Those who are evaluated for Post-Traumatic Stress Disorder may be given a variety of options for treatment, but before a diagnosis can be confirmed there are procedural steps an evaluator, counselor, or care provider will take to confirm a diagnosis.
One such step is to conduct formal interviews or surveys of a patient’s condition, another is to administer diagnostic tests. But another tool relies heavily on the patient’s direct input–the use of the PCL5 PTSD Checklist for DSM-V.
A Self-Reporting Tool For Patients And Care Providers
This checklist is described as a “self-report measure” which is intended to help determine the nature of PTSD symptoms. It can also be used to examine how severe those symptoms might be.
The National Library Of Medicine describes the PCL5 as a “widely used” self-reporting measurement of symptoms associated with PTSD. Changes to the PCL5 were implemented in 2015 to keep pace with changes to the Diagnostic and Statistical Manual of Mental Disorders (DSM) with regard to PTSD.
Those who use such tools generally expect them to change with the DSM V where applicable–this is an approach that will change over time as science continues to better define such conditions and their diagnoses.
That is one reason why older versions of the test can’t be used with the current DSM edition such as the DSM IV.
VA literature states clearly: “PCL-5 scores are not compatible with PCL for DSM-IV scores and cannot be used interchangeably.”
Who Uses The PCL5 PTSD Checklist?
There are many who use the PCL5, but for our purposes here the most important user is the Department of Veterans Affairs, which provides instructions for use of the PCL5, including a strict warning that this is a tool that is meant to be used in conjunction with other methods.
According to the VA official site, “The PCL-5 should not be used as a stand-alone diagnostic tool. When considering a diagnosis, the clinician will still need to use clinical interviewing skills, and a recommended structured interview”.
What is The Checklist Used For?
When the VA uses or encourages the use of the PCL-5 it should be for any of the following reasons:
- Monitoring symptom change during treatment
- Monitoring changes after treatment
- Screening for PTSD
- Making a “provisional PTSD diagnosis”
How The PCL5 Is Used
PCL5 is a tool used to evaluate recent PTSD symptoms. It can be administered to the patient (the questions read to them by phone or over the internet) or it can be a completely self-contained experience where the user reviews the questions and answers them to the best of their ability.
VA literature suggests that this can be a very informal process–a patient may complete the questionnaire in the privacy of their own homes, in the waiting room of a care provider, or even at the beginning or end of a counseling or therapy session.
Does Setting Matter?
VA literature for care providers suggests that the setting of the PCL-5 should be taken into account when trying to make a provisional determination about PTSD. Furthermore, the goals of the assessment may factor into how the results are interpreted. For example, VA instructions to test administrators for the PCL-5 include the following:
“The goal of assessment also should be considered. A lower cut-point score should be considered when screening or when it is desirable to maximize detection of possible cases. A higher cut-point score should be considered when attempting to make a provisional diagnosis or to minimize false positives.”
Timing Counts
VA guidelines stress that this test is, “intended to assess patient symptoms in the past month.” When alternate time frames are used, VA sources warn that such results have not not been validated.
The VA says administering the PCL 5 PTSD Checklist “more or less frequently than once a month” is a good idea.
One interesting feature of the checklist is that there is more than one. Among the simplest differences, there is a version of the checklist for civilians and one version for military people.
There are also separate checklists for reporting symptoms from the past week as well as the past month, and there are other versions that incorporate certain technical criteria in addition to what’s reported above.
What Is On The PCL5 PTSD Checklist?
VA literature states that the list of 20 questions on the checklist correspond with a series of possible answers based on how the patient reacts to the questions in terms of being troubled or bothered by the scenarios listed.
This is reported by the patient on a scale from 0 (not bothered at all) to 4 (extremely bothered).
Here is a sample question as presented on the VA official site:
- Item: In the past month, how much were you been bothered by: “Repeated, disturbing, and unwanted memories of the stressful experience?”
- Response: 5-point Likert (0 = “Not at all” to 4 = “Extremely”)
There are other questions, including queries such as how many times you experienced “Repeated, disturbing dreams of the stressful experience” and whether the patient is “Suddenly feeling or acting as if the stressful experience were actually happening again”.
Other questions involve whether the patient has engaged in avoidance behavior, or whether there is difficulty remembering crucial parts of the traumatic or stressful experience.
Joe Wallace is a 13-year veteran of the United States Air Force and a former reporter for Air Force Television News
