Post-traumatic stress disorder in people with learning disability

It is well recognised that traumatic events can cause psychological disorders in those who experience them. The most common disorders suffered are depression and substance misuse; others include acute stress reactions, anxiety states and personality changes. One disorder following trauma that has received considerable attention over the past 20 years is posttraumatic stress disorder (PTSD). PTSD occurs in 20–30% of people exposed to traumatic events and the prevalence in the general population is 1% (Helzer et al, 1987), with life-time prevalence of 9.2%. PTSD was introduced as a separate diagnosis in DSM–III. The defining criteria for PTSD in DSM–IV (American Psychiatric Association, 1994) is the experiencing of a traumatic stressor as opposed to an ordinarily unpleasant stressor, which is a threat to life or severe injury to self or others. In ICD–10 (World Health Organization, 1992) there is the broad category of neurotic, stress-related and somatoform disorders (F40 to F48). Within this category PTSD is listed with acute stress reaction and adjustment disorder. Recently, diagnostic criteria for learning disability have been developed, but with no change to those currently used within ICD–10 and DSM–IV for PTSD (Royal College of Psychiatrists, 2001). There is very limited literature on the subject of PTSD in people with learning disability. This begs the question of why PTSDs occurring in people with learning disability have been understudied to date. In part this is because PTSD was recognised as a separate concept only in the past 20 years. It is only in this time-scale that there has been a full acknowledgement that people with learning disability suffer from serious mental illness. It was as recently as 1983 that the seminal paper by Sovner & Hurley (1983), entitled “Do the mentally retarded suffer from affective disorders?”, asked such a fundamental question about mental health needs of those with learning disability. Disorders that are more recently described in the general population will take time, therefore, to be delineated and explained in those with learning disability. Also, it may be that accepting that people with learning disability do suffer trauma has been a difficult concept to comprehend. Certainly it is only in the past decade that universal experiences such as bereavement have come to be recognised and studied in those with learning disability (Hollins & Esterhuyzen, 1997). This article outlines the theoretical understanding of PTSD, which may be relevant to the field of learning disability, and discusses the nature of these disorders within this group. It then considers clinical assessment and treatment, finally commenting on the need for further research of these disorders.