PCL-5 is a 20-question PTSD symptom severity screener developed at the VA's National Center for PTSD by Drs. Frank Weathers, Brett Litz, Terence Keane and colleagues, and published in 2013 to align with DSM-5 PTSD criteria. Each item is rated 0–4 over a one-month recall period. Total score 0–80, with 4 DSM-5 cluster sub-scores (intrusion, avoidance, negative cognitions/mood, hyperarousal). Bands: 0–19 minimal, 20–30 sub-clinical, 31–49 probable PTSD (clinical-action threshold), 50–80 severe. PCL-5 is public-domain. It is a screening tool, not a diagnosis — the CAPS-5 clinician-administered interview is the gold standard for DSM-5 PTSD diagnosis. PCL-5 pairs with the ACE quiz for the standard trauma workup (current symptoms + past exposure).
On this page
The 20 questions describe specific PTSD symptoms — intrusive memories, flashbacks, avoidance, negative thoughts about yourself or the world, irritability, hyperarousal, sleep difficulty. Reading or rating them can be triggering.
- You can stop at any time. Close the page or press Retake later.
- Crisis resources stay visible above the questions while you take the quiz. Veterans: 988 then press 1 reaches the Veterans Crisis Line.
- Think of one stressful event before starting. Either the worst event in your life or the one bothering you most right now. Keep it in mind as you answer. The quiz does not ask you to type the event — just to hold it in mind.
- The score is not a diagnosis. A definitive PTSD diagnosis requires the CAPS-5 structured clinical interview administered by a trained clinician. PCL-5 is a screen for monitoring and starting a conversation.
- Your answers stay in your browser only. Nothing is sent to our servers.
In the past month, how much were you bothered by…
A PCL-5 score at or above 31 means a meaningful number of PTSD symptoms have been bothering you over the past month. It is not a diagnosis or a verdict. Three trauma-focused therapies — Cognitive Processing Therapy (CPT), Prolonged Exposure (PE), and EMDR — have strong evidence in randomized controlled trials and are VA-recommended. Two SSRIs (sertraline, paroxetine) are FDA-approved for PTSD. Treatment works, especially when started.
If you feel distressed: call or text 988. Veterans: 988 press 1 reaches the Veterans Crisis Line. Text HOME to 741741 for Crisis Text Line, or 911 if in immediate danger.
What the PCL-5 measures and why VA, NCPTSD, and ISTSS endorse it
PCL-5 is a 20-item self-report measure of current PTSD symptom severity developed at the Department of Veterans Affairs' National Center for PTSD by Drs. Frank Weathers, Brett Litz, Terence Keane, Patrick Palmieri, Brian Marx, and Paula Schnurr, and published in 2013 to align with the DSM-5 criteria for posttraumatic stress disorder. Each of the 20 items maps directly to one of the 20 DSM-5 PTSD symptoms. Sensitivity 67–88% and specificity 60–85% across diverse populations including veterans, combat-exposed civilians, and college students (Bovin et al. 2016).
PCL-5 lives inside the VA's National Center for PTSD assessment toolkit — the same instrument the VA uses for screening, monitoring, and outcome measurement in trauma-focused therapy. The International Society for Traumatic Stress Studies (ISTSS) lists PCL-5 in its adult trauma assessments. The SAMHSA TIP 57 Trauma-Informed Care uses PCL-5 as the standard PTSD screen for behavioral-health programs. PCL-5 is public-domain — VA-developed, no copyright restriction.
The 20 items are organized into four DSM-5 symptom clusters:
- Cluster B — Intrusion (Q1–5): unwanted memories, nightmares, flashbacks, distress at reminders, physical reactions to reminders
- Cluster C — Avoidance (Q6–7): avoiding internal reminders (thoughts, feelings) and external reminders (people, places)
- Cluster D — Negative cognitions and mood (Q8–14): memory gaps, negative beliefs, distorted blame, persistent negative emotions, anhedonia, detachment, numbing
- Cluster E — Hyperarousal (Q15–20): irritability/aggression, reckless behavior, hypervigilance, exaggerated startle, concentration difficulty, sleep disturbance
Each item is rated 0–4 ("not at all" / "a little bit" / "moderately" / "quite a bit" / "extremely") for past-month recall. Total score 0–80. Provisional cutoff for probable PTSD is 31 (some samples support 33). DSM-5 PTSD provisional diagnosis via PCL-5 also requires at least 1 cluster-B item, 1 cluster-C item, 2 cluster-D items, and 2 cluster-E items each rated ≥2 (moderately).
