The PTSD Checklist (PCL): Reliability, Validity, and Diagnostic Utility

Frank W. Weathers, Brett T. Litz,

Debra S. Herman, Jennifer A. Huska, & Terence M. Keane

The PTSD Checklist (PCL) is a new self-report rating scale for assessing post-traumatic stress disorder
(PTSD). The PCL consists of 17 items which correspond to the DSM-III-R symptoms of PTSD. Examinees are
instructed to indicate how much they have been bothered by each symptom in the past month using a 5-point (1-5)
scale. The anchors for the severity ratings are identical to those used on the SCL-90-R (Derogatis, 1983), and
range from "Not at all" to "Extremely." There are two versions of the PCL: the PCL-M, with reexperiencing
symptoms written specifically for military experiences, and the PCL-C, with reexperiencing symptoms written
generically to apply to any traumatic event. The PCL can be modified easily to fit specific assessment needs. For
example, in order to assess symptom severity repeatedly in the context of a treatment protocol, the time frame of
one month can be changed to "the past week" instead of "the past month." Similarly, the wording of the items can
be modified to reflect a specific traumatic event. In the second study described below the phrase "your military
experiences" was changed to "your ODS experiences."
The PCL is useful in a variety of clinical and research assessment contexts, especially when information
about PTSD symptoms is desired but administering a structured interview is not feasible. The PCL can be used as
a continuous measure of PTSD symptom severity by summing scores across the 17 items. It also can be used to
derive a PTSD diagnosis by considering a score of 3 (Moderately) or greater as a symptom, then following the
DSM-III-R diagnostic rule (1 B symptom, 3 C symptoms, and 2 D symptoms).

STUDY 1

Method
Subjects for the first study were 123 male Vietnam theater veterans who contacted the National Center
for PTSD either for clinical services or research participation. Demographic information for this sample is shown
in Table 1. In three separate sessions, two to three days apart, subjects completed the PCL twice, completed
several other questionnaire measures of PTSD and general psychopathology, and were administered the PTSD
module of the Structured Clinical Interview for DSM-III-R (SCID). The prevalence of current PTSD was 54%.
Several analyses were conducted to evaluate the psychometric properties of the PCL.
Results
1. Mean PCL scores were 63.6 (SD=14.1) for PTSD subjects and 34.4 (SD=14.1) for non-PTSD subjects.
2. Test-retest reliability was .96.
3. Internal consistency (alpha coefficient) was .93 for B symptoms, .92 for C symptoms, .92 for D symptoms,
and .97 for all 17 symptoms. Item-scale total correlations ranged from .62-.87.
4. Convergent validity was demonstrated by strong correlations between the PCL and: the Mississippi Scale (.93),
the PK scale of the MMPI-2 (.77), the Impact of Event Scale (.90), and the Combat Exposure Scale (.46).
5. Diagnostic utility was determined by using PCL scores to predict PTSD diagnoses derived from the SCID. The
optimally efficient cutoff score was 50, which yielded a sensitivity of .82, a specificity of .83, and a kappa of .64.

STUDY 2

Method
Subjects for the second study were 1006 nationally surveyed male (88%) and female (12%) veterans of
the Persian Gulf theater. Demographic information for this sample also is shown in Table 1.
The survey instrument included the PCL and the Mississippi Scale, both of which were modified to be
specific to the Persian gulf theater, and a measure of combat exposure. Approximately half of the subjects
completed the survey when they were seeking services (primarily psychotherapy or benefits counseling) at a vet
center, and half completed it at an Army base or through their National Guard or Reserve unit.
Results
1. Mean PCL scores were 64.2 (SD=9.1) for PTSD subjects and 29.4 (SD=11.5) for non-PTSD subjects.
2. Internal consistency (alpha coefficient) was .90 for B symptoms, .89 for C symptoms, .91 for D symptoms,
and .96 for all 17 symptoms. Item-scale total correlations ranged from .52-.80.
3. Convergent validity was demonstrated by a strong correlation between the PCL and the Mississippi Scale (.85).
4. A principal components analysis with varimax rotation yielded one large factor accounting for 59% of the
variance, and one smaller factor accounting for 7% of the variance. Loading most highly on the first factor were
items measuring reexperiencing (B1-B4), effortful avoidance (C1-C2), and hyperarousal (D4-D6). Loading most
highly on the second factor were items measuring numbing of responsiveness (C4-C7) and hyperarousal (D1-D3).

CONCLUSIONS

1. The PCL is an easily administered self-report rating scale for assessing the 17 DSM-III-R symptoms of PTSD.
2. The PCL has excellent test-retest reliability over a 2-3 day period.
3. Internal consistency is very high for each of the three groups of items corresponding to the DSM-III-R symptom
clusters as well as for the full 17-item scale.
4. The PCL correlates strongly with other measures of PTSD, such as the Mississippi Scale, the PK scale of the
MMPI-2, and the Impact of Event Scale, and also correlates moderately with level of combat exposure.
5. Used as a continuous measure, the PCL has good diagnostic utility. In Vietnam combat veterans a cutoff of 50
on the PCL is a good predictor of a PTSD diagnosis based on the SCID PTSD module.
6. Principal components analysis revealed one large factor, consisting primarily of reexperiencing and
hyperarousal items, and one much smaller factor, consisting primarily of emotional numbing items.
Table 1 -- Demographic and Psychometric Information

Vietnam Persian Gulf

Variable (n=123) (n=1006)
Age 43.74 (2.69) 30.46 (7.98)
Gender
Men 100.0% 82.8%
Women 0.0% 12.8%
Education
< High School 10.6% 1.8%
High School Degree 24.4% 56.2%
Some College 35.0% 28.3%
College 7.3% 8.7%
> College 7.4% 4.5%
Marital
Single 26.0% 33.6%
Married 28.4% 48.2%
Divorced 27.6% 9.7%
Separated 13.8% 6.1%
Widowed 2.4% .9%
Branch
Army 48.0% 63.4%
Navy 13.8% 9.3%
Air Force 7.3% 15.1%
Marines 29.3% 10.0%
Race
White 73.2% 64.1%
Black 22.8% 17.0%
Hispanic 2.4% 5.8%
Other 0.0% 5.8%
Mississippi Scale 106.63 (27.59) 74.13 (24.24)
PTSD Checklist 50.58 (20.24) 34.77 (16.83)