Scales and questionnaires aligned with ICD-11: validated tools for assessing PTSD, CPTSD, grief, adjustment disorders, personality and gaming disorder

Scales as support for ICD-11 diagnostics – not a replacement

In ICD-11 many diagnoses are described in a more clinical, functional and dimensional way than in older classifications. For this reason, supporting tools are increasingly used in practice: self-report questionnaires, clinical interviews, severity scales and functioning assessment tools.^[1]

These are not, however, a diagnosis in themselves. A scale result may indicate that a given area requires closer assessment, but it does not replace clinical conversation, mental state examination, differential diagnosis or assessment of the patient's life context. Self-report scales may, for example, “pick up” a high level of anxiety in a person who genuinely has an anxiety disorder, but also in a person in an acute phase of trauma, with a somatic illness, after losing their job or with insomnia – each of these situations calls for a different clinical response.

The most valuable tools are those developed directly on the basis of ICD-11 or that have validation studies confirming their structure, reliability and validity. These include the International Trauma Questionnaire, International Adjustment Disorder Questionnaire, International Prolonged Grief Disorder Scale, Personality Inventory for ICD-11, Gaming Disorder Test and WHODAS 2.0.^[1]

Table: validated tools aligned with ICD-11

Below is a summary of key tools directly aligned with or validated on the basis of ICD-11.^[2–12]

Tools for PTSD and complex PTSD – ITQ and ITI

ITQ – International Trauma Questionnaire

International Trauma Questionnaire (ITQ) is one of the most important tools aligned with ICD-11. It is used to assess symptoms of PTSD and complex PTSD (CPTSD) according to the ICD-11 model. It measures the three core PTSD domains: re-experiencing, avoidance and sense of current threat, as well as the three disturbances in self-organisation typical of CPTSD: affect dysregulation, negative self-concept and disturbed relationships. The International Trauma Consortium describes the ITQ as the most widely used tool for measuring ICD-11 PTSD and CPTSD in clinical and population research.^[2]

The ITQ is particularly useful when it is necessary to distinguish classic PTSD from CPTSD. The result can indicate whether the PTSD core alone predominates, or whether there are additional, persistent difficulties in affect regulation, self-image and relationships.

ITI – International Trauma Interview

International Trauma Interview (ITI) is a clinical diagnostic interview for assessing ICD-11 PTSD and CPTSD, administered by a clinician or trained researcher. Unlike the ITQ (self-report), the ITI enables a more detailed assessment of symptoms, trauma context, differential diagnosis with other disorders and impact on functioning. Validation studies confirm its usefulness as a psychometrically sound clinical tool.^[3]

The ITQ and ITI complement each other well: the self-report questionnaire assists with screening and severity measurement, while the clinical interview enables a more precise diagnostic assessment.

Tools for adjustment disorder – IADQ and ADNM

IADQ – International Adjustment Disorder Questionnaire

International Adjustment Disorder Questionnaire (IADQ) is one of the most important tools developed directly for ICD-11. It is used to assess adjustment disorder (6F43), whose core consists of: exposure to a stressor, preoccupation with the stressor or its consequences, difficulty adapting, a temporal connection between symptoms and the stressor, and functional impairment.^[4]

The IADQ is particularly useful when differentiating adjustment disorder from depression, anxiety and prolonged grief. The questionnaire result must always be combined with a clinical interview, assessment of duration, the dynamics of symptoms and the full picture of other disorders.

ADNM – Adjustment Disorder New Module

Adjustment Disorder New Module (ADNM) is an earlier and still widely used tool for assessing adjustment disorder symptoms. It is more comprehensive than the IADQ and well documented in the research literature.^[5]

Tools for assessing prolonged grief – IPGDS, TGI-SR+, TGI-CA

IPGDS – International Prolonged Grief Disorder Scale

International Prolonged Grief Disorder Scale (IPGDS) is one of the most important tools for assessing prolonged grief (6B42) according to ICD-11. The scale covers the core symptoms of the disorder, emotional pain, functional impairment and an assessment of whether the reaction goes beyond cultural norms.^[6]

TGI-SR+ – Traumatic Grief Inventory–Self Report Plus

Traumatic Grief Inventory–Self Report Plus (TGI-SR+) is particularly useful when a researcher or clinician wishes to assess prolonged grief symptoms according to both ICD-11 and DSM-5-TR. If the goal is solely ICD-11, the natural choice is the IPGDS. If comparison of both systems is needed – TGI-SR+.^[7]

TGI-CA – Traumatic Grief Inventory–Clinician Administered

Traumatic Grief Inventory–Clinician Administered (TGI-CA) is a clinical interview for assessing the severity of prolonged grief according to ICD-11 and DSM-5-TR. It is particularly important because a self-report scale may indicate high symptom severity, while a clinical interview is essential to distinguish prolonged grief from depression, PTSD and adjustment disorder.^[8]

Tools for measuring personality disorder severity in ICD-11 – PiCD, PDS-ICD-11, SASPD

In the ICD-11 model, personality disorder is described on two levels: severity (mild / moderate / severe) and trait domains (negative affectivity, detachment, dissociality, disinhibition, anankastia). PDS-ICD-11 measures severity, PiCD measures the domains. Both levels are needed for a complete assessment.

