The International Trauma Questionnaire (ITQ) is a freely available, 18-item self-report measure that screens for post-traumatic stress disorder (PTSD) and complex PTSD (CPTSD) as defined in the World Health Organization's ICD-11. Developed by Cloitre and colleagues in 2018, it captures six PTSD symptoms, six disturbances in self-organization symptoms, and six functional impairment items, and yields both dimensional scores and a provisional diagnostic classification.
ICD-11 alignment. The ITQ is the most widely used instrument designed specifically to operationalize the ICD-11 distinction between PTSD and CPTSD, supporting diagnostic clarity in clinical and research settings.
Rapid screening. The 18 items can be completed in five to seven minutes, making the ITQ practical for primary care, behavioral health intake, and trauma-focused programs.
Provisional diagnosis and dimensional scores. It produces a clear provisional categorization (PTSD vs. CPTSD vs. neither) and continuous symptom severity scores, supporting both clinical screening and outcome monitoring.
Treatment outcome tracking. Repeated administration captures meaningful change in PTSD and CPTSD symptoms during the course of therapy, with published evidence supporting its sensitivity to treatment effects.
Cross-cultural reach. The ITQ has been translated into more than 20 languages and validated in diverse clinical and community samples, including veterans, survivors of sexual violence, and refugees.
Free and unrestricted. The ITQ is in the public domain, with no licensing fees, which makes it accessible to community mental health programs, integrated care clinics, and academic studies alike.
Primary care and integrated behavioral health. Used as a brief screener when patients endorse trauma exposure or present with symptoms of hyperarousal, avoidance, or affective dysregulation; positive screens prompt referral or warm handoff.
Outpatient mental health. Administered at intake, mid-treatment, and discharge to support diagnosis, treatment planning, and outcome measurement.
Trauma-specialty and refugee clinics. Used as a core diagnostic measure to distinguish PTSD from CPTSD and to identify the disturbances in self-organization (DSO) features that often require longer or stage-based treatment.
Veteran and military health. Validated for use with treatment-seeking veterans and frequently used alongside other measures to triage care.
Research. Standard outcome measure in trauma research, including epidemiologic studies of population-level PTSD and CPTSD prevalence.
Telehealth. Well-suited to remote completion before or between sessions, capturing symptom course without lengthening visit time.
18-item structure. The ITQ contains three blocks of items:
Respondents are asked to identify their most distressing traumatic experience, then rate how much each symptom has bothered them in the past month.
Scoring system. Each item is rated on a five-point Likert scale: 0 = Not at all, 1 = A little, 2 = Moderately, 3 = Quite a bit, 4 = Extremely. A symptom or impairment item is considered present at a rating of 2 or higher.
| Score / pattern | Interpretation |
|---|---|
| PTSD symptom score (0–24) | Sum of the six PTSD items; higher = greater severity |
| DSO symptom score (0–24) | Sum of the six DSO items; higher = greater severity |
| Total CPTSD symptom score (0–48) | Sum of all 12 symptom items |
| At least one symptom rated ≥2 in each of the three PTSD clusters plus functional impairment | Provisional PTSD |
| PTSD criteria met AND at least one symptom rated ≥2 in each of the three DSO clusters plus DSO functional impairment | Provisional CPTSD |
| PTSD criteria not met | No ICD-11 PTSD or CPTSD diagnosis indicated |
A provisional diagnosis is a screening result, not a clinical diagnosis. Clinician confirmation through structured interview and clinical formulation is required.
Digital delivery is well suited to a trauma-focused workflow. Zentake's platform supports the ITQ with auto-scoring and calculations so the PTSD, DSO, and CPTSD totals plus the provisional diagnostic classification land in the chart before the clinician opens the note. Flagging of high-risk responses lets you trigger an internal alert when symptom severity crosses a clinic-defined threshold or when a paired suicide-risk item is endorsed. Longitudinal measures tracking graphs change over time so therapy progress is visible across sessions. Conditional logic can branch to additional safety questions when functional impairment is elevated, and the ITQ is delivered ahead of session through pre-visit intake with HIPAA-compliant storage and EHR integration.
The ITQ supports documentation of medical-necessity for trauma-focused treatment, contributes to outcome reporting for value-based behavioral health contracts, and aligns with Joint Commission and CMS expectations to use validated screening and outcome measures in behavioral health care. Because it is public domain, no licensing audit risk exists.
Q1: How long does the ITQ take to complete?
Most patients complete the 18-item ITQ in five to seven minutes. Items are short, clearly worded, and follow a consistent rating scale, which keeps the assessment efficient enough for routine use in primary care, behavioral health intake, and integrated care settings. Digital delivery further reduces friction by removing manual scoring time.
Q2: Is the ITQ scientifically validated?
Yes. The ITQ was developed and published by Cloitre and colleagues in 2018 and has been validated in dozens of studies across multiple populations and languages. Independent confirmatory factor analyses support the two-factor PTSD/DSO model, and head-to-head studies show strong correlations with the PCL-5 and other established trauma measures.
Q3: Is the ITQ free to use in clinical practice?
Yes. The ITQ is in the public domain and free to use for clinical, training, and research purposes without licensing fees. Practices should retain a current copy of the official scoring guidance and cite the developers when publishing data, but no permission request is required.
Q4: How does the ITQ differ from the PCL-5?
The PCL-5 measures PTSD as defined in the DSM-5 (20 items, four-cluster model). The ITQ measures PTSD and complex PTSD as defined in the ICD-11 (12 symptom items in two factors plus functional impairment). Many trauma-focused programs use the ITQ when an ICD-11 framework or the PTSD/CPTSD distinction is clinically relevant.
Q5: Can the ITQ confirm a CPTSD diagnosis?
The ITQ provides a provisional CPTSD classification when PTSD criteria are met and the three DSO clusters each have at least one symptom rated 2 or higher plus functional impairment. A formal diagnosis still requires clinician interview, history of prolonged or repeated trauma, and clinical formulation. The ITQ supports diagnosis — it does not replace it.
Q6: Can Zentake export ITQ results?
Yes. Zentake exports completed ITQ data with timestamped responses, subscale and total scores, and the provisional diagnostic flag. Exports support PDF for the chart, CSV for analytics or research, and direct EHR routing through Zentake's integrations. All exports remain encrypted and HIPAA-compliant with full audit logging.
1. Cloitre M, Shevlin M, Brewin CR, Bisson JI, Roberts NP, Maercker A, Karatzias T, Hyland P. The International Trauma Questionnaire: development of a self-report measure of ICD-11 PTSD and complex PTSD. Acta Psychiatrica Scandinavica. 2018;138(6):536–546. onlinelibrary.wiley.com.
2. U.S. Department of Veterans Affairs, National Center for PTSD. International Trauma Questionnaire (ITQ). ptsd.va.gov.
3. Karatzias T, et al. The International Trauma Questionnaire measures reliable and clinically significant treatment-related change in PTSD and complex PTSD. European Journal of Psychotraumatology. 2021. pmc.ncbi.nlm.nih.gov.
Last updated: May 2026.
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