International Trauma Questionnaire ITQ
International Trauma Questionnaire ITQ overview
Creator and Context
The International Trauma Questionnaire (ITQ) is the reference self report measure for the ICD-11 diagnoses of PTSD and Complex PTSD.
It was developed by Cloitre, Shevlin, Brewin, Bisson, Roberts, Maercker, Karatzias and Hyland and published in 2018. It has 18 items: six PTSD symptom items, three PTSD functional impairment items, six Disturbances in Self Organization items and three related impairment items. It is freely available in the public domain.
Presenting Conditions
The ITQ measures two constructs:
ICD-11 PTSD: re experiencing in the here and now, avoidance, and a persistent sense of current threat
Disturbances in Self Organization (DSO): affective dysregulation, negative self concept, and disturbances in relationships
PTSD plus DSO is what defines Complex PTSD in ICD-11.
Administration
Self administered. PTSD symptoms and both impairment blocks are rated for the past month on a 5 point scale from 0 (Not at all) to 4 (Extremely). The DSO items ask how the person typically feels, thinks and relates, with no fixed recall window.
Desired Audience
Trauma exposed adults in community and clinical settings. A separate version, the ITQ-CA, exists for children and adolescents aged 7 to 17.
The ITQ is the tool of choice where care is organised around ICD-11 rather than DSM-5, which includes most of the UK, Europe, Australia and New Zealand. It is particularly useful for distinguishing PTSD from Complex PTSD, a distinction that materially changes the treatment plan.
Considerations
The ITQ is aligned to ICD-11. Complex PTSD is not a DSM-5 diagnosis, so the ITQ and the PCL-5 are not interchangeable.
A person can receive a diagnosis of either PTSD or Complex PTSD, never both.
The endorsement threshold is a score greater than 2, meaning 3 or 4 on the 0 to 4 scale. An off by one error here changes the diagnostic outcome.
It provides a provisional classification only and does not replace clinical interview.
How to score the International Trauma Questionnaire ITQ
Conducting the assessment
The person completes six PTSD symptom items and three PTSD impairment items for the past month, then six DSO items describing how they typically feel and relate, and three DSO impairment items.
Interpretation
Dimensional scoring gives a PTSD score (sum of the six PTSD items, 0 to 24) and a DSO score (sum of the six DSO items, 0 to 24).
The diagnostic algorithm counts any item scored greater than 2 as endorsed.
PTSD requires one of two symptoms endorsed in each of the three PTSD clusters, plus at least one PTSD functional impairment item endorsed.
DSO requires one of two symptoms endorsed in each of the three DSO clusters, plus at least one DSO impairment item endorsed.
Complex PTSD is indicated when both PTSD and DSO criteria are met. PTSD alone is indicated when PTSD criteria are met but DSO criteria are not.
Clinical Considerations
Use the ITQ to shape sequencing. A Complex PTSD profile usually means stabilisation and affect regulation work before trauma processing.
Track the PTSD and DSO scores separately over time. They often move at different rates.
Treat the classification as provisional and confirm through clinical interview.
International Trauma Questionnaire ITQ use cases
Assessing ICD-11 PTSD and Complex PTSD
Differentiating PTSD from Complex PTSD to guide treatment planning
Measuring symptom severity and functional impairment
Outcome monitoring in trauma services
Category
Trauma
Research Summary
Cloitre, M., Shevlin, M., Brewin, C. R., et al. (2018). The International Trauma Questionnaire: Development of a self report measure of ICD-11 PTSD and complex PTSD. Acta Psychiatrica Scandinavica, 138(6), 536 to 546.
Redican, E., Nolan, E., Hyland, P., et al. (2021). A systematic literature review of factor analytic and mixture models of ICD-11 PTSD and CPTSD using the International Trauma Questionnaire. Journal of Anxiety Disorders, 79, 102381.
Brewin, C. R., Cloitre, M., Hyland, P., et al. (2017). A review of current evidence regarding the ICD-11 proposals for diagnosing PTSD and complex PTSD. Clinical Psychology Review, 58, 1 to 15.
Other Assessment Guides
Adverse Childhood Experience (ACE)
Explore the Adverse Childhood Experience (ACE) Assessment, its development, significance, and application in psychological practice. Understand how to calculate ACE scores and interpret results.
PTSD Checklist for DSM-5 PCL-5
A practitioner guide to the PCL-5, the 20 item DSM-5 aligned measure of PTSD symptom severity. Covers administration, scoring, the 31 to 33 screening range and how to track treatment response.
Primary Care PTSD Screen for DSM-5 PC-PTSD-5
A guide to the PC-PTSD-5, the five item primary care screen for PTSD. Covers administration, the cut point of 4, sex differences in performance and when to escalate to a full assessment.
Note on Assessment licensing
Some assessments are copyright protected and require a licence or the copyright holder's permission for clinical, commercial or digital use. Where that applies, obtaining and maintaining that permission is the responsibility of the practice or organisation using the assessment. Tacklit provides the digital administration, scoring and reporting. We do not grant, transfer or supply rights to the underlying instrument.