Important: PCL-5 is a screen, not a diagnosis. The gold standard for definitive DSM-5 PTSD diagnosis is the Clinician-Administered PTSD Scale for DSM-5 (CAPS-5), a structured clinical interview administered by a trained clinician. PCL-5 is useful for: initial screening, monitoring symptom change during trauma-focused treatment, starting a clinical conversation, and tracking response over time. It pairs naturally with the ACE quiz — ACE for past exposure history, PCL-5 for current symptoms = standard trauma workup.
What the 4 score bands mean
PCL-5 band interpretation comes from Weathers 2013 + Bovin et al. 2016 + VA NCPTSD guidance. Bands are descriptive of population symptom-severity profiles, not individual destinies. Each band below explains the score range, what it reflects clinically, what guidance the VA attaches to it, and the substance-use co-occurrence relevant for users on a treatment directory.
A PCL-5 total score of 0 to 19 indicates minimal current PTSD symptoms below the sub-clinical threshold. This band represents either no significant past-month symptoms or symptoms below the level requiring clinical action. A low PCL-5 does not rule out past trauma exposure or future symptom emergence — consider the ACE quiz for past exposure if relevant. If a specific concern brought you here, that concern is valid; PCL-5 measures past-month symptoms and may not capture episodic distress around anniversaries or specific triggers. Cluster sub-scores below the cutoff can still be informative — for example, an isolated Cluster B intrusion score with otherwise low total can flag specific reminder-driven distress. Re-screen if symptoms emerge or escalate, and consider PHQ-9 or GAD-7 if depression or anxiety is the more prominent current concern.
A score of 20 to 30 indicates sub-clinical PTSD symptoms — some symptoms present but below Weathers's clinical-action threshold of 31. Many people in this band have meaningful trauma symptoms that affect daily life without meeting the provisional DSM-5 threshold. Watchful waiting plus re-screen 4–6 weeks is a typical first response, but trauma-focused therapy can be effective at this band especially if specific cluster sub-scores are elevated (high Cluster B intrusion, for example). Consider PHQ-9 (depression) and GAD-7 (anxiety) screens for co-occurring concerns — PTSD often presents alongside one or both. Sleep hygiene, social connection, brief CBT techniques, grounding exercises, and avoidance of substances as coping (alcohol and cannabis can worsen long-term PTSD trajectory even when they offer short-term relief) are protective. SAMHSA-funded community mental-health centers offer brief sliding-scale trauma work without the longer-term commitment of full CPT or PE protocols.
A score of 31 to 49 is the VA's clinical-action threshold for probable PTSD. Trauma-focused psychotherapy is strongly indicated. VA strongly recommends three first-line evidence-based therapies: Cognitive Processing Therapy (CPT), Prolonged Exposure (PE) therapy, and EMDR (Eye Movement Desensitization and Reprocessing). All three have strong evidence in randomized controlled trials. Two SSRIs are FDA-approved for PTSD: sertraline (Zoloft) and paroxetine (Paxil). Prazosin is off-label for trauma-related nightmares. For co-occurring substance use disorder (very common in this band), integrated dual-diagnosis treatment per SAMHSA TIP 57 — addressing PTSD and SUD simultaneously, not sequentially — outperforms standard SUD treatment. SAMHSA 1-800-662-4357 can route to programs.
