International Trauma Questionnaire

The International Trauma Questionnaire (ITQ), developed by Cloitre et al.

Questions: 18
Duration: 7 min
Original title: International Trauma Questionnaire
Adaptation: International Trauma Questionnaire
Authors: Cloitre, M., Shevlin, M., Brewin, C.R., Bisson, J.I., Roberts, N.P., Maercker, A., Karatzias, T., & Hyland, P.
Created: 2018

The International Trauma Questionnaire (ITQ), developed by Cloitre et al. (2018), is the premier validated tool for assessing both PTSD and Complex PTSD (CPTSD) under the ICD-11 framework. Unlike earlier models that captured a broad array of post-traumatic stress responses, the ICD-11 conceptualization narrows the focus to core, culturally invariant symptom clusters. This enables clinicians to precisely recognize PTSD symptoms without confounding them with generic distress or secondary comorbid features.

For clinicians working with survivors of prolonged, repeated, or developmental trauma, the ITQ is indispensable for evaluating the additional dimension of Disturbances in Self-Organization (DSO). By distinguishing standard trauma responses from the pervasive affective and relational disruptions of CPTSD, the instrument helps organize clinical formulations and treatment priorities. It provides a clear framework to unpack these common trauma reactions and guide subsequent psychoeducation.

Administered regularly, the ITQ functions as a sensitive tracking tool. It anchors the clinical conversation in specific behavioral and emotional anchors, making it easier to map out the cognitive maintaining processes of PTSD and tailor interventions accordingly.

Example result

Fictitious result, computed from a sample set of answers.

The ITQ is an 18-item self-report questionnaire assessing symptoms of Post-Traumatic Stress Disorder (PTSD) and Complex Post-Traumatic Stress Disorder (CPTSD) according to the ICD-11. It covers two subscales with three clusters each: PTSD (re-experiencing, avoidance, sense of threat) and Disturbances in Self-Organization (DSO: affective dysregulation, negative self-concept, disturbances in relationships), complemented by functional impairment items. It enables screening, provisional diagnosis, and symptom monitoring in adults exposed to a traumatic event.

CIM-11 · item ≥ 2 ("Moderately")→ Criteria not met

PTSD (ICD-11)10 / 24

—Re-experiencing (PTSD)0/2 items ≥ 2

✓Avoidance (PTSD)2/2 items ≥ 2

✓Sense of threat (PTSD)1/2 items ≥ 2

✓PTSD functional impairment2/3 items ≥ 2

Complex PTSD (ICD-11)14 / 24

✓Affective dysregulation (DSO)1/2 items ≥ 2

✓Negative self-concept (DSO)1/2 items ≥ 2

✓Disturbances in relationships (DSO)2/2 items ≥ 2

✓DSO functional impairment1/3 items ≥ 2

Dichotomous diagnosis: a symptom is present if its item is scored ≥ 2. PTSD: at least one symptom present in each of the three PTSD clusters, plus at least one associated functional impairment. Complex PTSD: PTSD criteria met AND at least one symptom present in each of the three DSO clusters, plus DSO impairment. An individual receives an indication for PTSD or Complex PTSD, never both.

Cloitre et al. (2018)

Affective dysregulation (DSO)

4/ 8

Measures difficulties managing emotions, including heightened emotional reactivity and emotional numbing.

items 10, 11

Avoidance (PTSD)

5/ 8

Measures deliberate efforts to avoid internal and external reminders that evoke memories of the traumatic event.

items 3, 4

Disturbances in relationships (DSO)

7/ 8

Evaluates difficulties in forming and maintaining close relationships, and feeling distant or cut off from others.

items 14, 15

Re-experiencing (PTSD)

1/ 8

Assesses intrusive memories, flashbacks, or nightmares where the traumatic event feels as though it is happening again in the present moment.

items 1, 2

Sense of threat (PTSD)

4/ 8

Evaluates persistent feelings of current danger, manifesting as hypervigilance and heightened startle response.

items 5, 6

Negative self-concept (DSO)

3/ 8

Assesses persistent negative beliefs about oneself, including feelings of worthlessness and viewing oneself as a failure.

