Trauma and post‐traumatic stress disorder (PTSD) in a high secure forensic learning disability population: future directions for practice
| Pages | 49-56 |
| Published date | 27 September 2010 |
| Date | 27 September 2010 |
| DOI | https://doi.org/10.5042/amhid.2010.0544 |
| Author | Irene Brackenridge,Catrin Morrissey |
| Subject Matter | Education,Health & social care |
49
Advances in Mental Health and Intellectual Disabilities Volume 4 Issue 3 September 2010 © Pier Professional Ltd
PRACTICE
Introduction
The concept of post-traumatic stress disorder (P TSD)
was introd uced in the third edition of the Diagnostic and
Statistical Manual of Mental Disorders (DSM-III) i n 1980,
directly i nfluenced by the V ietnam conflict (196 4–1973).
The emotio nal difficulties expe rienced by some V ietnam
servicemen may have been a direct consequence of the
war experi ence itself, or th e result of second ary problems
associated with social re-inte gration in the aft ermath of war
(Walker, 1 981). Aspects of t he revised PTSD di agnostic
criteria i n the fourth editi on of the DSM c ontinue to attract
controversy and debate. While there is apparent adherence
to a pre -determined, prescript ive and restricted range of
life event s which are regard ed as traumatic s ingle stressors,
the inclus ion of the ‘not limited to’ stateme nt in relation to
Criterion A1 may cause confu sion about the au thenticity
of other PTSD-type stressors. PTSD describes a cluster
of physiol ogical and psycholog ical symptoms occurr ing in
response to direct involvement in, witnessing or exposure
to a sing le, often life-threat ening event (America n Psychiatric
Association, 1994). A valid diagnosis of PTSD depends on
all the symptoms relating to the same traumat ic incident
(Briere, 2 004).
In addition to PTSD, other unfavourable outcomes of
trauma exposure include eating disorders, substance misuse,
Irene Brackenridge
Registered Nurse in Learning Disabilities
Catrin Morrissey
Lead Psychologist
National Centre for High Secure Learning Disability Services, Rampton Hospital, Nottinghamshire Healthcare NHS Trust,
and Institute of Mental Health, Nottingham, UK
Abstract
Literature on trauma and post-traumatic stress disorder (PTSD) has neglected the needs of people with intellectual disability, particularly those
in forensic settings. The National Centre for High Secure Learning Disability Services at Rampton Hospital conducted a service evaluation
on aspects of trauma experience and post-trauma symptoms in the current population. File information and self-reports indicated that
most individuals had experienced a great deal of lifetime trauma, typically multiple types of abuse. A high rate of potentially trauma-related
symptoms was noted in files. However, file records of potentially traumatic events, including abuse, were often lacking in detail. There was
limited information about the events themselves, and there was no information to suggest that any trauma-specific assessments had been
used to measure trauma exposure or symptoms. PTSD as a diagnosis was rarely considered, and there was little consideration of trauma-
specific interventions. While some individuals said that their experiences had resulted in a lot of distress, others could not talk about the past
at all. This paper discusses the problem of assessing past trauma and response in a forensic intellectual disability population, and future
directions for practice in forensic services. The service under study plans to address the needs of patients who have experienced trauma and
abuse by conducting routine structured assessments, offering adapted evidence-based psychological interventions where appropriate, and
providing trauma-specific education for staff to promote a compassionate approach.
Key words
post-traumatic stress disorder; intellectual disability; learning disabilities; forensic
Trauma and post-traumatic stress disorder (PTSD)
in a high secure forensic learning disability population:
future directions for practice
10.5042/amhid.2010.0544
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