In another article on this website, we noted that:
The diagnosis of post-traumatic stress disorder (PTSD) is known to be frequently missed in clinical practice. Why? Because commonly, patients with PTSD don’t spontaneously tell clinicians about either the traumatic event they have experienced or about the typical symptoms of PTSD.
That is why it is important for us to actively screen all our patients for the possible diagnosis of PTSD. How should we do this?
1. High-risk groups
Use the PCL-5, a 20-item questionnaire, to screen for possible/ probable PTSD.
2. All others
Step 1: Ask ONE question (from the questionnaire called PC-PTSD-5) that asks about a history of major trauma.
Step 2: If the person responds “Yes” to that one question, proceed and ask them all five questions about PTSD symptoms from the PC-PTSD-5 questionnaire.
Note: Both these questionnaires were suggested by the VA/DoD Clinical Practice Guideline for Management of Posttraumatic Stress Disorder and Acute Stress Disorder (2023). But research evidence regarding which questionnaire to use for PTSD screening is weak.
On this page, let’s discuss how to use the Primary Care PTSD Screen for DSM-5 (PC-PTSD-5).
About the PC-PTSD-5
– The words “Primary Care” should not be taken to mean that the questionnaire is only suitable for use in primary care settings. It is a brief questionnaire that is suitable for use in a wide variety of settings, though we recommend that to screen people from high-risk groups for possible PTSD, a more detailed questionnaire like the PCL-5 should be preferred.
– The PC-PTSD-5 questionnaire can be downloaded at no cost from the following link: https://www.ptsd.va.gov/professional/assessment/documents/pc-ptsd5-screen.pdf
– It is VERY important that we remember that the PC-PTSD-5 cannot diagnose PTSD. It was “designed to identify individuals with probable PTSD. Those screening positive require further assessment…” (source).
– The PC-PTSD-5 starts with one preliminary question about a lifetime history of a traumatic event and gives examples of the kinds of trauma that it is asking about—“unusually or especially frightening, horrible, or traumatic.”
Preliminary question
Here is the wording of the preliminary question:
Sometimes things happen to people that are unusually or especially frightening, horrible, or traumatic. For example:
• a serious accident or fire
• a physical or sexual assault or abuse
• an earthquake or flood
• a war
• seeing someone be killed or seriously injured
• having a loved one die through homicide or suicide.
Have you ever experienced this kind of event? YES NO
Those who answer YES to the question above, about whether they have ever experienced this kind of traumatic event, are asked to answer five YES/NO questions about how that traumatic event has affected them over the past month.
Here are the five questions:
In the past month, have you…
1. had nightmares about the event(s) or thought about the event(s) when you did not want to? YES/ NO
2. tried hard not to think about the event(s) or went out of your way to avoid situations that reminded you of the event(s)? YES/ NO
3. been constantly on guard, watchful, or easily startled? YES/ NO
4. felt numb or detached from people, activities, or your surroundings? YES/ NO
5. felt guilty or unable to stop blaming yourself or others for the event(s) or any problems the event(s) may have caused? YES/ NO
In another article on this website (see Four types of symptoms are present in PTSD), we had noted that we diagnose PTSD using DSM-5 diagnostic criteria only if symptoms from all four of the following categories are present:
These are:
– Intrusion symptoms
– Avoidance
– Arousal/ Reactivity
– Cognition/ Mood (negative alterations)
If we go back to the five questions from the PC-PTSD-5 in the section above, we can see that:
– Q1 was about intrusion symptoms
– Q2 was about Avoidance
– Q3 was about Arousal/ Reactivity, and
– Q4 and Q5 were about Cognition/ Mood.
How to score and interpret the PC-PTSD-5
Scoring the PC-PTSD-5 is the easy part. As noted above, if the patient says YES to the preliminary question about whether they have ever experienced a traumatic event of the kind being asked about, one that was “unusually or especially frightening, horrible, or traumatic,” they are asked to answer five YES/NO questions about how that traumatic event has affected them over the past month.
– A YES answer to each of the five questions should be given one point
– The total number of points should be added up.
What total score on the PC-PTSD-5 should be considered to indicate that the person may have PTSD and should now be carefully evaluated by a clinician for possible PTSD? A cut-off score of 3 or 4 is used for this purpose.
Does the following make sense to you? If we use a lower total score to indicate that a clinician should systematically evaluate the patient for possible PTSD, all of the following will happen:
1. Fewer patients who really do have PTSD will be missed; that is, there will be fewer false negatives.
2. The number of patients that the clinician has to evaluate will go up.
3. The number of these patients whose score on the PC-PTSD-5 was 3 or more but were not diagnosed with PTSD by the clinician will increase; that is, the number of false positives will increase.
The opposite of all this would happen if a higher cut-off score were used to trigger a clinician evaluation.
So, we have to choose which of the following we consider to be more important for our purpose because we realize that there is a trade-off between these two things:
1. Reduce the number of patients with PTSD who are missed by the screening.
2. Reduce the number of patients who don’t have PTSD but proceed to the stage of clinician evaluation.
What cut-off score should we use for the PC-PTSD-5?
Please first make sure you are clear about the following general principles about screening tools.
The primary aim of SCREENING, whether using a questionnaire, a laboratory test, or something else, is to identify people who MAY have the condition and, so, should be evaluated using a more definitive test. Why not do the more definitive test on everyone? Because the definitive tests are either much more expensive or come with risks or use up scarce resources.
Note that those in whom the screening tool is negative will NOT move on to being evaluated using the more definitive test. That is why a good screening tool should be positive in as many as possible of those who really have the condition for which the screening is being done. In technical terms, we say that screening tools must, first and foremost, have high sensitivity. And, the cut-off on a screening tool should be set to reduce the number of patients with the condition who are missed; that is, to reduce false negatives. When we do this, we cannot avoid the problem of identifying more people as possibly having the condition who later turn out, based on the definitive test, not to have the condition (false positives).
