Calculators / Anxiety and trauma

ITQ

International Trauma Questionnaire. ICD-11 PTSD and complex PTSD.

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The ITQ calculator is in the Library.

Every rating scale calculator comes with the Library, along with the prescribing guides, medication handouts, DSM-5 criteria and sheets, and the Guide Builder.

Use it for

  • Screening a trauma-exposed adult for ICD-11 PTSD and complex PTSD, when the complex picture is a question.
  • Telling PTSD alone from PTSD with disturbances in self-organization, which can change the treatment plan.
  • Following PTSD and DSO symptom severity with the two six-item symptom sums.

Do not use it for

  • Diagnosing PTSD or CPTSD on its own. A positive result is probable and needs an interview.
  • DSM-5 PTSD. The PCL-5 and the CAPS-5 are the DSM-5 tools.
  • Verifying the event. The ITQ rests on a trauma the person identifies.
  • Children and adolescents. Use the ITQ-CA.

Ask the person to name the worst event that has happened to them, briefly, and keep it in mind for the first nine items. The first nine items refer to the past month.

The second set of items (10 to 18) asks how true each statement is in general: how the person typically feels, thinks about themselves and relates to others.

Has the person identified a worst event to answer about?Answer for the clinician. If there is no identified event, the ITQ does not apply.

PTSD: re-experiencing in the here and now

Below are problems that people sometimes report in response to traumatic or stressful life events. How much have you been bothered by that problem in the past month?

1Having upsetting dreams that replay part of the experience or are clearly related to the experience?
2Having powerful images or memories that sometimes come into your mind in which you feel the experience is happening again in the here and now?

PTSD: avoidance

3Avoiding internal reminders of the experience (for example, thoughts, feelings, or physical sensations)?
4Avoiding external reminders of the experience (for example, people, places, conversations, objects, activities, or situations)?

PTSD: sense of current threat

5Being "super-alert", watchful, or on guard?
6Feeling jumpy or easily startled?

PTSD: functional impairment

In the past month have the above problems:

7Affected your relationships or social life?
8Affected your work or ability to work?
9Affected any other important part of your life such as parenting, or school or college work, or other important activities?

DSO: affective dysregulation

Below are problems that people who have had stressful or traumatic events sometimes experience. The questions refer to the ways you typically feel, the ways you typically think about yourself and the ways you typically relate to others. Answer thinking about how true each statement is of you.

10When I am upset, it takes me a long time to calm down.
11I feel numb or emotionally shut down.

DSO: negative self-concept

12I feel like a failure.
13I feel worthless.

DSO: disturbances in relationships

14I feel distant or cut off from people.
15I find it hard to stay emotionally close to people.

DSO: functional impairment

In the past month, have the above problems in emotions, in beliefs about yourself and in relationships:

16Created concern or distress about your relationships or social life?
17Affected your work or ability to work?
18Affected any other important parts of your life such as parenting, or school or college work, or other important activities?

ITQ

Answer the questions to see the result.

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More about the ITQ

About the ITQWhat it is and what it is for

The ITQ measures PTSD and complex PTSD (CPTSD) as ICD-11 defines them. ICD-11 PTSD has three symptom groups: re-experiencing in the here and now, avoidance, and a sense of current threat. CPTSD is PTSD plus three more groups called disturbances in self-organization (DSO): problems regulating emotion, a negative sense of self, and difficulty in relationships.

Each of the 12 symptom items is rated from 0 to 4. A group counts as met when at least one of its two items is rated 2 (moderately) or higher, and a diagnosis also needs functional impairment tied to those symptoms. The ITQ is scored by this rule and not by a total or a cutoff, and a person gets PTSD or CPTSD, never both.

How to use itGiving it and scoring it

Have the person name the worst event and keep it in mind. Give them the 18 items. Items 1 to 9 refer to the past month. Items 10 to 15 ask what is true in general, and items 16 to 18 return to the past month.

Score each item 0 to 4. A cluster is met when at least one of its two items is 2 or higher. Impairment is met when at least one of its three items is 2 or higher. PTSD needs all three PTSD clusters plus impairment. CPTSD needs PTSD plus the three DSO clusters and DSO impairment.

Interpreting the scoreScore ranges and what they suggest
ResultWhat it suggestsUsual response
0Neither PTSD nor CPTSDThe PTSD criteria are not met. DSO symptoms alone are not a diagnosis.No ICD-11 trauma diagnosis by the ITQ. Interview if the history says otherwise.
1Probable PTSDAll three PTSD groups met, with PTSD-related impairment. The DSO criteria are not all met.Interview to confirm. Trauma-focused psychotherapy is first line.
2Probable complex PTSDPTSD criteria plus all three DSO groups, with impairment from each.Interview to confirm. Treatment often includes stabilization and skills work alongside or before trauma-focused therapy.

The ITQ has no total score or cutoff. Each group needs at least one of its two items rated 2 (moderately) or higher, and functional impairment needs at least one of its three items rated 2 or higher. Complex PTSD takes precedence over PTSD.

Pearls and pitfallsTips and common mistakes
  • Write down the index event. Without it, later scores cannot be compared.
  • A positive result is a reason for a trauma interview, not a diagnosis.
  • Expect overlap with borderline personality disorder. The ITQ shows the symptom picture and does not decide the personality question.
  • In a person who dissociates or avoids the topic, the PTSD symptom items can come out low.
  • The ITQ is free to use and has been translated widely. Use the official translations.
EvidenceAccuracy and reliability
  • Cloitre and colleagues (2018) developed the ITQ and reported that PTSD and DSO symptoms form separate factors, consistent with the ICD-11 model.
  • The scale has been translated and tested in many countries and in general population and clinical samples. The two-part structure has held up in these studies.
  • The developers state that diagnosis is made by the item-level algorithm and that sum-score cutoffs are not recommended.
Source, license and referencesWhere it comes from

The ITQ was developed by Marylene Cloitre, Mark Shevlin, Chris Brewin, Neil Roberts, Thanos Karatzias and colleagues. It is free to use for clinical and research purposes, with credit to the developers. See traumameasuresglobal.com for the official forms and translations. Wording here follows the published English form.

  1. Cloitre M, Shevlin M, Brewin CR, et al. The International Trauma Questionnaire: development of a self-report measure of ICD-11 PTSD and complex PTSD. Acta Psychiatr Scand. 2018;138(6):536-546.
  2. Karatzias T, Shevlin M, Fyvie C, et al. Evidence of distinct profiles of posttraumatic stress disorder (PTSD) and complex posttraumatic stress disorder (CPTSD) based on the new ICD-11 trauma questionnaire (ICD-TQ). J Affect Disord. 2017;207:181-187.
  3. World Health Organization. ICD-11 for Mortality and Morbidity Statistics: 6B40 Post traumatic stress disorder, 6B41 Complex post traumatic stress disorder.

Clinical decision support, not a diagnosis. Each calculator scores a published scale the way its authors intended. A score informs a clinical interview and examination and never replaces them. If you are a patient using this page, please review the result with your clinician. In an emergency, call 911 or call or text 988 in the United States.