Psychometric Validation of the Posttraumatic Stress Disorder Checklist for DSM-5 (PCL-5) in Adults With Substance Use Disorders

OBJECTIVE: The Posttraumatic Stress Disorder (PTSD) Checklist for the Diagnostic and Statistical Manual of Mental Disorders, fifth edition (PCL-5) is one of the most widely used instruments in clinical practice, but there remain ongoing debates about its factor structure. Further, no study to date has undertaken psychometric validation of the PCL-5 among individuals seeking treatment for substance use disorder (SUD), a population for whom PTSD is highly concurrent and relevant to clinical care. The present study sought to examine three PTSD structural models and measurement invariance across sex and age in patients with SUD. METHOD: The sample consisted of adults (N = 1,222; M_age = 41.17; 71.03% male) who completed the PCL-5 at admission to inpatient treatment for SUD. Confirmatory factor analysis and tests of measurement invariance (age, sex) were conducted. RESULTS: Confirmatory factor analysis revealed that previously observed six-factor anhedonia and seven-factor hybrid models provided superior fit over the original four-factor model of PTSD, with optimal results found for the hybrid model. Configural, metric, and scalar measurement invariance for the six- and seven-factor models were observed for sex (males vs. females) and age (median split: < 41 vs. ≥ 41). CONCLUSION: Collectively, this study adds to growing evidence in support of a seven-factor model and validates the use of the PCL-5 in adult SUD treatment populations. Limitations of some of the alternative structures and priorities for future research on the overlap of PTSD and SUD are discussed. (PsycInfo Database Record (c) 2025 APA, all rights reserved).