A systematic literature review of factor analytic and mixture models of ICD-11 PTSD and CPTSD using the International Trauma Questionnaire

Enya Redican, Emma Nolan, Philip Hyland, Marylène Cloitre, Orla McBride, Thanos Karatzias, Jamie Murphy, Mark Shevlin

Research output: Contribution to journalReview articlepeer-review

55 Citations (Scopus)
12 Downloads (Pure)


The 11th version of the International Classification of Diseases (ICD-11; WHO, 2018) describes two distinct trauma related disorders, Posttraumatic Stress Disorder (PTSD) and Complex PTSD (CPTSD). This review aims to summarise and synthesize evidence from factor analytic and mixture modelling studies that have investigated the latent structure of the International Trauma Questionnaire. A systematic search of PsycInfo, Web of Science, Scopus and Pubmed databases was conducted to identify relevant articles. Thirty-three studies met the inclusion criteria for this systematic review. The latent structure of the ITQ was best represented by two models; a correlated six-factor model (Re-experiencing, Avoidance, Threat, Affect Dysregulation, Negative Self Concept, and Disturbed Relationships) and a two-factor second-order model (PTSD and Disturbances in Self-Organization). Mixture model studies consistently identified distinct classes representing those displaying PTSD and CPTSD symptoms. Numerous studies demonstrated support for the factorial and discriminant validity of PTSD and CPTSD when analysed in conjunction with other variables. Overall, support was found for the conceptual coherence of PTSD and CPTSD as empirically distinguishable disorders, as measured by the ITQ. The available evidence demonstrates that the ITQ is a valid measure of ICD-11 PTSD and CPTSD. Recommendations for future research are included.

Original languageEnglish
Article number102381
Pages (from-to)1-17
Number of pages17
JournalJournal of Anxiety Disorders
Issue number102381
Early online date1 Mar 2021
Publication statusPublished (in print/issue) - 30 Apr 2021

Bibliographical note

Funding Information:
This work was supported by the Department for the Economy PhD studentship. The Department for the Economy had no role in the study design, the collection, analysis and interpretation of data, in writing the report and in the decision to submit the article for publication.

Publisher Copyright:
© 2021 Elsevier Ltd

Copyright 2021 Elsevier B.V., All rights reserved.


  • factor structure
  • latent classes
  • systematic review
  • International Trauma Questionnaire
  • ICD-11
  • Factor structure
  • ICD-11 CPTSD
  • Systematic review
  • Latent classes
  • International Classification of Diseases
  • Humans
  • Self Concept
  • Surveys and Questionnaires
  • Stress Disorders, Post-Traumatic/diagnosis


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