The PC-PTSD-5 takes under two minutes. The PCL-5 takes five to ten. Both identify PTSD, but they serve different clinical purposes, and using the wrong one wastes time or misses cases.
Two tools, two purposes
The PC-PTSD-5 is a 5-item yes/no screener developed for primary care and high-volume settings. It answers one question: should this patient be evaluated further for PTSD? A score of 4 or higher (out of 5) triggers follow-up assessment.
The PCL-5 is a 20-item measure covering all DSM-5 PTSD symptoms. Patients rate each symptom 0-4, producing a total score from 0-80. It provides the detail needed for treatment planning, tracks response over time, and maps directly to diagnostic criteria.
| Feature | [PC-PTSD-5](/surveys/pc-ptsd-5) | [PCL-5](/surveys/pcl5) |
|---|---|---|
| Items | 5 | 20 |
| Response format | Yes/No | 5-point scale |
| Time to complete | <2 minutes | 5-10 minutes |
| Score range | 0-5 | 0-80 |
| Primary purpose | Screening | Assessment and monitoring |
| Tracks treatment response | No | Yes |
When to use which
Use PC-PTSD-5 for screening. In primary care, emergency departments, or any setting where PTSD isn't the primary focus but you need to identify who warrants further evaluation. A practice seeing 25 patients daily can add a 5-question screen; adding a 20-item assessment for everyone isn't feasible.
Use PCL-5 for assessment and monitoring. In mental health settings, for patients with positive screens, or when PTSD is already the clinical focus. PCL-5's item-level detail shows which symptom clusters are driving impairment (intrusion versus avoidance versus hyperarousal), which guides treatment selection. Its 0-80 score range makes tracking treatment response meaningful: a 10-20 point reduction indicates clinically significant improvement.
In trauma specialty settings, skip straight to PCL-5. Tiered screening makes sense when screening large populations with unknown PTSD prevalence. When patients present specifically for trauma treatment, starting with the full assessment is more efficient.
The tiered approach
For practices that aren't trauma-focused but want systematic screening:
1. Screen with PC-PTSD-5 at intake, annual visits, or when trauma history is noted
2. For scores of 4-5, administer PCL-5, same visit or before next appointment
3. For PCL-5 scores of 33+, conduct clinical evaluation and treatment planning
4. During treatment, repeat PCL-5 every 2-4 weeks to track response
This workflow means most patients complete only a 5-item screen. The full measure goes only to those who need it.
Cutoff scores
PC-PTSD-5 cutoffs depend on your clinical context:
- A cutoff of 3 maximizes sensitivity (95% in validation studies), fewer missed cases but more false positives. Use when missing PTSD is unacceptable.
- A cutoff of 4 balances sensitivity and specificity (83% sensitivity, 85% specificity), recommended for most settings.
- A cutoff of 5 minimizes false positives. Consider when follow-up resources are constrained.
Research shows optimal cutoffs differ by gender: 4 for men, 3 for women. At a cutoff of 4, women have significantly higher false negative rates. Consider using 3 for female patients or maintaining clinical suspicion at scores of 3.
PCL-5 cutoffs have been debated. The commonly cited threshold of 31-33 provides acceptable accuracy, but recent research suggests context matters: a cutoff of 34 optimizes clinical utility (89% sensitivity, 65% specificity), 38 works better for prevalence estimation, and 42-43 identifies clear-cut cases in resource-limited settings. Rather than treating any cutoff as absolute, consider it alongside clinical judgment.
For tracking treatment response: a 5-10 point PCL-5 change indicates reliable change (exceeds measurement error); 10-20 points indicates clinically meaningful improvement.
Scoring for diagnosis
PCL-5 isn't diagnostic by itself, but it maps to DSM-5 criteria. Treating items rated 2+ ("Moderately" or higher) as endorsed symptoms, you can check whether the pattern meets diagnostic thresholds:
- At least 1 intrusion symptom (items 1-5)
- At least 1 avoidance symptom (items 6-7)
- At least 2 negative cognition/mood symptoms (items 8-14)
- At least 2 hyperarousal symptoms (items 15-20)
This is screening, not diagnosis. Clinical interview confirms. For definitive diagnostic assessment, the Clinician-Administered PTSD Scale (CAPS-5) is the reference standard, though its 45-60 minute administration time limits routine use.
Comorbidity matters
PTSD rarely presents alone. Consider pairing with:
- PHQ-9 for depression (common comorbidity)
- GAD-7 if anxiety symptoms are prominent
- Substance use screening when indicated
Standard PTSD measures may underrepresent complex trauma presentations: dissociation, affect dysregulation, relational difficulties. For patients with prolonged interpersonal trauma histories, consider supplementing with complex PTSD measures.
Clinical judgment supersedes scores
A negative PC-PTSD-5 doesn't rule out PTSD if clinical suspicion is high. A PCL-5 score below 33 doesn't mean a patient won't benefit from treatment. Subthreshold PTSD, clinically significant symptoms that don't quite meet full criteria, often responds well to intervention.
The instruments inform clinical decisions. They don't make them.