Posttraumatic Stress Disorder Checklist (PCL)

Summary   

This 17-item self-report scale for PTSD is based on DSM-IV criteria and takes 5-7 mins to complete. There are slightly different versions for use with military (M) or civilian (C) populations, as well as a version focused on a "specific stressful experience" (S).

Author/publisher details   

National Center for PTSD, Boston, USA.
http://www.ncptsd.va.gov/

Date   

1993

Description   

The PCL is a 17-item self-report checklist of PTSD symptoms based closely on the DSM-IV criteria.
Respondents rate each item from 1 ("not at all") to 5 ("extremely") to indicate the degree to which they have been bothered by that particular symptom over the past month.

Three versions of the PCL are available, although the differences are slight. The PCL-M is a military version and questions refer to "a stressful military experience". The PCL-C is a general civilian version that is not linked to a specific event; the questions refer to "a stressful experience from the past". The PCL-S can be referenced to any specific traumatic event; participants are asked to nominate the event and questions refer to "the stressful experience". Scoring is the same for all three versions.

Versions of the PCL are also available in Bosnian, Chinese and Spanish (see below).

Scoring and Psychometrics   

Scoring
Respondents rate each item from 1 ("not at all") to 5 ("extremely") to indicate the degree to which they have been bothered by that particular symptom over the past month. Thus, total possible scores range from 17 to 85. Notwithstanding the fact that self-report scales should not be used to make a formal diagnosis, the PCL has shown good diagnostic utility, with Weathers et al. (1993) recommending a cut-off score of 50 as optimal for indicating a probable diagnosis of combat-related PTSD. An alternative strategy is to use individual items according to the DSM criteria (i.e., at least one symptom from items 1 - 5, and at least three from items 6 - 12, and at least two from items 13 - 17). They suggest a cut off score of 3 or more for each item as being most appropriate for this approach.

Psychometrics
The PCL has demonstrated strong psychometric properties. Estimates of internal consistency (Cronbach's alpha) range between .94 (Blanchard et al, 1996) to .97 (Weathers et al. 1993) . Test-retest reliability has been reported as .96 at 2-3 days and .88 at 1 week (Blanchard et al.,1996; Ruggiero et al.,2003).

The PCL correlates positively with the Mississippi PTSD Scale with convergent validity of between r = .85 and .93 (Weathers et al, 1993). Strong correlations have also been reported with MMPI-2 Keane PTSD Scale (.77), IES (.77-.90) and CAPS .92 (Blanchard et. al., 1996)

A cutoff score of 50 for a PTSD diagnosis has demonstrated good sensitivity (.78 to .82) and specificity (.83 to .86). Lowering the cutoff score to 44 revealed better sensitivity (.94), specificity (.86) and overall diagnostic efficiency (.90) with MVA victims (Blanchard et. al., 1996).

Bosnian (Charney et al, unpublished)
To our knowledge the Bosnian version is unpublished. Enquiries should be directed to: Dr Meredith Charney, Department of Psychiatry, Massachusetts General Hospital, Boston, MA mecharney@partners.org

Chinese (Wu et.al In Press)
The PCL has been translated in to traditional 'complex' Chinese (the written Chinese used in Hong Kong and Taiwan), and simple Chinese (the written Chinese used in Mainland China) . Wu etal tested the psychometric properties in a sample of 481 survivors of motor vehicle accidents. Reliability and validity of the Chinese PCL were found to be satisfactory. The translation was validated by stringent back-translation. Taking into consideration the difference in language and culture, a bilingual clinical psychologist first translated the PCL aiming at retaining the meaning of each item in the Chinese version. Then an independent bilingual clinical psychologist back-translated the translated PCL into English for content comparison. The content of the final Chinese PCL was further verified by back-translation procedure until the meaning of each item matched with the original item. For more details see the paper or contact the author. Enquiries about the Chinese version should be directed to: Dr Kitty Wu, Department of Clinical Psychology, Caritas Medical Center, 111 Wing Hong Street, Shamshuipo, Kowloon, Hong Kong, China. wukyk@ha.orh.hk

Spanish (Marshall, 2004; Orlando & Marshall, 2002)
The psychometrics of the Spanish PCL have been reported in detail in two papers. They attest to the general equivalence of English and Spanish language versions of the PCL as tools for measuring PTSD symptom severity in Spanish and English speaking trauma survivors. When using this version please note that the wording has been adjusted to enquire about a specific trauma ('attack'). As a cautionary note, Orlando and Marshall (2002) report that although the English and Spanish versions are not fully equivalent on an item-by item basis, no bias was observed at the level of composite PCL scale score, indicating that the 2 language versions are suitably similar for scale-level analyses (i.e the total PCL score). The Spanish version was developed using double translation procedures, detailed on page 52 of the 2002 paper. For further information see the papers, or contact the authors: RAND 1776 Main Street, Santa Monica, CA USA 90407 Grant.marshall@rand.org

Key/core References   

Blanchard, E. B., Jones Alexander, J., Buckley, T. C., & Forneris, C. A. (1996). Psychometric properties of the PTSD Checklist (PCL). Behaviour Research and Therapy, 34, 669-673.

Forbes, D., Creamer, M., & Biddle, D. (2001). The validity of the PTSD checklist as a measure of symptomatic change in combat-related PTSD. Behaviour Research & Therapy, 39, 977-986.

Ruggiero, K. J., Del Ben, K., Scotti, J. R., & Rabalais, A. E. (2003). Psychometric Properties of the PTSD Checklist--Civilian Version. Journal of Traumatic Stress, 16, 495-502.

Weathers, F. W., Litz, B. T., Herman, D. S., Huska, J. A., & Keane, T. M. (1993). The PTSD Checklist (PCL): Reliability, validity, and diagnostic utility. Paper presented at the 9th Annual Conference of the ISTSS, San Antonio, TX.

Translations

Bosnian
Unpublished

Chinese
Wu, KK. et al (In press) Psychometric Properties and Confirmatory Factor Analysis of the Posttraumatic Stress Disorder Checklist (PCL) for Chinese Survivors of Motor Vehicle Accident Hong Kong Journal of Psychiatry.

Spanish
Miles, J.V.C., Marshall, G.N., & Schell, T.S. (in press).  Spanish and English versions of the PTSD Checklist - Civilian Version (PCL-C): Testing for differential item functioning.

Marshall, G. N. (2004). Posttraumatic stress disorder symptom checklist: Factor structure and English-Spanish measurement invariance. Journal of Traumatic Stress, 17(3), 223-23

Orlando, M., & Marshall, G. N. (2002). Differential item functioning in a Spanish translation of the PTSD checklist: detection and evaluation of impact. Psychological Assessment, 14(1), 50-59.

Further Information   
(e.g., Links)   

Additional information has been compiled on the Measurement Experts site: http://www.ncptsd.va.gov/ncmain/ncdocs/
assmnts/ptsd_checklist_pcl.html

View manual   

No manual exists for the PCL; it is used in the same way as other self report scales and is self explanatory. For advice on interpretation, see above and refer to key references.

View tool   

This resource should be used in an ethical and responsible manner and should be used only for the purpose(s) for which it has demonstrable validity. Please observe copyright where indicated and reference it appropriately.

English language versions
ISTSS Members: Download PCL-C
ISTSS Members: Download PCL-M 
ISTSS Members: Download PCL-S 

Other Languages:
Click here to view PCL-S 'Traditional/Complex Chinese Version
Click here to view PCL-S Simple Chinese Version
Click here to view PCL-S ('attack') Spanish-English Version
Click here to view PCL-C Spanish Version 
Click here to view PCL-C Greek Version