A score of 50 to 80 indicates severe PTSD symptoms substantially above the clinical-action threshold. Combined trauma-focused therapy plus medication is strongly indicated. Specialized PTSD treatment programs and complex-PTSD treatment models are appropriate. Consider inpatient or residential PTSD treatment for severe cases that do not respond to outpatient trauma-focused therapy. Veterans: VA Polytrauma System of Care + VA Vet Centers offer specialized inpatient and intensive-outpatient PTSD programs nationwide. Suicide-risk assessment is appropriate at this score — severe PTSD substantially elevates suicide attempt risk. If you are in distress: call or text 988 (Veterans: 988 press 1), text HOME to 741741, or 911 if in immediate danger.
Why PCL-5 matters for substance use disorder treatment
PTSD and substance use disorder co-occur in roughly 50% of cases (Pietrzak et al. 2011). Among veterans in SUD treatment, approximately 40% have PTSD. Among civilians in SUD treatment, the rate ranges 20–40% depending on population.
Untreated PTSD predicts lower SUD remission and higher relapse. The bidirectional relationship is well-documented: substance use can be a coping mechanism for PTSD symptoms (the "self-medication hypothesis"), and substance use disorders create their own traumatic experiences that can deepen PTSD. Treating one without the other is incomplete.
Integrated dual-diagnosis treatment
Best evidence supports integrated treatment that addresses PTSD and SUD simultaneously in a single program by clinicians trained in both. SAMHSA TIP 57: Trauma-Informed Care in Behavioral Health Services is the federal standard. Specific manualized integrated treatments include:
- COPE (Concurrent Treatment of PTSD and Substance Use Disorders Using Prolonged Exposure) — manualized 12-session protocol; strong RCT evidence
- Seeking Safety — present-focused, stabilization-oriented; introduced before PTSD-specific exposure work; widely available
- Trauma-focused CBT for SUD populations — addresses cognitive distortions specific to trauma-SUD intersection
When evaluating treatment programs, ask explicitly:
- Do clinicians have specific training in CPT, PE, or EMDR? Generic "trauma-informed" framing without specific therapy capability is insufficient.
- Does the program screen with PCL-5 at intake and monitor with PCL-5 over time? If yes, evidence-based PTSD work is likely happening.
- Is medication management coordinated? Sertraline/paroxetine for PTSD; naltrexone/buprenorphine for SUD; coordination matters.
- Veterans only: VA Vet Centers + VA Polytrauma System offer specialized PTSD programs; Veterans Choice / Community Care can cover private trauma-focused therapy if VA wait times are long.
From a PCL-5 score to a real next step: CPT, PE, EMDR, SSRIs, and integrated dual-diagnosis
If your PCL-5 score is 31 or higher, the VA's clinical-action threshold has been reached. A score is not a diagnosis but a structured starting point for trauma-focused care.
Find a trauma-focused therapist
- VA-recommended evidence-based therapies (3 first-line):
- Cognitive Processing Therapy (CPT) — 12-session manualized; strong evidence; widely available
- Prolonged Exposure (PE) therapy — 8–15 sessions; strong evidence; VA-trained therapist directories available
- EMDR (Eye Movement Desensitization and Reprocessing) — bilateral stimulation + memory reconsolidation; strong evidence; EMDRIA directory
- Find a therapist: VA Vet Centers (veterans), Psychology Today filter by trauma specialty, ISTSS clinician directory, ADAA therapist finder.
- Cost note: CPT and PE are 12–15 sessions; EMDR 8–12 for single-incident, longer for complex trauma. Verify in-network coverage. SAMHSA-funded community mental-health centers offer sliding-scale.
Medication options (pharmacotherapy)
- FDA-approved for PTSD: sertraline (Zoloft), paroxetine (Paxil) — both SSRIs.
- Off-label but evidence-supported: prazosin (alpha-1 antagonist) for nightmares; venlafaxine (SNRI); topiramate for hyperarousal.
- Not first-line: benzodiazepines (alprazolam, clonazepam) — can worsen PTSD symptoms long-term and carry addiction risk especially with co-occurring SUD.
- Cannabis: evidence is mixed; some patients report short-term symptom relief but long-term cannabis use is associated with persistent PTSD severity.
