Does the PTSD Checklist Miss Some at Risk for Negative Stress Reactions?

The gold standard for measuring symptoms of posttraumatic stress (PTSD) is the PTSD Checklist (PCL). When this test is administered, it measures the severity of symptoms associated with negative stress reactions and can help mental health professionals determine who may be experiencing clinical levels of PTSD. However, many people who have subclinical levels of PTSD are at risk for negative behaviors such as risk taking, drug and alcohol misuse, and aggression. In an effort to determine if the PCL accurately disseminates those most vulnerable to negative stress responses, Dr. Janie M. Brown of Research Triangle Institute International in North Carolina recently conducted a study that involved administering the PCL to military personnel.

Soldiers who have been exposed to combat are more likely to experience traumatic events than those who have never been deployed. Therefore, Brown chose to survey 6,074 reserve personnel and 8,354 active-duty personnel, all of whom had seen military combat within the previous two years. She assessed the veterans for alcohol use, risk taking, impulsiveness, and other behaviors associated with negative stress reactions. Brown discovered that the lower the PCL scores, the lower the negative behavior, including aggression, violence, drug use, and impulsivity. This finding was true for both groups of participants.

One of the most revealing findings of this study was that participants did not have to have clinical levels of PTSD in order to exhibit significantly negative behaviors. In fact, those who fell well below the clinical range still had high levels of substance-use issues, risk taking, and aggression. With respect to drinking, the results showed that the active-duty personnel were more vulnerable to negative behaviors than the reserve members and that even low PCL scores put them at risk for negative outcomes pertaining to alcohol use. “Thus, even for those who do not exhibit strong PTSD symptomatology, screening for other high-risk behaviors should be conducted,” Brown said. She believes that lowering the PTSD clinical ranges could identify more individuals at risk for maladaptive stress responses. In addition, Brown noted that this study did not consider the number, length, or location of deployments—only the fact the participants had been deployed. Future research should explore how deployment variances affect PTSD levels and how that may relate to stress responses.

Brown, Janice M., Jason Williams, Robert M. Bray, and Laurel Hourani. Ostdeployment alcohol use, aggression, and posttraumatic stress disorder. Military Medicine 1771.10 (2012): 1184-190. Print.

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  • Chris B

    Chris B

    November 15th, 2012 at 3:30 PM

    I really would hate to think that the difference between getting a correct diagnosis or not is dependent on how I score on some checklist

  • Carlos


    November 16th, 2012 at 3:53 AM

    When the itemized lists work, they are great. But there has to be more than that in order to get an individualized diagnosis that works best for the patient. You can’t simply go by what one person thinks or says- you actually have to make it unique to anyone’s special needs and requirements.

  • nellie


    November 16th, 2012 at 6:48 PM

    its never enough to check whether a person’s symptoms are ABOVE a certain level,a problem is a problem,even if its magnitude is low.

    some people may react differently than others so we really need to watch out for negative behavior even in those with low symptom levels.and moreover,prevention is better than cure,so why not monitor for such behavior anyway.

  • taipan


    November 20th, 2012 at 3:21 AM

    different reactions are going to occur at different times and under different circumstances depending upon the mindset of the PTSD PTSD subject. For example I would have a different reaction if attacked by a police officer that I would affect act by a civilian believe me I have experience with both as a homeless veteran I’ve been beat up by the police a lot more that I have ever been beat up by other homeless people

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