items 12, 13

DSO functional impairment

3/ 12

Measures the impact of DSO symptoms on relationships, social life, work capabilities, and other important areas of life.

items 16, 17, 18

012

DSO severity

14/ 24

Dimensional severity of disturbances in self-organization (affective dysregulation, negative self-concept, relationships).

items 10, 11, 12, 13, 14, 15

0–3

Minimal

4–6

Mild

7–10

Moderate

11–16

Severe

17–24

Very severe

PTSD functional impairment

6/ 12

Measures the impact of PTSD symptoms on relationships, social life, work capabilities, and other important areas of life.

items 7, 8, 9

012

PTSD severity

10/ 24

Dimensional severity of PTSD symptoms (re-experiencing, avoidance, sense of threat).

items 1, 2, 3, 4, 5, 6

0–3

Minimal

4–6

Mild

7–10

Moderate

11–16

Severe

17–24

Very severe

Have your patient take this test

Assign it in one click: your patient answers on their phone, you receive the score and its interpretation.

Assign this test to a patient

What the test measures

The ITQ systematically measures the two core symptom domains defining trauma-related disorders in the ICD-11: standard PTSD features and Disturbances in Self-Organization (DSO). It evaluates symptom severity over the past month and the functional impairment associated with each cluster, giving clinicians a reliable PTSD symptom checklist for structural assessment. The items map directly onto the following diagnostic dimensions:

Re-experiencing: The intrusion of traumatic memories in the present tense, whether through vivid nightmares or flashbacks.
Avoidance: Active efforts to suppress internal emotional or physical sensations, as well as behavioral avoidance of external triggers.
Sense of Threat: Pervasive hypervigilance and an exaggerated startle response indicative of an overactive autonomic nervous system.
Affective Dysregulation: Severe difficulties in modulating emotional responses, manifesting as either prolonged reactivity or emotional numbing, which can sometimes mirror depersonalization and derealization symptoms.
Negative Self-Concept: Deeply entrenched beliefs of being worthless, defeated, or fundamentally flawed as a direct result of the trauma.
Disturbances in Relationships: Pervasive difficulties in establishing and maintaining emotional closeness or feeling connected to others.
Functional Impairment: The degree to which these symptoms actively disrupt the individual's occupational, social, and daily life.

This measure is intended for adults who have experienced single-incident or prolonged traumatic events, to evaluate the specific presentation and severity of their post-traumatic distress.

When and why to use it

Clinicians deploy the ITQ across different phases of trauma therapy to ensure diagnostic clarity, direct treatment focus, and monitor symptom trajectory. It is particularly valuable when the clinical picture is complicated by pervasive relational or emotional difficulties, helping to accurately recognize Complex PTSD and differentiate it from overlapping presentations such as borderline personality organization.

Clinical Indication	Diagnostic Value
Intake baseline	Establishes an initial profile of both PTSD and DSO symptoms to map the severity of the trauma imprint and guide treatment planning.
Differential support	Clarifies whether interpersonal and emotional difficulties stem from CPTSD's disturbances in self-organization or require a different diagnostic framework.
Screening and cut-off	Utilizes the algorithm to determine if the patient meets the clinical threshold for a provisional ICD-11 diagnosis of PTSD or CPTSD.
Monitoring change	Tracks fluctuations in both symptom intensity and functional impairment over time, evaluating whether trauma-focused or schema therapy approaches are yielding measurable shifts in self-concept and reactivity.

A validated score on the ITQ adds critical precision over clinical impression alone, anchoring the diagnostic formulation in specific criteria and ensuring that core trauma maintaining loops are identified and systematically tracked.

Clinical library

750+ clinical tools

A library built with and for clinicians, ready to use in session and extend between appointments.