The PC-PTSD-5 is a questionnaire designed to SCREEN for possible PTSD. By using a lower cut-off, we will reduce the chances that someone with PTSD will be missed. Please note that if the PC-PTSD-5 is considered to be negative for a particular person (that is, below the cut-off score being used), the clinician will not do a detailed evaluation for possible PTSD on that person.
Of course, as we lower the cut-off score on the PC-PTSD-5 to increase its sensitivity, the clinician has to evaluate more patients for possible PTSD, and more of those will turn out not to have PTSD.
Bottom line
A cut-off score of 4 (that is, a score of 4 or 5) on the PC-PTSD-5 should usually be used to indicate that the person may have PTSD and should be evaluated in detail for this. In a civilian primary care population, using a cut-off score of 4, the PC-PTSD-5 had a sensitivity of 100% and a specificity of 85% (Williamson et al., 2022).
But the cut-off score that is chosen may depend, in part, on the clinical setting, the types of patients being screened, and the availability of clinicians to do full evaluations for possible PTSD.
There may be situations in which a lower cut-off score of 3 should be used:
1. For any reason, it is particularly important to identify all patients with PTSD.
2. In women, in particular, a lower cut-off score of 3 should be strongly considered. This is because, in women, using a cut-off score of 4 was found to lead to too many false negatives (source).
Related Pages
Posttraumatic stress disorder (PTSD)—Clinical features
Four types of symptoms are present in PTSD
How is “Complex PTSD” different from PTSD?
Not all trauma is associated with posttraumatic stress disorder (PTSD)
What is nightmare disorder, and why is it important?
An overview of Trauma- and Stressor-Related Disorders
Please share these reliable sources for education about PTSD
Posttraumatic stress disorder (PTSD)—Screening
Screen patients for a history of major trauma and, if present, for PTSD
How to screen for PTSD using the PC-PTSD-5 questionnaire
How to screen for PTSD using the PCL-5 questionnaire
Posttraumatic stress disorder (PTSD)—Treatment
PTSD-associated nightmares: Menu of treatment options
Does prazosin work for PTSD? If so, for which symptoms?
How exactly should we dose prazosin in PTSD?
(Relative) contraindications to prazosin for PTSD-associated nightmares
Warning! Prazosin can lead to hypotension/ syncope after the first dose
These medications can be very problematic along with prazosin
Should we consider doxazosin an alternative to prazosin for PTSD?
Posttraumatic stress disorder (PTSD)—Other articles
Practice guidelines for posttraumatic stress disorder (PTSD)
What can we do to support “National Post-Traumatic Stress Disorder Awareness Month”?
Posttraumatic Stress Disorder: PTSD (Main Menu)
References
Lathan EC, Petri JM, Haynes T, Sonu SC, Mekawi Y, Michopoulos V, Powers A. Evaluating the Performance of the Primary Care Posttraumatic Stress Disorder Screen for DSM-5 (PC-PTSD-5) in a Trauma-Exposed, Socioeconomically Vulnerable Patient Population. J Clin Psychol Med Settings. 2023 Dec;30(4):791-803. doi: 10.1007/s10880-023-09941-9. Epub 2023 Jan 30. PMID: 36715813; PMCID: PMC9885055.
Patton SC, Hinojosa CA, Lathan EC, Welsh JW, Powers A. Validating the primary care posttraumatic stress disorder screen for DSM-5 (PC-PTSD-5) in a substance misusing, trauma-exposed, socioeconomically vulnerable population. Addict Behav. 2023 Apr;139:107592. doi: 10.1016/j.addbeh.2022.107592. Epub 2022 Dec 21. PMID: 36584543; PMCID: PMC9993036.
Primary Care PTSD Screen for DSM-5 (PC-PTSD-5). Available at https://www.ptsd.va.gov/professional/assessment/screens/pc-ptsd.asp Accessed October 29, 2025.
Primary Care PTSD Screen for DSM-5 (PC-PTSD-5). Available at https://www.ptsd.va.gov/professional/assessment/documents/pc-ptsd5-screen.pdf. Accessed October 29, 2025.
Prins A, Bovin MJ, Smolenski DJ, Marx BP, Kimerling R, Jenkins-Guarnieri MA, Kaloupek DG, Schnurr PP, Kaiser AP, Leyva YE, Tiet QQ. The Primary Care PTSD Screen for DSM-5 (PC-PTSD-5): Development and Evaluation Within a Veteran Primary Care Sample. J Gen Intern Med. 2016 Oct;31(10):1206-11. doi: 10.1007/s11606-016-3703-5. Epub 2016 May 11. PMID: 27170304; PMCID: PMC5023594.
VA/DoD Clinical Practice Guideline Working Group. VA/DoD clinical practice guideline for the management of posttraumatic stress disorder and acute stress disorder. Version 4.0. Washington, DC: Department of Veterans Affairs, Department of Defense; 2023. Available at https://www.healthquality.va.gov/guidelines/MH/ptsd/VA-DoD-CPG-PTSD-Full-CPG-Edited-11162024.pdf. Accessed October 29, 2025.
Williamson MLC, Stickley MM, Armstrong TW, Jackson K, Console K. Diagnostic accuracy of the Primary Care PTSD Screen for DSM-5 (PC-PTSD-5) within a civilian primary care sample. J Clin Psychol. 2022 Nov;78(11):2299-2308. doi: 10.1002/jclp.23405. Epub 2022 Jun 28. PMID: 35763419.
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