovery from PTSD is possible. With appropriate treatment, many people see significant improvement in their symptoms. Here are resources and strategies to support the recovery process:

Self-Care Strategies:

  • Establish safety and routine: Create a predictable daily structure. Knowing what to expect reduces anxiety and helps the nervous system regulate.
  • Physical exercise: Regular aerobic exercise (walking, swimming, cycling) reduces PTSD symptoms by helping regulate the stress response. Aim for 30 minutes most days.
  • Sleep hygiene: Maintain consistent sleep and wake times, keep the bedroom dark and cool, avoid caffeine after noon, and develop a calming pre-sleep routine.
  • Grounding techniques: Use the 5-4-3-2-1 technique (identify 5 things you see, 4 you touch, 3 you hear, 2 you smell, 1 you taste) when experiencing flashbacks or dissociation.
  • Breathing exercises: Practice diaphragmatic breathing (belly breathing) for 5–10 minutes daily. Box breathing (inhale 4 counts, hold 4, exhale 4, hold 4) can help during acute distress.
  • Limit alcohol and substances: These can temporarily numb symptoms but worsen PTSD long-term and interfere with treatment effectiveness.

Support Groups:

  • Peer support groups (in person or online) provide connection with others who understand the experience
  • National Alliance on Mental Illness (NAMI) offers free support groups nationwide
  • Many VA Medical Centers offer PTSD-specific group programs

VA Resources for Veterans:

  • VA PTSD Treatment Programs: Every VA Medical Center offers specialized PTSD treatment, including residential (inpatient) programs for intensive care
  • Vet Centers: Community-based counseling centers offering readjustment services to combat veterans and their families — no VA enrollment required
  • Veterans Crisis Line: Call 1-800-273-8255 (press 1), text 838255, or chat at VeteransCrisisLine.net — 24/7
  • PTSD Coach App: A free mobile app developed by VA’s National Center for PTSD. Includes self-assessment tools, coping skills, and direct links to support. Available on iOS and Android.
  • AboutFace: VA’s website featuring veteran stories of PTSD treatment and recovery

For Family Members and Caregivers:

  • Learn about PTSD to better understand what your loved one is experiencing
  • Encourage treatment without pressuring; offer to help with logistics (driving to appointments, childcare)
  • Take care of your own mental health — caregiver burnout is real
  • Consider couples or family therapy, which can address relationship impacts of PTSD
  • VA’s Caregiver Support Line: 1-855-260-3274

Frequently Asked Questions

The PCL-5 (PTSD Checklist for DSM-5) is a 20-item self-report measure developed by the U.S. Department of Veterans Affairs’ National Center for PTSD. It assesses the 20 DSM-5 symptoms of PTSD organized into four symptom clusters: intrusion, avoidance, negative alterations in cognitions and mood, and alterations in arousal and reactivity. The PCL-5 is one of the most widely used PTSD screening tools in both clinical and research settings worldwide. It is in the public domain and freely available for use.

A PCL-5 total score of 33 or higher is the recommended cutoff for a provisional diagnosis of PTSD. This cutoff was established through research comparing PCL-5 scores with clinician-administered PTSD diagnoses (using the CAPS-5, the gold-standard diagnostic interview). A score at or above 33 suggests probable PTSD that warrants further clinical evaluation. However, the PCL-5 alone cannot diagnose PTSD — a comprehensive clinical assessment is required. Some research settings use different cutoffs (e.g., 31–33) depending on the population being studied.

The PCL-5 was updated from the previous version (PCL, also called PCL-M, PCL-C, or PCL-S) to align with the DSM-5 criteria for PTSD, which were significantly revised from DSM-IV. Key differences include: the rating scale changed from 1–5 to 0–4; three new symptoms were added (distorted blame, persistent negative emotions, and reckless/self-destructive behavior); the symptom structure changed from three clusters (DSM-IV) to four clusters (DSM-5); and the total score range changed from 17–85 to 0–80. Scores from the PCL-5 are not directly comparable to the previous PCL versions.

For monitoring treatment progress, the PCL-5 is typically administered at baseline and then at regular intervals, such as every 1–2 weeks during active treatment or monthly during maintenance. A change of 5–10 points on the PCL-5 is considered a reliable change (not due to measurement error), and a change of 10–20 points suggests clinically meaningful improvement. The PCL-5 asks about symptoms in the past month, so retaking it more frequently than every 1–2 weeks may not capture meaningful change.

No. The PCL-5 is a screening and symptom monitoring tool, not a diagnostic instrument. While it can identify probable PTSD and track symptom changes over time, a formal PTSD diagnosis requires a comprehensive clinical evaluation by a qualified mental health professional. The gold standard for PTSD diagnosis is the Clinician-Administered PTSD Scale for DSM-5 (CAPS-5), a structured clinical interview. The PCL-5 is best used as a screening tool, to monitor symptom change during treatment, and to supplement a clinical interview.

If your total score is below 33 and cluster criteria are not met, you may not currently meet the threshold for probable PTSD, but any distressing symptoms deserve attention. If your score is 33 or above, or if multiple symptom clusters are met, we strongly recommend seeking a professional evaluation. You can print your results and bring them to an appointment with a therapist, psychiatrist, or primary care provider. For veterans, VA Medical Centers and Vet Centers offer specialized PTSD services at no cost. Remember: PTSD is highly treatable, and early intervention leads to better outcomes.

Medical Disclaimer

This PCL-5 Assessment is provided for educational and informational purposes only and does not constitute medical advice, diagnosis, or treatment. The PCL-5 is a screening tool developed by the U.S. Department of Veterans Affairs and is not a clinical diagnostic instrument. A score at or above the cutoff suggests probable PTSD but does not replace a comprehensive evaluation by a qualified healthcare professional. If you are experiencing a mental health crisis, please contact the 988 Suicide & Crisis Lifeline (call or text 988) or the Veterans Crisis Line (1-800-273-8255, press 1). All calculations are performed in your browser — no personal data is stored on our servers or shared with any third party.

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References

  1. Weathers FW, Litz BT, Keane TM, Palmieri PA, Marx BP, Schnurr PP. The PTSD Checklist for DSM-5 (PCL-5). Scale available from the National Center for PTSD; 2013. www.ptsd.va.gov
  2. Blevins CA, Weathers FW, Davis MT, Witte TK, Domino JL. The Posttraumatic Stress Disorder Checklist for DSM-5 (PCL-5): Development and initial psychometric evaluation. J Trauma Stress. 2015;28(6):489-498.
  3. Bovin MJ, Marx BP, Weathers FW, et al. Psychometric properties of the PTSD Checklist for Diagnostic and Statistical Manual of Mental Disorders-Fifth Edition (PCL-5) in veterans. Psychol Assess. 2016;28(11):1379-1391.
  4. Wortmann JH, Jordan AH, Weathers FW, et al. Psychometric analysis of the PTSD Checklist-5 (PCL-5) among treatment-seeking military service members. Psychol Assess. 2016;28(11):1392-1403.

PCL-5: Weathers, F.W., Litz, B.T., Keane, T.M., Palmieri, P.A., Marx, B.P., & Schnurr, P.P. (2013). The PTSD Checklist for DSM-5 (PCL-5). National Center for PTSD. Public domain — U.S. Department of Veterans Affairs.