1. Annemarie van den Brink Erica Aldenkamp
What happens? When the regular protocol is too difficult for the complex PTSD/ ID patient?
Annemarie van den Brink
Erica Aldenkamp

2. Programme Casus ID/ BIF Complex PTSD ID/BIF and PTSD Diagnosis
Treatment

3. I. Alice

4. Programme Casus ID/ BIF Complex PTSD ID/BIF and PTSD Diagnosis
Treatment

5. II. ID/BIF

6. Dutch figures IQ < 85 = 15 % of the Dutch population
70< IQ > 85 (BIF) = 13,6 % of the Dutch population
IQ < 70 ( Mild / Moderate / Severe ID) = 1,4 %
In The Netherlands the BIF patients are classified as Mild ID.
Amount of Dutch BIF patients in mental health care increases.

7. Intellectual Disability
Intellectual functioning
Level of social development
Level of emotional development
Adaptive skills
Context

8. BIF people: increased vulnerability for developing mental health problems (3-4 times as much)
In The Netherlands: ± 20% of the patients in mental health care function at IQ level < 85.

9. More vulnerable for getting PTSD
Biological vulnerability
Genetic liability, problems in information processing
Social problems
Vulnerable for getting traumatised, living in a multi problem context, socioeconomic
Psychological problems
Low self esteem, coping problems
Developmental problems
Problems in attachment, unstable caretaking,

10. Programme Casus ID/ BIF Complex PTSD ID/BIF and PTSD Diagnosis
Treatment

11. III. Complex -PTSD
Neither a classification in DSM nor ICD

12. Complex PTSD consequences of exposure to Multiple traumatic events
PTSD symptoms +
Damage in self Emotion- regulation problem Trouble in social interaction Dissociation

13. Mild PTSD Severe PTSD damage of self interpersonal Re-experiencing
Hyperarousal
Avoiding
emotion regulation
dissociation

14. Programme Casus ID/ BIF Complex PTSD ID/BIF and PTSD Diagnosis
Treatment

15. IV. ID/BIF and Complex PTSD

16. Mild PTSD Severe PTSD Intellectual Disability/ BIF damage of self
interpersonal
Re-experiencing
Hyperarousal
Mild PTSD
Severe PTSD
Avoiding
emotion regulation
dissociation
Intellectual Disability/ BIF

17. Programme
Casus
ID/ BIF
Complex PTSD
ID and PTSD
Diagnosis
Treatment

18. V. Diagnostic challenges
Expressing oneself
Behaviour problems <-> PTSD symptoms
Knowledge-gaps in referrals
Symptoms might look differently
Lack of diagnostic & treatment guidelines
Lack of diagnostic instruments (ADIS LVB)

19. How to diagnose Complex PTSD in BIF/ID patients
Multidimensional/ multidisciplinary
DMID additional to ICD/ DSM
Trauma assessment

20. 1. Multi dimensional diagnosis Psychiatric symptoms History Somatic
social
psychiatric
history
Psychiatric symptoms
History
Somatic
Cognitive functioning
Emotional functioning
Social functioning
Adaptive skills
Context
Personality traits

22. Diagnostics Complex PTSD /ID
Multidimensional/ multidisciplinary
DM-ID additional to ICD/ DSM
Trauma assessment

23. 2. DM-ID <-> PTSD more disintegration, dissociation
aggressive behaviour can mask intense fear
oppositional behaviour or noncompliance as manifestation of avoiding
hyper arousal may be labelled as ADHD
sometimes symptoms are less specified, like unspecific nightmares

24. Complex PTSD isn’t in DM-ID
Adaptations should be made:
Self
Interpersonal problems
Emotion Regulation
Dissociation

25. Diagnostics Complex PTSD /ID
Multidimensional/ multidisciplinary
DM-ID additional to ICD/ DSM
Trauma assessment

26. 3. Trauma inventory

27. Programme Casus ID/ BIF Complex PTSD ID and PTSD Diagnosis
Treatment / Therapy

28. VI. Tailored - Treatment
Use regular guidelines with adaptation when necessary

29. Challenges Treatment/ ID
Attitude
More time needed
Smaller steps
Collaboration with next of kin / proffesional support workers
Etc.

30. Regular Treatment protocol Complex PTSD
Discourse

31. Stabilizing Processing Re-socialization
Time
Processing
Re-socialization

32. Time for remodeling

33. Stabilizing EMDR Re-socialization
Time
EMDR
Re-socialization

34. Stabilization EMDR Re-socialization
Time

35. Why Stabilizing EMDR in CPTSD/BIF?
PTSD symptoms are there
Stable functioning is unattainable for some patients
Training regulation skills meets with lack of basic coping skills
Learning by experience suits patients with ID/BIF
Learning regulation skills leads to empowerment
   

36. Stabilizing
What are stabilizing techniques and steps? Some are being provided by the therapist, some by the patient, some by the context, the support group.

37. Stabilizing EMDR skills used by the therapist
Use regular protocol
Clustering traumatic memories
Safe Place
Vary strength of BLS
RDI CW
Adjusting width of associations – level instability
Short sets
Grounding
Provide stabilizing skills
Involve support system

38. Adjust width of associations

39. Stabilizing skills used by the patient
Recognition of triggers/ Orientation exercise/Safe Place/Being in control/Recognition of emotions/Emotion regulation skills/Use the crisis alert plan/Dealing with shame and guilt / Learning to trust again

40. Stabilizing skills used by support group
Reliable other
Explanation, education
Awareness of triggers
Orientation exercise
Use of crisis alert plan
Support & re-socialization

42. Erica Aldenkamp Annemarie van den Brink info@poli-plus. nl www
Erica Aldenkamp Annemarie van den Brink