PCL

PEMBIMBING

DR. AHMADI SP. KJ

KOAS

JEFFRI SETIADI
• The PTSD Checklist, Civilian Version (PCL-C) was developed by Frank Weathers and his
colleagues at the National Center for PTSD (1993). The scale consists of 17 questions that
now correspond to DSM-IV.
• Respondents are asked how often they have been bothered by each symptom is the past month on
a 5-point severity scale. According to the authors, the questions may be worded generically to refer
to "stressful experiences in the past" (PCL-C) or to describe reactions to a specific event (PCL-S).
Initial psychometric data was derived by using a military version of the PCL (PCL-M) in a sample of
Vietnam veterans, in which the prevalence of PTSD was high. Internal consistency coefficients were
very high for the total scale (.97) and for each subscale (.92 - .93).
• Test-retest reliability over 2 - 3 days was .96. The PCL-M correlated highly with the Mississippi Scale
for Combat Related PTSD (.93), the PK Scale of the MMPI (.77), and the Impact of Event Scale (.90).
In this sample, the PCL-M was quite predictive of PTSD caseness as assessed with the SCID; a cutoff
score of 50 had a sensitivity of .82, a specificity of .83, and a kappa of .64.
• Other researchers have also presented evidence supporting the reliability and validity of the
PCL-C or PCL-S. In a sample of 40 motor vehicle accident and sexual assault victims (of
whom 18 had PTSD on the Clinician Administered PTSD Scale (CAPS), Blanchard, Alexander,
Buckley, and Forneris (1996) found an alpha of .94 and an overall correlation between total
PCL-S and CAPS scores of .93.
• They found that a score of 44 (rather than 50) maximized diagnostic efficiency (sensitivity of
.94, specificity of .86, overall efficiency of .90). In a sample of individuals in France who had
experienced a variety of events, Ventureya, Yao, Cottraux, Note, and Guillard (2002) reported
excellent internal consistency (.86) and test-retest reliability (.80) for the total PCL-S score.
Using the cutpoint of 44 recommended by Blanchard et al. (1996), the PCL-S showed a
sensitivity of .97, a specificity of .87, and an overall diagnostic efficacy of .94.
• The PCL appears to have much to recommend it. Because it was developed by the
National Center for PTSD, it is in the public domain. It is reliable, and the M and S
versions map directly onto DSM criteria. The M and S versions have been shown to
correlate highly with clinician-administered measures. Less information is available about
version C, the civilian version that does not identify a specific event, and the reader
should be cautious about generalizing psychometric findings from one version of the
scale to another. Also, the published cutpoints should be used with caution as they were
derived from samples with high prevalence rates of current PTSD and may not be
appropriate for samples with lower rates.
 WHAT IS THE PCL-5?

• The PTSD Checklist for DSM-5 is a 20-item self-report measure that assesses the
presence and severity of PTSD symptoms. Items on the PCL-5 correspond with DSM-5
criteria for PTSD. The PCL-5 has a variety of purposes, including:

• Quantifying and monitoring symptoms over time

• Screening individuals for PTSD

• Assisting in making a provisional diagnosis of PTSD

• 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 (e.g., Clinician-Administered PTSD Scale for DSM-5, CAPS-5) to
determine: whether the symptoms meet criteria for PTSD by causing clinically significant
distress or impairment, and whether those symptoms are not better explained by or
attributed to other conditions (i.e., substance use, medical conditions, bereavement, etc.).
 HOW IS THE PCL-5 ADMINISTERED?
• The PCL-5 is a self-report measure that can be read by respondents themselves or read to them either in person or over the telephone. It can be completed in approximately 5-10 minutes.

• The preferred administration is for the patient to self-administer the PCL-5. Patients can complete the measure: in the waiting area prior to a session, at the beginning of a session, at the close of a session, or at home prior to an appointment.

• The PCL-5 is intended to assess patient symptoms in the past month. Versions of the PCL-5 that assess symptoms over a different timeframe (e.g., past day, past week, past 3 months) have not been validated. For various reasons it often makes sense to administer the PCL-5 more or less frequently than once a month, and in those cases the timeframe in the
directions may be changed to meet the purpose of the assessment, though providers should be aware that such changes may alter the psychometric properties of the measure

• How is the PCL-5 scored and interpreted?

• Respondents are asked to rate how bothered they have been by each of 20 items in the past month on a 5- point Likert scale ranging from 0-4. Items are summed to provide a total severity score (range = 0-80).

