THE INTERNATIONAL TRAUMA QUESTIONNAIRE (ITQ)
OVERVIEW:
The attached instrument is a brief, simply-worded measure, focusing only on the core features of PTSD and CPTSD,
and employs straightforward diagnostic rules. The ITQ was developed to be consistent with the organizing principles
of the ICD-11, as set forth by the World Health Organization, which are to maximize clinical utility and ensure
international applicability through a focus on the core symptoms of a given disorder. The ITQ is freely available in the
public domain to all interested parties. Evaluation of the measure continues particularly as it relates to the definition of
functional impairment for both PTSD and CPTSD and possibly the content of the items as they might relate to being
predictive of differential treatment outcome.
DIAGNOSTIC ALGORITHMS are as follows:
PTSD. A diagnosis of PTSD requires the endorsement of one of two symptoms from the symptom clusters of (1) re-
experiencing in the here and now, (2) avoidance, and (3) sense of current threat, plus endorsement of at least one
indicator of functional impairment associated with these symptoms. Endorsement of a symptom or functional
impairment item is defined as a score > 2.
CPTSD. A diagnosis of CPTSD requires the endorsement of one of two symptoms from each of the three PTSD
symptoms clusters (re-experiencing in the here and now, avoidance, and sense of current threat) and one of two
symptoms from each of the three Disturbances in Self-Organization (DSO) clusters: (1) affective
dysregulation, (2) negative self-concept, and (3) disturbances in relationships. Functional impairment must be identified
where at least one indicator of functional impairment is endorsed related to the PTSD symptoms and one indicator of
functional impairment is endorsed related to the DSO symptoms. Endorsement of a symptom or functional impairment
item is defined as a score > 2.
An individual can receive either a diagnosis of PTSD or CPTSD, not both. If a person meets the criteria for CPTSD, that
person does not also receive a PTSD diagnosis.
Scoring instructions are available at the end of this document.
THE REFERENCE for the measure is:
Cloitre, M., Shevlin M., Brewin, C.R., Bisson, J.I., Roberts, N.P., Maercker, A., Karatzias, T., Hyland, P. (in press). The
International Trauma Questionnaire: Development of a self-report measure of ICD-11 PTSD and Complex PTSD. Acta
Psychiatrica Scandinavica. DOI: 10.1111/acps.12956
BACKGROUND PUBLICATIONS:
Brewin, C. R., Cloitre, M., Hyland, P., Shevlin, M., Maercker, A., Bryant, R. A.,…Reed, G.
M. (2017). A review of current evidence regarding the ICD-11 proposals for diagnosing PTSD and complex PTSD.
Clinical Psychology Review, 58, 1-15. doi: 10.1016/j.cpr.2017.09.001.
Karatzias T., Shevlin M., Fyvie C., Hyland P., Efthymiadou E., Wilson D.,…Cloitre M. (2017). 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). Journal of Affective Disorders, 207, 181-187.
http://dx.doi.org/10.1016/j.jad.2016.09.032
Hyland, P., Shevlin M., Brewin C.R., Cloitre M., Downes A.J., Jumbe, S.,...Roberts, N.P. (2017). Validation of post‐
traumatic stress disorder (PTSD) and complex PTSD using the International Trauma Questionnaire. Acta Psychiatrica
Scandinavica. 136, 313-322. doi: 10.1111/acps.12771.
Shevlin, M., Hyland, P., Roberts, N. P., Bisson, J. I., Brewin C.R. & Cloitre M. (2018). A psychometric assessment of
Disturbances in Self-Organization symptom indicators for ICD-11 Complex PTSD using the International Trauma
Questionnaire, European Journal of Psychotraumatology, 9:1, DOI: 10.1080/20008198.2017.1419749
Cloitre et al. (2018) Acta Psychiatrica Scandinavica. DOI: 10.1111/acps.12956
International Trauma Questionnaire
Instructions: Please identify the experience that troubles you most and answer the questions in relation to
this experience.
Brief description of the experience _______________________________________________
When did the experience occur? (circle one)
a.
less than 6 months ago
b.
6 to 12 months ago
c.
1 to 5 years ago
d.
5 to 10 years ago
e.
10 to 20 years ago
f.
more than 20 years ago
Below are a number of problems that people sometimes report in response to traumatic or stressful life
events. Please read each item carefully, then circle one of the numbers to the right to indicate how much you
have been bothered by that problem in the past month.
