> ## Documentation Index > Fetch the complete documentation index at: https://docs.getrivet.ca/llms.txt > Use this file to discover all available pages before exploring further. # PCL-5 — PTSD Checklist for DSM-5 > The standard 20-item DSM-5 PTSD measure — for trauma-focused intake, treatment monitoring, and outcome documentation. The PCL-5 is the dominant self-report measure of DSM-5 PTSD severity. If you do trauma-focused work — EMDR, CPT, prolonged exposure, written exposure therapy — this is the instrument you'll administer most often. Twenty items, one month look-back, mapped one-to-one to DSM-5 PTSD symptoms across four diagnostic clusters. US Department of Veterans Affairs publication, public domain. ## What it measures DSM-5 PTSD symptom severity, organized into the four diagnostic clusters: * **Cluster B — Intrusion (items 1-5).** Memories, dreams, flashbacks, upset reactions to reminders, physical reactions. * **Cluster C — Avoidance (items 6-7).** Avoiding internal reminders, avoiding external reminders. * **Cluster D — Negative cognition and mood (items 8-14).** Amnesia, negative beliefs, blame, negative emotions, anhedonia, detachment, emotional numbing. * **Cluster E — Arousal and reactivity (items 15-20).** Irritability, risk-taking, hypervigilance, exaggerated startle, concentration problems, sleep disturbance. The items reference "the stressful experience." Before administering, anchor the client to a specific index trauma — the PCL-5 quantifies symptoms, it doesn't characterize the event. ## When to use it * **Trauma-focused intake** to establish a PTSD baseline. * **Every 4-8 sessions during trauma-focused treatment** to track trajectory. * **Pre/post a discrete protocol** (8-session CPT, full EMDR reprocessing of a target, completed prolonged exposure). * **Discharge documentation** to record outcome. ## How clients fill it out Twenty items rated 0-4 (Not at all → Extremely). Five to seven minutes. Reading level grade 6-7. In Rivet, the client answers on your screen in-session or via a link async. The four cluster subscales surface alongside the total as soon as scoring completes. ## Scoring and severity cutoffs ### Total score Sum of all 20 items. Range 0-80. A total of **33 or higher** is the cutoff for probable PTSD in civilian samples (Bovin et al. 2016 — veteran samples use 31). Rivet uses ≥33 as the surface flag. ### DSM-5 cluster algorithm A symptom is counted as "endorsed" when rated 2 or higher (Moderately or above): * **Cluster B (items 1-5):** ≥1 item endorsed * **Cluster C (items 6-7):** ≥1 item endorsed * **Cluster D (items 8-14):** ≥2 items endorsed * **Cluster E (items 15-20):** ≥2 items endorsed When all four clusters meet criteria → provisional DSM-5 PTSD diagnosis. The cluster algorithm is documented in the template and the cluster subscales show on the result, but the strict per-item endorsement check is something you apply by inspecting responses — Rivet doesn't auto-render a "provisional PTSD" banner. ## Clinical change A **5-10 point drop** is the practitioner convention for clinically meaningful improvement (Wortmann et al. 2016 lands on 10 points as the stronger signal; the 5-point benchmark is the looser response threshold often used between sessions). A total ≥ 50 indicates severe PTSD symptomatology. ## Risk flagging The PCL-5 doesn't include a suicide item. Trauma populations carry elevated suicide risk independent of total score — pair with C-SSRS at intake and at any inflection point in treatment. ## PCL-5 vs ITQ, CPSS-5 and ACE The PCL-5 is the adult DSM-5 measure. Each of the others answers a different question. * **vs [ITQ](/clinical-templates/screening/itq)** — the two diagnostic systems parted ways in 2019, when ICD-11 recognised Complex PTSD as a distinct condition and DSM-5 did not. The PCL-5 maps DSM-5; the ITQ maps ICD-11 and is the instrument that separates PTSD from CPTSD. If the history is chronic or developmental and the presentation includes affect dysregulation, negative self-concept and difficulty staying close to people, the ITQ is asking about that directly and the PCL-5 isn't. * **vs [CPSS-5](/clinical-templates/screening/cpss-5)** — the same DSM-5 criteria written for ages 8 to 18. Use it for anyone in that range; the PCL-5 was validated in adults. * **vs [ACE](/clinical-templates/screening/ace)** — not a comparison so much as a different axis. The ACE counts categories of childhood adversity, once; the PCL-5 measures current symptom severity and is meant to be repeated. A high ACE score is not a PTSD score. The PCL-5 also quantifies symptoms without characterising the index trauma — you name the event with the client before they fill it in, and that conversation is not something the instrument does for you. ## Is it free to use? **Yes.** A work of the US Department of Veterans Affairs' National Center for PTSD, and therefore public domain. ## Citation 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).* US Department of Veterans Affairs, National Center for PTSD. Bovin, M. J., Marx, B. P., Weathers, F. W., Gallagher, M. W., Rodriguez, P., Schnurr, P. P., & Keane, T. M. (2016). "Psychometric properties of the PTSD Checklist for Diagnostic and Statistical Manual of Mental Disorders-Fifth Edition (PCL-5) in veterans." *Psychological Assessment,* 28(11): 1379-1391. US government work, public domain. Verbatim canonical wording. ## When not to use it * **The diagnostic frame is ICD-11, not DSM-5.** Use the ITQ — it maps ICD-11 PTSD and adds Complex PTSD. * **You're assessing a child or adolescent.** Use the CPSS-5. * **You haven't established an index trauma yet.** PCL-5 items presume one. Do the trauma history first. * **You want to characterize what happened, not how it affects the client now.** PCL-5 is symptom severity only — it doesn't catalog events. ## Related articles The ICD-11 counterpart — PTSD plus Complex PTSD. The pediatric counterpart for ages 8-18. The protocol where PCL-5 sees the most use in Rivet.