If you have substance-use concerns alongside PTSD
- Take an SUD screen too. AUDIT-10 (alcohol), DAST-10 (drugs), or CAGE (quick alcohol triage).
- Ask treatment programs: "Do you offer integrated PTSD + SUD treatment?" — "What manualized protocol do you use (COPE, Seeking Safety)?" — "Is the same therapist trained in CPT/PE and SUD?" If answers are vague, look elsewhere.
- Call SAMHSA 1-800-662-4357 — the helpline can route to integrated dual-diagnosis programs in your area.
VA programs and veteran-specific PTSD-SUD care
PCL-5 is the screening instrument the VA itself uses. If you are a veteran, the VA's National Center for PTSD has built the most comprehensive trauma-care system in the United States. Key entry points:
- VA Vet Centers — 300+ community-based locations offering free counselling for combat veterans and their families. No VA enrolment required.
- Veterans Crisis Line: 988 then press 1, text 838255, or chat at veteranscrisisline.net. 24/7, free, confidential.
- VA Polytrauma System of Care — for combat-injured veterans with TBI plus PTSD. Specialized inpatient and intensive-outpatient programs.
- Veterans Choice / Community Care — covers private trauma-focused therapy if VA wait times exceed 30 days or distance exceeds 30 miles.
- National Center for PTSD at ptsd.va.gov — the developers of PCL-5 maintain free educational resources, self-help tools, and treatment locator.
- VA SUD treatment — integrated PTSD-SUD programs at most VA Medical Centers. Ask about COPE or Seeking Safety availability.
If PCL-5 is not the right fit: ACE, PHQ-9, GAD-7, AUDIT-10, and DAST-10
PCL-5 measures current PTSD symptoms over the past month. ACE measures past exposure to childhood adversity (count of 10 categories). Together they give the standard trauma workup. The screeners below cover related but distinct questions: depression (PHQ-9), anxiety (GAD-7), alcohol (AUDIT-10 or CAGE), drugs (DAST-10).
AUDIT-10 (Alcohol Use Disorders Identification Test)
10-question WHO-validated alcohol screener. Pair with PHQ-9 for a full alcohol-plus-depression picture — the combination is the standard primary-care SBIRT workflow.
DAST-10 (Drug Abuse Screening Test)
10-question Skinner-1982 drug-use screener (excluding alcohol and tobacco). Pair with PHQ-9 if substance use other than alcohol is a concern.
PHQ-9 (Patient Health Questionnaire-9)
9-question Kroenke-2001 depression severity screener. Depression co-occurs with substance use disorder in 30–40% of cases — integrated treatment is best evidence.
GAD-7 (Generalized Anxiety Disorder)
7-question anxiety severity screener (Spitzer 2006 — same author family as PHQ-9). Anxiety co-occurs with depression in roughly 50% of cases. At cutoff ≥10: 89% sensitivity, 82% specificity for GAD.
CAGE-4
4-question alcohol screener (Ewing JAMA 1984). Faster than AUDIT-10 but less sensitive. Public-domain. Cutoff ≥2 has 71% sensitivity / 90% specificity for AUD.
PHQ-2
2-item subset of PHQ-9 (anhedonia + depressed mood). Faster pre-screen used in primary care before triggering full PHQ-9.
ACE (Adverse Childhood Experiences)
10-question retrospective measure of childhood adversity (Felitti / CDC 1998). Public-domain. ACE ≥4 increases adult substance use disorder risk by 7×. Trauma-informed counterpart to current-symptom screeners.
WHO ASSIST
Longer 8-item WHO instrument covering alcohol, tobacco, cannabis, cocaine, stimulants, inhalants, sedatives, hallucinogens, opioids. For one-shot multi-substance screening. WHO ASSIST manual.
PCL-5 terms: CAPS-5, CPT, PE, EMDR, COPE, integrated treatment
Six terms appear repeatedly across this page — the screening instrument itself (PCL-5), the diagnostic gold standard that follows it (CAPS-5 clinician interview), three VA-recommended evidence-based trauma therapies (CPT, PE, EMDR), the manualized integrated PTSD+SUD treatment (COPE), and the SAMHSA-recommended approach to co-occurrence (integrated dual-diagnosis treatment).