Not
at all
A little
bit
Moderately
Quite
a bit
Extremely
P1. Having upsetting dreams that replay part of the
experience or are clearly related to the experience?
0
1
2
3
4
P2. Having powerful images or memories that
sometimes come into your mind in which you feel the
experience is happening again in the here and now?
0
1
2
3
4
P3. Avoiding internal reminders of the experience (for
example, thoughts, feelings, or physical sensations)?
0
1
2
3
4
P4. Avoiding external reminders of the experience (for
example, people, places, conversations, objects,
activities, or situations)?
0
1
2
3
4
P5. Being “super-alert”, watchful, or on guard?
0
1
2
3
4
P6. Feeling jumpy or easily startled?
0
1
2
3
4
In the past month have the above problems:
P7. Affected your relationships or social life?
0
1
2
3
4
P8. Affected your work or ability to work?
0
1
2
3
4
P9. Affected any other important part of your life such
as parenting, or school or college work, or other
important activities?
0
1
2
3
4
Cloitre et al. (2018) Acta Psychiatrica Scandinavica. DOI: 10.1111/acps.12956
Below are problems that people who have had stressful or traumatic events sometimes experience. The
questions refer to ways you typically feel, ways you typically think about yourself and ways you typically
relate to others. Answer the following thinking about how true each statement is of you.
How true is this of you?
Not
at
all
A
little
bit
Moderately
Quit
a bit
Extremely
C1. When I am upset, it takes me a long time to calm
down.
0
1
2
3
4
C2. I feel numb or emotionally shut down.
0
1
2
3
4
C3. I feel like a failure.
0
1
2
3
4
C4. I feel worthless.
0
1
2
3
4
C5. I feel distant or cut off from people.
0
1
2
3
4
C6. I find it hard to stay emotionally close to people.
0
1
2
3
4
In the past month, have the above problems in emotions, in beliefs about yourself and in relationships:
C7. Created concern or distress about your relationships
or social life?
0
1
2
3
4
C8. Affected your work or ability to work?
0
1
2
3
4
C9. Affected any other important parts of your life
such as parenting, or school or college work, or other
important activities?
0
1
2
3
4
1. Diagnostic scoring for PTSD and CPTSD
PTSD
If P1 or P2 > 2 criteria for Re-experiencing in the here and now (Re_dx) met
If P3 or P4 > 2 criteria for Avoidance (Av_dx) met
If P5 or P6 > 2 criteria for Sense of current threat (Th_dx) met
AND
At least one of P7, P8, or P9 > 2 meets criteria for PTSD functional impairment (PTSDFI)
If criteria for ‘Re_dx’ AND ‘Av_dx’ AND ‘Th_dx’ AND ‘PTSDFI’ are met, the criteria for PTSD are met.
CPTSD
If C1 or C2 > 2 criteria for Affective dysregulation (AD_dx) met
If C3 or C4 > 2 criteria for Negative self-concept (NSC_dx) met
If C5 or C6 > 2 criteria for Disturbances in relationships (DR_dx) met
AND
At least one of C7, C8, or C9 > 2 meets criteria for DSO functional impairment (DSOFI)
If criteria for ‘AD_dx’ AND ‘NSC_dx’ AND ‘DR_dx’, and ‘DSOFI’ are met, the criteria for DSO are met.
PTSD is diagnosed if the criteria for PTSD are met but NOT for DSO.
CPTSD is diagnosed if the criteria for PTSD are met AND criteria for DSO are met.
Not meeting the criteria for PTSD or meeting only the criteria for DSO results in no diagnosis.
2. Dimensional scoring for PTSD and CPTSD.
Scores can be calculated for each PTSD and DSO symptom cluster and summed to produce PTSD and
DSO scores.
PTSD
Sum of Likert scores for P1 and P2 = Re-experiencing in the here and now score (Re)
Sum of Likert scores for P3 and P4 = Avoidance score (Av)
Sum of Likert scores for P5 and P6 = Sense of current threat (Th)
PTSD score = Sum of Re, Av, and Th
DSO
Sum of Likert scores for C1 and C2 = Affective dysregulation (AD)
Sum of Likert scores for C3 and C4 = Negative self-concept (NSC)
Sum of Likert scores for C5 and C6 = Disturbances in relationships (DR)
DSO score = Sum of AD, NSC, and DR
