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Challenges in the Assessment of Trauma Among Individuals with Disabilities

Data from the field of disabilities suggests that individuals diagnosed with disabilities may be at higher risk for being exposed to and experiencing events that could precipitate the development of trauma symptoms when compared to their nondisabled counterparts (Strauser, Lustig & Uruk, 2007). On an average, individuals diagnosed with a disability have between 4 to 10 times more chances of becoming a victim from interpersonal violence than a person without a disability (Focht-New, Barol, Clements & Milliken, 2008). According to the Diagnostic and Statistical Manual of Mental Disorders (4th ed., text rev.; DSM-IV-TR; American Psychiatric Association, 1994), a traumatic event is defined as an occurrence in which both of the following were present: first, the person experienced, witnessed, or was confronted with an event or events that involved actual or threatened death or serious injury, and second, there was a threat to the physical integrity of self or others. McCarthy (2001) stated that it is well recognized that a traumatic event can cause psychological disorders in those who experience them. Because of the augmented probability that individuals diagnosed with disability may experience violence, it is recommended that mental health professionals be educated about the symptoms associated with trauma (Strauser, Lustig & Uruk, 2006).

Anxiety Disorders, Trauma, and Emotional Memory: According to the National Institute of Mental Health (2008), anxiety disorders are the leading forms of mental illness impacting the lives of more than 40 million Americans ages 18 years and older (18%). One of the anxiety disorders is post-traumatic stress disorder which can be found in more than 7.7 million American Adults. Sotgiu and Mormont (2008) argued that it is necessary to differentiate between traumatic events and emotional events. All traumatic events have an emotional component; however, not all emotional events may be classified as traumatic. Emotional events can be described as situations that are relevant to a person’s well-being and could be either positive or negative. Examples of negative emotional events are arguing with a close friend, learning that a family member is ill, being verbally threatened or failing an exam. Cases such as birth of a child, romantic kiss, receiving a present or getting a job are considered to be positive events.

Challenges in Assessment: Personally experienced events, either traumatic or emotional, are encoded in mental representations that are stored in long term memory. Consequently, they may be subject to reconstructive processes that can influence the retrieval of originally coded information (Sotgiu & Mormont, 2008). A presentation of a particular anxiety disorder, trauma in particular, may be different among those individuals who are diagnosed with severe developmental delay or those who does not have the communication skills necessary to describe their thoughts, feelings and mood (McCarthy, 2001). An additional challenge that mental health professionals are faced with is the accuracy and ability to utilize the DSM-IV when assessing individuals diagnosed with disabilities. One of the criticisms regarding the DSM-IV as an assessment tool is related to the ability of the tool to assist mental health professionals with determining an appropriate diagnosis. The categories in the DSM-IV are not mutually exclusive or exhaustive. This could lead mental health professional to assign an incorrect diagnosis which will lead to an inappropriate focus of treatment. Since most mental health conditions do not occur in isolation and in many cases mental health disorders co-occur, the assessment of trauma could be challenged.

Oren Shtayermman, PhD, MSW, is an Assistant Professor of Mental Health Counseling, is the Mental Health Counseling Program Coordinator and is a Research Associate at the New York Institute of Technology School of Health Professions, Behavioral and Life Sciences located in Old Westbury, New York.

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