- PCL-5 · PTSD Checklist for DSM-5
- 20-item self-report screener developed at VA's National Center for PTSD by Drs. Frank Weathers, Brett Litz, Terence Keane and colleagues, published 2013. Aligned with DSM-5 PTSD criteria via 4 cluster sub-scores. Public-domain. Cutoff 31 for probable PTSD.
- CAPS-5 · Clinician-Administered PTSD Scale for DSM-5
- The diagnostic gold standard for PTSD. Structured clinical interview administered by trained clinician, taking 45–60 minutes. Gives a definitive DSM-5 diagnosis with severity rating. PCL-5 screens; CAPS-5 diagnoses. Most VA PTSD programs use CAPS-5 to confirm diagnosis after PCL-5 screen.
- CPT · Cognitive Processing Therapy
- VA-recommended trauma-focused therapy. 12 sessions, manualized. Focuses on identifying and challenging distorted beliefs about the trauma (self-blame, world is dangerous, can't trust anyone). Strong evidence in RCTs across veteran and civilian populations. Available in individual and group format.
- PE · Prolonged Exposure therapy
- VA-recommended trauma-focused therapy. 8–15 sessions. Combines imaginal exposure (revisiting the traumatic memory in detail) with in-vivo exposure (gradually approaching avoided real-world reminders). Strong evidence. Often paired with COPE for PTSD+SUD.
- EMDR · Eye Movement Desensitization and Reprocessing
- VA-recommended trauma-focused therapy developed by Dr. Francine Shapiro 1987. Combines exposure to traumatic memory with bilateral stimulation (eye movements, taps, sounds). Strong evidence for both single-incident and complex trauma. EMDRIA directory for certified clinicians.
- COPE · Concurrent Treatment of PTSD and SUD
- Manualized integrated treatment combining Prolonged Exposure for PTSD with relapse-prevention CBT for SUD. 12 sessions. Strong RCT evidence (Back et al. 2014). Used in VA SUD programs and increasingly in civilian SUD treatment. Trains therapists to deliver both interventions concurrently rather than sequentially.
- Integrated dual-diagnosis treatment
- Best-evidence approach for PTSD plus co-occurring substance use disorder — addressing both diagnoses simultaneously in a single program by clinicians trained in both. SAMHSA TIP 57 establishes this as the federal standard. Outperforms sequential or separate treatment for relapse rates and PTSD symptom reduction.
PCL-5 FAQ: anonymity, score interpretation, treatment, ACE difference, veterans
Ten common questions about PCL-5 — whether the quiz is anonymous, how to interpret total + cluster sub-scores, what treatments work (CPT, PE, EMDR, SSRIs), how PCL-5 differs from ACE (current symptoms vs past exposure), how PTSD intersects with substance use disorder, and the veteran-specific resources via VA.
Is this PCL-5 quiz anonymous?
Yes. Answers and scores are computed entirely in your browser. Nothing is sent to our servers. No email required. No account. No tracking of individual responses.
Is the PCL-5 a diagnosis?
No. PCL-5 is a screening tool, not a diagnosis. Provisional cutoff for probable PTSD is 31. Definitive diagnosis requires the Clinician-Administered PTSD Scale for DSM-5 (CAPS-5), a structured clinical interview administered by a trained clinician.
Who developed the PCL-5?
Drs. Frank Weathers, Brett Litz, Terence Keane, Patrick Palmieri, Brian Marx, and Paula Schnurr at the VA's National Center for PTSD developed PCL-5 in 2013 to align with DSM-5 PTSD criteria. The instrument is public-domain — no copyright restriction.
What does my PCL-5 score mean?
Total ranges 0 to 80. Bands: 0–19 minimal, 20–30 sub-clinical, 31–49 probable PTSD (the VA's clinical-action threshold), 50–80 severe. Cluster sub-scores indicate which PTSD symptom dimension is most prominent: B intrusion, C avoidance, D negative cognitions/mood, E hyperarousal. VA-recommended trauma-focused treatments at scores ≥31: Cognitive Processing Therapy (CPT), Prolonged Exposure (PE), EMDR.