Access all the tools

Several resource types

Psychoeducation handouts

Understand at a glance

Interactive exercises

To do and fill in

Interactive programs

A structured path

Audios

Meditation and relaxation

Psychometric tests

Automatic scoring

The questions

Please identify the experience that troubles you most and answer the questions in relation to this experience. Briefly detail the nature of the experience and how long ago it occurred. Questions 1 to 9 concern difficulties you may have experienced IN THE PAST MONTH: for each, indicate how much you have been bothered by that problem, from 0 (Not at all) to 4 (Extremely). Items 10 to 15 refer to ways you typically feel, think about yourself, and relate to others: indicate how true each statement is of you. Items 16 to 18 refer to the impact, in the past month, of these problems concerning your emotions, beliefs about yourself, and your relationships.
1. Having disturbing dreams where part of the experience is replayed or that are clearly related to the experience?
Evaluates the presence of trauma-related nightmares and sleep disturbances.
- Not at all
- A little bit
- Moderately
- A lot
- Extremely
2. Having strong images or memories come to mind as if the experience is happening again right here and now?
Probes for dissociative flashbacks or intrusive memories where the trauma feels currently active.
- Not at all
- A little bit
- Moderately
- A lot
- Extremely
3. Avoiding internal reminders of the experience (e.g., thoughts, feelings, or physical sensations)?
Assesses experiential avoidance of distressing thoughts, emotions, or somatic sensations linked to the trauma.
- Not at all
- A little bit
- Moderately
- A lot
- Extremely
4. Avoiding external reminders of the experience (e.g., people, places, conversations, objects, activities, or situations)?
Measures behavioral avoidance of people, places, or situations that trigger trauma memories.
- Not at all
- A little bit
- Moderately
- A lot
- Extremely
5. Being super-alert, watchful, or on guard?
Captures pervasive hypervigilance and a persistent sense of current threat.
- Not at all
- A little bit
- Moderately
- A lot
- Extremely
6. Having an exaggerated startle response or jumping easily?
Evaluates heightened physiological reactivity and exaggerated startle response.
- Not at all
- A little bit
- Moderately
- A lot
- Extremely
7. Has this affected your relationships and social life?
Assesses the functional impact of PTSD symptoms on the individual's social and interpersonal life.
- Not at all
- A little bit
- Moderately
- A lot
- Extremely
8. Has this affected your work or your ability to work?
Probes the degree to which core PTSD symptoms disrupt occupational or academic functioning.
- Not at all
- A little bit
- Moderately
- A lot
- Extremely
9. Has this affected other important parts of your life, such as your ability to care for your children, your studies, or any other important activities?
Captures broader functional impairment in parenting or other critical life domains due to PTSD symptoms.
- Not at all
- A little bit
- Moderately
- A lot
- Extremely
10. When I get upset, it takes me a long time to calm down.
Evaluates emotional hyper-reactivity and difficulty returning to a baseline state of calm.
- Not at all
- A little bit
- Moderately
- A lot
- Extremely
11. I feel numb or emotionally shut down.
Assesses emotional numbing and restricted affect as a form of dysregulation.
- Not at all
- A little bit
- Moderately
- A lot
- Extremely
12. I feel like a failure.
Probes for internalized feelings of defeat and negative self-evaluation.
- Not at all
- A little bit
- Moderately
- A lot
- Extremely
13. I feel worthless.
Captures profound diminishment of self-worth often observed in complex trauma profiles.
- Not at all
- A little bit
- Moderately
- A lot
- Extremely
14. I feel distant or cut off from other people.
Evaluates subjective feelings of alienation and disconnection from others.
- Not at all
- A little bit
- Moderately
- A lot
- Extremely
15. I find it hard to stay emotionally close to other people.
Assesses persistent difficulties in sustaining intimacy and interpersonal trust.
- Not at all
- A little bit
- Moderately
- A lot
- Extremely
16. Have these problems caused you worry or distress regarding your relationships or social life?
Measures the subjective distress and functional impact of self-organization disturbances on relationships.
- Not at all
- A little bit
- Moderately
- A lot
- Extremely
17. Have these problems affected your work or your ability to work?
Probes the occupational disruption caused specifically by affective and relational dysregulation.
- Not at all
- A little bit
- Moderately
- A lot
- Extremely
18. Have these problems affected other important parts of your life, such as your ability to care for your children, your studies, or any other important activities?
Captures the broader life impairment resulting from disturbances in self-organization.
- Not at all
- A little bit
- Moderately
- A lot
- Extremely