• 0 = Not at all

• 1 = A little bit

• 2 = Moderately

• 3 = Quite a bit

• 4 = Extremely

• The PCL-5 can determine a provisional diagnosis in two ways:  Treating each item rated as 2 = "Moderately" or higher as a symptom endorsed, then following the DSM-5 diagnostic rule which requires at least:

• 1 Criterion B item (questions 1-5),

• 1 Criterion C item (questions 6-7),

• 2 Criterion D items (questions 8-14),

• 2 Criterion E items (questions 15-20).

•  Summing all 20 items (range 0-80) and using cut-point score of 33 appears to be a reasonable based upon current psychometric work. However, when choosing a cut-point score, it is essential to consider the goals of the assessment and the population being assessed. The lower the cut-point score, the more lenient the criteria for inclusion, increasing the
possible number of false-positives. The higher the cut-point score, the more stringent the inclusion criteria and the more potential for false-negatives. If a patient meets a provisional diagnosis using either of the methods above, he or she needs further assessment (e.g., CAPS-5) to confirm a diagnosis of PTSD
 HOW IS THE PCL-5 SCORED AND INTERPRETED?
• How is the PCL-5 scored and interpreted?
• Respondents are asked to rate how bothered they have been by each of 20 items in the past month on a
5- point Likert scale ranging from 0-4. Items are summed to provide a total severity score (range = 0-
80).
• 0 = Not at all
• 1 = A little bit
• 2 = Moderately
• 3 = Quite a bit
• 4 = Extremely
• The PCL-5 can determine a provisional diagnosis in two ways:  Treating each item rated as 2 = "Moderately" or higher as a
symptom endorsed, then following the DSM-5 diagnostic rule which requires at least:
• 1 Criterion B item (questions 1-5),
• 1 Criterion C item (questions 6-7),
• 2 Criterion D items (questions 8-14),
• 2 Criterion E items (questions 15-20).
•  Summing all 20 items (range 0-80) and using cut-point score of 33 appears to be a reasonable based upon current
psychometric work. However, when choosing a cut-point score, it is essential to consider the goals of the assessment and the
population being assessed. The lower the cut-point score, the more lenient the criteria for inclusion, increasing the possible
number of false-positives. The higher the cut-point score, the more stringent the inclusion criteria and the more potential for
false-negatives. If a patient meets a provisional diagnosis using either of the methods above, he or she needs further assessment
(e.g., CAPS-5) to confirm a diagnosis of PTSD
 DSM-5 CRITERIA FOR PTSD

• Full copyrighted criteria are available from the American Psychiatric Association (1). All of the criteria are
required for the diagnosis of PTSD. The following text summarizes the diagnostic criteria:
• Criterion A (one required): The person was exposed to: death, threatened death, actual or
threatened serious injury, or actual or threatened sexual violence, in the following way(s):
• Direct exposure
• Witnessing the trauma
• Learning that a relative or close friend was exposed to a trauma
• Indirect exposure to aversive details of the trauma, usually in the course of professional duties (e.g., first
responders, medics)
 CRITERION B (ONE REQUIRED):

• The traumatic event is persistently re-experienced, in the following way(s):

• Unwanted upsetting memories
• Nightmares
• Flashbacks
• Emotional distress after exposure to traumatic reminders
• Physical reactivity after exposure to traumatic reminders
 CRITERION C (ONE REQUIRED):

• Avoidance of trauma-related stimuli after the trauma, in the following way(s):

• Trauma-related thoughts or feelings
• Trauma-related reminders
• Criterion D (two required): Negative thoughts or feelings that began or worsened after the trauma,
in the following way(s):
• Inability to recall key features of the trauma
• Overly negative thoughts and assumptions about oneself or the world
• Exaggerated blame of self or others for causing the trauma
• Negative affect
• Decreased interest in activities
• Feeling isolated
• Difficulty experiencing positive affect
 CRITERION E (TWO REQUIRED):

• Trauma-related arousal and reactivity that began or worsened after the trauma, in the
following way(s):
• Irritability or aggression
• Risky or destructive behavior
• Hypervigilance
• Heightened startle reaction
• Difficulty concentrating
• Difficulty sleeping
• Criterion F (required): Symptoms last for more than 1 month.
• Criterion G (required): Symptoms create distress or functional impairment (e.g., social, occupational).
• Criterion H (required): Symptoms are not due to medication, substance use, or other illness.
• Two specifications:
• Dissociative Specification. In addition to meeting criteria for diagnosis, an individual experiences high levels
of either of the following in reaction to trauma-related stimuli:
• Depersonalization. Experience of being an outside observer of or detached from oneself (e.g., feeling as if "this is not
happening to me" or one were in a dream).
• Derealization. Experience of unreality, distance, or distortion (e.g., "things are not real").

• Delayed Specification. Full diagnostic criteria are not met until at least six months after the trauma(s),
although onset of symptoms may occur immediately