> ## Documentation Index
> Fetch the complete documentation index at: https://docs.getrivet.ca/llms.txt
> Use this file to discover all available pages before exploring further.
# ITQ — scoring PTSD and Complex PTSD (CPTSD)
> How to score the International Trauma Questionnaire, the ICD-11 cutoffs that separate PTSD from Complex PTSD, and what disturbances in self-organization look like on the scale.
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.
## What it measures
Eighteen items in six sections:
### 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.
### PTSD functional impairment (3 items)
* P7 relationships/social, P8 work, P9 other important areas.
### 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.
### DSO functional impairment (3 items)
* C7 relationships/social, C8 work, C9 other important areas.
## 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.
## 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.
## 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.
### 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)
**The cluster-endorsed label is a proxy, not the strict
algorithm.**
Rivet uses subscale-sum ≥ 2 as a fast proxy for the strict
per-item ≥ 2 algorithm. The proxy is close but not identical: a
1 + 1 cluster sums to 2 and surfaces "endorsed," but neither
individual item meets the strict ≥ 2 threshold.
When the proxy reads "endorsed" near the threshold, verify by
inspecting per-item responses before treating the cluster as
meeting ICD-11 criteria. For diagnostic decisions the per-item
inspection is what binds, not the proxy.
## 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.
## 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.
## 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](/clinical-templates/screening/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.
## Is it free to use?
**Yes.** Free clinical use, per Cloitre and colleagues.
## 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.
## 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.
## Related articles
The DSM-5 counterpart for DSM-aligned practice.
Borderline-specific severity tracker for DBT-style
presentations.
The retrospective childhood adversity screener — context for
CPTSD presentations.