ITQ — scoring PTSD and Complex PTSD (CPTSD)

The ITQ exists because in 2019 ICD-11 split trauma into two diagnoses where DSM-5 has one: ICD-11 PTSD, and ICD-11 Complex PTSD (CPTSD). The CPTSD diagnosis adds three “disturbances in self-organization” (DSO) clusters on top of the PTSD core — affective dysregulation, negative self-concept, and disturbed relationships — that describe the chronic, attachment-disrupted trauma presentations the field had been calling “complex trauma” informally for decades. If you work in the ICD-11 frame, see chronic trauma presentations, or run Phase-Based CPTSD protocols (Cloitre STAIR, modified EMDR for CPTSD, dialectical-behavioral trauma protocols) this is the trauma instrument that maps your work.

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What it measures

Eighteen items in six sections:

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PTSD symptoms (6 items)

• Re-experiencing (P1, P2) — upsetting dreams, powerful images.
• Avoidance (P3, P4) — avoiding internal reminders, avoiding external reminders.
• Sense of threat (P5, P6) — being super-alert, jumpy/startled.

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PTSD functional impairment (3 items)

• P7 relationships/social, P8 work, P9 other important areas.

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DSO symptoms (6 items)

• Affective Dysregulation (C1, C2) — long time to calm down, numb or shut down.
• Negative Self-Concept (C3, C4) — feeling like a failure, feeling worthless.
• Disturbed Relationships (C5, C6) — distant or cut off, hard to stay emotionally close.

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DSO functional impairment (3 items)

• C7 relationships/social, C8 work, C9 other important areas.

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When to use it

• Differential when CPTSD is suspected — chronic trauma history, attachment disruption, DBT-style presentation.
• Pre/post Phase-Based CPTSD protocols (Cloitre STAIR, modified EMDR for CPTSD).
• Treatment response monitoring in any CPTSD-focused work.

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How clients fill it out

Eighteen items on a 5-point frequency scale 0-4 (Not at all → Extremely) over the past month. Five to seven minutes. Reading level grade 7.

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Scoring and severity cutoffs

Rivet shows cluster subscale totals and surfaces a “cluster endorsed” label when each 2-item symptom cluster sums to 2 or more.

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What the ICD-11 algorithm actually requires

ICD-11 PTSD — ALL of:

• ≥1 item rated ≥2 in Re-experiencing
• ≥1 item rated ≥2 in Avoidance
• ≥1 item rated ≥2 in Sense of threat
• ≥1 functional impairment item rated ≥2 (P7-P9)

ICD-11 CPTSD — PTSD criteria above AND:

• ≥1 item rated ≥2 in Affective Dysregulation
• ≥1 item rated ≥2 in Negative Self-Concept
• ≥1 item rated ≥2 in Disturbed Relationships
• ≥1 DSO functional impairment item rated ≥2 (C7-C9)

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Clinical change

The ITQ is sensitive to change across both PTSD and DSO clusters. Phase-Based CPTSD protocols typically show DSO changes that lag behind PTSD changes — the affective regulation and self-concept clusters move slower than the re-experiencing cluster. Track both trajectories.

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Risk flagging

The ITQ doesn’t include a suicide item. CPTSD presentations carry elevated suicide risk — pair with C-SSRS at intake and at inflection points in treatment.

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ITQ vs PCL-5

They belong to two different diagnostic systems, and that is the whole answer. DSM-5 has one PTSD diagnosis; ICD-11 added Complex PTSD as a separate condition in 2019. The PCL-5 is built on DSM-5 and has no way to register CPTSD. The ITQ is built on ICD-11 and puts six items on the disturbances in self-organization — affect dysregulation, negative self-concept, disturbed relationships — that make the difference. Practically: use the PCL-5 as the general adult trauma measure and when the file needs a DSM-5-aligned number. Use the ITQ when the history is chronic, relational or developmental and you want to know whether you are formulating CPTSD, and as the outcome measure in phase-based work where the self-organization symptoms are the treatment target. Nothing stops you running both. They are shorter than they look and they report on different things.

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Is it free to use?

Yes. Free clinical use, per Cloitre and colleagues.

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Citation

Cloitre, M., Shevlin, M., Brewin, C. R., Bisson, J. I., Roberts, N. P., Maercker, A., Karatzias, T., & Hyland, P. (2018). “The International Trauma Questionnaire: Development of a self-report measure of ICD-11 PTSD and Complex PTSD.” Acta Psychiatrica Scandinavica, 138(6): 536-546. Free clinical use.

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When not to use it

• The diagnostic frame is DSM-5. Use the PCL-5.
• The client is a child or adolescent. Use the CPSS-5; the ITQ is validated in adults.
• No trauma history has been established. Like the PCL-5, the ITQ presumes the client is anchored to trauma exposure. Establish the history first.

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