Page 14 - Post-traumatic stress disorder in adults with mild intellectual disability: Screening, assessment, and brief intensive EMDR therapy

Chapter 1
therapist every Tuesday morning. However, she found EMDR
therapy too overwhelming. She suddenly bursts into tears when
she has to talk about her memories of sexual abuse during a
session, and it feels as if she is being re-abused. In the days
following therapy, she often thought about the sexual abuse and
became more aggressive. A few days after the session, Hilda
decided to discontinue therapy. “I’d rather forget about it than
have to think about everything again”, she told her caregivers.
Her PTSD symptoms have persisted, and problems in her daily
life, such as poor sleep, withdrawal, and behavioural problems,
continue.
There are many more individuals like Hilda, with a similar life history and
similar psychological and behavioural problems. Although emerging studies
suggest that post-traumatic stress disorder (PTSD) may be relatively
common in adults with mild intellectual disability or borderline intellectual
functioning (MID-BIF), it still often goes unrecognised in these individuals
(Mevissen et al., 2020a; Nieuwenhuis et al., 2019), partly due to the lack
of suitable diagnostic instruments until recently (Hoogstad et al., 2025).
Once diagnosed, it is important that individuals with MID-BIF receive PTSD
treatment, as untreated PTSD can cause serious problems (e.g. Benedict
et al., 2020; Davis et al., 2022; Gibson et al., 2020). Although the number of
studies is growing, especially on EMDR therapy in individuals with MID-BIF
(e.g. Byrne et al., 2020; Penninx et al., 2021; Verhagen et al., 2023), there
is still limited evidence regarding the effectiveness of EMDR therapy for
adults with MID-BIF, especially for those with severe behavioural problems.
Research in individuals without MID-BIF shows that intensive trauma-
focused treatment is particularly effective, as it leads to a relatively fast
reduction in PTSD symptoms and shows low dropout rates (e.g. Niles et al.,
2018). To date, no studies have explored the effectiveness of brief intensive
EMDR treatment in adults with MID-BIF and severe behavioural problems,
or how these individuals experience such an intensive format of trauma
treatment. Addressing these knowledge gaps is essential to improving
PTSD recognition and to developing more effective and tailored treatment
approaches for these individuals.
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