Evaluating the ICD-11 PTSD and Complex PTSD Constructs: A Meta-Analytic Confirmatory Factor Analysis of the International Trauma Questionnaire

The International Trauma Questionnaire (ITQ) is a widely used diagnostic tool for post-traumatic stress disorder (PTSD) and complex PTSD (CPTSD). Although findings are mixed, investigations of the ITQ's internal structure have most often supported a six-factor first-order model and a two-factor second-order model. This study utilized meta-analytic factor analysis to investigate the ITQ's latent structure. A systematic search of PsycINFO, Web of Science, PubMed, MEDLINE, Cochrane, Scopus, CINAHL, and ProQuest Dissertations was conducted, with 57 studies (total N = 43,066) included in the final analysis. A two-stage meta-analytic structural equation modeling approach was implemented which pooled correlation matrices and performed confirmatory factor analyses. The two-factor second-order model demonstrated good fit, emphasizing its clinical relevance. However, a seven-factor correlated first-order model demonstrated superior fit, consistently outperforming other models across ITQ versions, symptom severity levels, English versus translated versions, and both PTSD and non-PTSD samples. This model indicates that CPTSD encompasses a broad range of symptoms and specifically that the distinction between affective hyperactivation and hypoactivation is important to progress the construct validity of CPTSD. Additionally, reliability analyses revealed limited internal consistency at the subscale level. These findings highlight the need for comprehensive assessments and refined item content to enhance CPTSD measurement.