How is PCL-5 different from ACE?
PCL-5 measures current PTSD symptoms over the past month. ACE measures past exposure to childhood adversity (count of 10 categories during first 18 years of life). They answer different clinical questions and are often used together: ACE for exposure history + PCL-5 for current symptom severity = standard trauma workup. You can have a high ACE with no current PTSD (resilience) or low ACE with PTSD from a single later event.
Can this quiz replace a clinical evaluation?
No. PCL-5 is a screen. Definitive PTSD diagnosis requires the CAPS-5 structured clinical interview administered by a trained clinician. PCL-5 is useful for screening, monitoring symptom change over time during treatment, and starting a clinical conversation.
Is my data saved anywhere?
No. The quiz uses client-side JavaScript only. Questions and answers never leave the page. You can take a screenshot or print the page to share with a clinician, but nothing is stored on our servers.
What treatments work for PTSD?
VA strongly recommends three trauma-focused psychotherapies: Cognitive Processing Therapy (CPT), Prolonged Exposure (PE) therapy, and EMDR. All three have strong evidence in randomized controlled trials. Two SSRIs are FDA-approved for PTSD: sertraline (Zoloft) and paroxetine (Paxil). Prazosin is off-label for nightmares. For co-occurring substance use, integrated dual-diagnosis treatment per SAMHSA TIP 57 (e.g., COPE protocol) outperforms sequential treatment.
How does PTSD connect to substance use?
PTSD and substance use disorder co-occur in approximately 50% of cases (Pietrzak et al. 2011). Among veterans in SUD treatment, ~40% have PTSD. Untreated PTSD predicts lower SUD remission and higher relapse. Integrated dual-diagnosis treatment is the evidence-based approach. COPE (Concurrent Treatment of PTSD and Substance Use Disorders) is a manualized integrated treatment with strong evidence.
Are there VA-specific resources for veterans?
Yes. The Veterans Crisis Line is 988 then press 1 (or text 838255). VA Vet Centers offer free counselling at 300+ locations nationwide. The National Center for PTSD (the developers of PCL-5) maintains free educational resources at ptsd.va.gov. Veterans Choice / Community Care covers private trauma-focused therapy if VA wait times are long.
PCL-5 primary sources: Weathers 2013, VA NCPTSD, ISTSS, SAMHSA TIP 57
Every fact and threshold on this page traces to one of the 11 sources below: the VA's National Center for PTSD (the developers and maintainers of PCL-5), the VA Vet Centers and Veterans Crisis Line, ISTSS clinical resources, SAMHSA TIP 57 trauma-informed-care guidance, NIDA on PTSD-SUD comorbidity, and crisis resources (988, 741741, RAINN).
- VA National Center for PTSD — PCL-5 instrument page (Weathers et al. 2013).
- VA NCPTSD — PTSD treatment options.
- VA Vet Centers (300+ community locations, free counselling).
- Veterans Crisis Line (988 press 1, or text 838255).
- 988 Suicide & Crisis Lifeline.
- SAMHSA National Helpline (1-800-662-4357).
- SAMHSA TIP 57 — Trauma-Informed Care in Behavioral Health Services.
- ISTSS — PCL-5 clinical resource page.
- Crisis Text Line (text HOME to 741741).
- RAINN — sexual-violence support, 1-800-656-HOPE.
- NIDA — Comorbidity: Substance Use Disorders and Other Mental Illnesses.
reviewedBy schema appears in the structured data, and this notice stays visible. We do not provide medical advice and we do not replace evaluation by a licensed clinician. Medical emergency: 911. Crisis: 988 (Veterans: 988 press 1). Sexual-violence support: RAINN 1-800-656-HOPE. Free, confidential substance-use guidance 24/7: SAMHSA 1-800-662-4357. Behavioral-health and substance-use treatment records are protected under 42 CFR Part 2 and HIPAA.
