Page 77 - Post-traumatic stress disorder in adults with mild intellectual disability: Screening, assessment, and brief intensive EMDR therapy

Brief intensive EMDR therapy for PTSD
Introduction
Individuals with mild intellectual disability or borderline intellectual
functioning (MID-BIF; IQ 50-85) may be at an increased risk of developing
post-traumatic stress disorder (PTSD) compared to the general population
(Mason-Roberts et al., 2018; Mevissen et al., 2020). This elevated risk can
be attributed to frequent exposure to traumatic events (McDonnell et al.,
2019; Nieuwenhuis et al., 2019) and difficulties in processing these events
owing to deficits in adaptive and cognitive functioning (Skelly, 2020). The
prevalence of PTSD in this group ranged from 10% to ≥40%, with higher
rates observed among individuals living in supported housing (Mevissen et
al., 2020; Versluis et al., 2025).
PTSD symptoms in individuals with MID-BIF are similar to those of
individuals without intellectual disabilities (Hoogstad et al., 2023; Mevissen
et al., 2020). Additionally, these symptoms overlap with behavioural
problems such as verbal or physical aggression (Kildahl & Helverschou,
2024; Rittmannsberger et al., 2020). Rittmannsberger et al. (2020) found
that the association between trauma exposure and challenging behaviour
in individuals with MID-BIF was mediated by the severity and frequency
of PTSD symptoms. Partly due to these behavioural problems, PTSD in
individuals with MID-BIF often remains undiagnosed (Kildahl et al., 2020)
and untreated (Keesler, 2020). Classifying people with PTSD requires
more than observing visible behaviour; it requires knowledge of what type
of events a person may have been exposed to, and how this is linked to
their current symptoms (American Psychiatric Association, 2022). Without
such a nuanced approach, individuals with MID-BIF may be directed
towards behaviour-based interventions. Such interventions may not treat
the underlying problems and when PTSD symptoms persist, restrictive
measures are sometimes used as a last resort (e.g. fixation and locked
doors) which may lead to more PTSD symptoms. Despite ongoing concerns
regarding the efficacy and quality of involuntary care for individuals with
intellectual disabilities (Heyvaert et al., 2014, 2015), these practices
remain prevalent (Bakkum et al., 2023; Fitton & Jones, 2020), especially
in individuals with severe behavioural problems (Hastings et al., 2013).
For example, Schippers et al. (2018a, 2018b) found that certain coercive
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