Post-traumatic stress disorder (PTSD) is a mental health condition in which an individual develops psychological symptoms in response to an extremely distressing experience. The symptoms can vary and may include “flashbacks” or vivid memories of the trauma, anxiety, depression, psychotic symptoms, intense avoidance of the event, place, person, etc. that were associated with the trauma, and others.
Our sense at the Adult Down Syndrome Center is that the trauma is “in the eye of the beholder.” In other words, what one person may find traumatic, another might not. Horrific accidents, war, violence, etc. are easily understood and nearly universally perceived as traumas. However, we have noted that what some others would consider a non-traumatic event can be traumatic to one of our patients. In a sense, it does not really matter if someone else does not see the inciting event as traumatic; it is important if the person who is experiencing the symptoms has perceived it as traumatic.
We have long thought that people with Down syndrome (DS) are more likely to be susceptible to PTSD because of their tendency towards strong visual memories. Many people with DS seem to have photographic memories. Some even seem to have “videographic” memories. They seem to be able (or almost able) to replay a memory as if they are turning on a video. If the memory is a negative one, that ability to replay it would seem to be a factor in PTSD.
When we reviewed the number of individuals with certain mental health conditions in our health care system, we found that PTSD is less common in people with DS that those without DS. We think that the reason is that a significant problem in diagnosing PTSD in people with DS is that often the person is not able to inform others what the trauma is or was. Therefore, we diagnose the effect (such as anxiety, depression, decline in skills, etc.) but do not diagnose PTSD because we do not have a clear history of the trauma.
Treatment generally includes treatment of the associated mental health diagnosis, often anxiety and/or depression. We typically recommend one or more of the following:
A complete physical to rule out other health problems that may be causing or contributing to the symptoms.
Medications to reduce the intensity of the symptoms of PTSD or associated diagnoses.
Counseling from a sensitive and knowledgeable therapist. Different approaches to and types of counseling may be used by a therapist depending on the individual's needs, preferences, and skill level. Types of counseling include supportive counseling, family counseling, and/or supportive family counseling, among others. Approaches include insight-oriented, behavior-changing, social learning, and cognitive behavioral, again among others.
Therapies such as art therapy, equine or pet therapy, music therapy, occupational therapy, etc.
Desensitization. This is a gradual and incremental process to help an individual tolerate being around something that reminds them of the distressing experience. If a particular site is distressing, interventions at the site of stress may also be beneficial.
Relaxation techniques tailored to each individual's needs, skill level, and interests.
More information about mental health of people with Down syndrome can be found here.