Page 17 - Post-traumatic stress disorder in adults with mild intellectual disability: Screening, assessment, and brief intensive EMDR therapy

General introduction
their lifetime. While most recover naturally from its psychological impact,
an estimated 11% develop PTSD at some point in their lives, with a current
prevalence of approximately 1.3% (Hoeboer et al., 2025). Whether an
individual develops PTSD following a potentially traumatic event depends
on various factors, including genetic predisposition, type and number of
traumatic events, and protective factors such as social context (Aftyka
et al., 2017; Brewin et al., 2000; Iversen et al., 2008; Lindsay et al., 2020).
Additionally, a low IQ is associated with increased vulnerability (Ozer et al.,
2003).
Undetected and untreated PTSD is associated with a wide range of adverse
outcomes, including sleep disturbances, substance abuse, delinquent
behaviour, elevated suicide risk, and increased healthcare costs due to its
long-term impact (Benedict et al., 2020; Davis et al., 2022; Gibson et al.,
2020; Marsiglio et al., 2014; Pietrzak et al., 2011). Despite these serious
consequences, there are often long delays between the onset of PTSD
symptoms and the initiation of appropriate treatment (Goldstein et al.,
2016; Pietrzak et al., 2012). To support timely recognition and improve care
pathways for individuals with PTSD, multidisciplinary treatment guidelines
for PTSD (Federatie Medisch Specialisten, 2025) in the Netherlands offers
evidence-based recommendations for the assessment and treatment
of PTSD in adults. The guidelines include references to individuals with
intellectual disabilities but make no mention of individuals with BIF, and
the recommendations for individuals with ID are predominantly based
on research conducted in the general population. While the guidelines
acknowledge the importance of considering intellectual disabilities when
diagnosing and treating PTSD, they do not specify how to select or adapt
appropriate diagnostic tools or treatment approaches for this group.
Furthermore, the guidelines assume that a suspected PTSD diagnosis is
present, despite PTSD often being particularly challenging to recognise in
individuals with MID-BIF (Mevissen et al., 2020; Nieuwenhuis et al., 2019;
see also the section: PTSD not recognised in individuals with MID-BIF).
Consequently, the characteristics and needs of people with MID-BIF may
not be fully addressed in these guidelines.
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