Page 19 - Post-traumatic stress disorder in adults with mild intellectual disability: Screening, assessment, and brief intensive EMDR therapy

General introduction
C) can be perceived as a consequence of limited adaptive skills, negative
alterations in cognition and mood (PTSD cluster D) can be incorrectly seen
as symptoms of an anxiety disorder or a mood disorder, and alterations
in arousal and reactivity (PTSD cluster E) may be mistaken for symptoms
of attention-deficit/hyperactivity disorder (ADHD) or to reflect a mismatch
between an individual’s social and emotional functioning and the social
context in which they live. As a result, PTSD symptoms may be inaccurately
attributed to symptoms of other mental health condition or an ID.
A second explanation for the under-recognition of PTSD in individuals
with MID-BIF is the overlap between behavioural problems and PTSD
symptoms, as described in Criterion E, which includes “Irritable behaviour
or angry outbursts (with little or no provocation), typically expressed as
verbal or physical aggression towards people or objects” and “Reckless
or self-destructive behaviour”. However, research suggests that this
relationship is more complex than symptom overlap alone. For example,
Rittmannsberger et al. (2020) found in a cross-sectional study that trauma
exposure was indirectly associated with behavioural problems through
PTSD symptoms. Because such behavioural problems are often highly
visible and disruptive in care settings, professionals may focus primarily on
managing these behaviours, thereby overlooking the possibility that these
are trauma-related (McNally et al., 2021). This mechanism differs from
diagnostic overshadowing in the sense that it does not involve attributing
PTSD symptoms to a specific diagnosis or ID but rather overlooking PTSD
as an underlying cause of the behavioural problems. These findings show
that trauma-related symptoms can be hidden by externalising behaviour,
making it harder to recognise PTSD in individuals with MID-BIF.
Finally, professional caregivers have limited knowledge of and awareness
of the trauma histories of individuals with MID-BIF. While a PTSD diagnosis
requires an understanding of traumatic events and their relationship with
current symptoms (APA, 2022), professional caregivers often lack insight
into their clients’ life histories. In many cases, traumatic events are not
documented in client files, and caregivers may not enquire about them
either. Professional caregivers are frequently unaware of the traumatic
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