PiCD – Personality Inventory for ICD-11

Personality Inventory for ICD-11 (PiCD) is used to assess five maladaptive personality trait domains: negative affectivity, detachment, dissociality, disinhibition and anankastia. It does not measure the severity of the disorder, only the trait style. It is particularly useful after it has been established that a personality disorder or personality difficulty is actually present. In Poland, PiCD has been adapted and validated – Cieciuch, Strus and Łakuta described the Polish validation as a tool for measuring pathological personality traits in the dimensional ICD-11 model.^[9]

PDS-ICD-11 – Personality Disorder Severity ICD-11 Scale

PDS-ICD-11 measures personality dysfunction across domains of self-functioning, interpersonal functioning, emotions, cognition, behaviour, psychosocial functioning and risk. There is also a clinician-rated version (PDS-ICD-11 Clinician-Rating Form).^[10]

SASPD – Standardized Assessment of Severity of Personality Disorder

SASPD is a brief (9-item) tool for quick screening of overall severity of personality disorder in line with the ICD-11 logic. It does not describe trait domains as specifically as PiCD and should not be used as the sole tool for a diagnostic decision. It is useful as a starting point for further clinical assessment or in screening research.^[11]

Tools for gaming disorder – GDT, GADIS-A, GADIT

GDT – Gaming Disorder Test

Gaming Disorder Test (GDT) is the shortest (4 items) and most direct tool for assessing gaming disorder in line with ICD-11. The four items correspond to the main ICD-11 criteria: loss of control, increasing priority, continuation despite consequences and functional impairment. In Poland a preliminary validation of the Polish version of the GDT exists. A high GDT score does not automatically mean a diagnosis – it is necessary to assess whether gaming causes significant functional impairment and whether it is not secondary to depression, ADHD or other problems.^[12]

GADIS-A – Gaming Disorder Scale for Adolescents

Gaming Disorder Scale for Adolescents (GADIS-A) is a tool for assessing gaming disorder designed for adolescents. It is more comprehensive than the GDT and specific to this age group. Studies confirm its good psychometric properties. For adolescents, diagnosis requires particular care and cannot be based solely on parent–child conflict over gaming time.

GADIT – Gaming Disorder Identification Test

Gaming Disorder Identification Test (GADIT) is a newer (8-item) tool based on the latest definition of gaming disorder. It can serve as an alternative to the GDT with a slightly richer item structure, but less visibility in the literature.

WHODAS 2.0 – functioning assessment independent of diagnosis

WHO Disability Assessment Schedule 2.0 (WHODAS 2.0) does not diagnose a specific mental disorder, but is an important tool in the ICD-11 context because it assesses functioning. Many ICD-11 diagnoses require not only the presence of symptoms, but also an assessment of distress and functional impairment – a criterion that symptom scales often omit.^[13]

WHODAS 2.0 can help describe how severely a problem affects daily life regardless of the diagnosis – whether it concerns depression, PTSD, gaming disorder, personality disorder or another condition. It is available in three versions: 36-item (full), 12-item (short) and a proxy version (for a carer). It can be used as a self-report questionnaire or as an interview.

Other clinically useful tools

Not every popular psychological tool is officially linked to ICD-11. Many useful tools measure symptoms consistent with the clinical description, but were not developed directly on the basis of this classification.

• PHQ-9 and GAD-7 – screening tools for depression and generalised anxiety disorder, developed on the basis of DSM. Widely used in practice and clinically useful.
• ASRS (Adult ADHD Self-Report Scale) and DIVA-5 – tools for screening and interviewing about ADHD, developed on the basis of DSM.
• AQ and RAADS-R – adult screening questionnaires for autism spectrum conditions.
• ADOS-2 and ADI-R – clinical gold standards requiring specialist training, based mainly on DSM-IV/5.
• PCL-5 – PTSD scale based on DSM-5.

Most common errors when using questionnaires in diagnosis

Ignoring the functional impairment criterion. Many ICD-11 disorders require that symptoms lead to significant functional impairment. A symptom scale does not measure this – that is the purpose of, for example, WHODAS 2.0.

Absence of differential diagnosis. The same level of anxiety symptoms may correspond to an anxiety disorder, PTSD, adjustment disorder, ASD, ADHD or a somatic condition. A questionnaire does not carry out differential diagnosis – the clinician does.

Using unvalidated online tests as diagnostic tools. A test's popularity online has no bearing on its psychometric validation. An online test result is never a diagnosis and should not be cited as confirmation of a diagnosis.

Summary

The best scales and questionnaires are tools developed or validated in scientific research directly on the basis of ICD-11 criteria. Their role is to bring order to clinical assessment: to identify areas requiring further interview, to measure symptom severity, to monitor change and to support communication between researchers and practitioners.

They do not, however, replace diagnosis. In ICD-11, a diagnosis requires understanding the symptoms, duration, context, functioning, differential diagnosis and whether the clinical picture genuinely meets the requirements of the given category. This assessment is carried out solely by a qualified clinician. The content of this article is educational.

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