Sexual abuse in individuals with intellectual disability: a psychomotor perspective

Sexual abuse is a worldwide problem that has far-reaching consequences for health and psychosocial functioning. Research has demonstrated that individuals with intellectual disability (ID) are at greater risk of sexual abuse than individuals with (higher than) average IQ. To mitigate the consequences of sexual abuse, prevent re-victimization and improve quality of life, early detection and adequate assessment and treatment of sexual abuse are indispensable. Two requirements in particular stand out to achieve this. First, a clear policy and protocol to identify and handle sexual abuse and their effective implementation within a care facility is a prerequisite. This is crucial for care professionals, including body- and movement-oriented therapists, to know how to act if they suspect or detect sexual abuse. In addition, such a protocol should provide information about which assessment tools and treatments are recommended. Second, care professionals should have knowledge about the consequences of sexual abuse in individuals with ID. For body- and movement-oriented therapists, knowledge about the impact of sexual abuse on body experience is of specific value as this is the main focus of their treatment approach. However, hardly any studies are available on sexual abuse in individuals with ID, as a result of which the knowledge basis to fulfil these requirements is largely lacking. This thesis demonstrated that most care facilities for individuals with ID comply with the national legal requirements on sexual abuse, which demand the availability of a protocol on sexual and mandatory reporting to the Health and Youth Care Inspectorate (in Dutch ‘Inspectie Gezondheidszorg en Jeugd’, IGJ). However, the care facilities varied widely in the extent to which the protocols on sexual abuse are brought to the staff’s attention and used in practice. Furthermore, a review of the literature on the clinical characteristics of individuals with ID who have been sexually abused was provided. Higher levels of aggression, self-injury, inappropriate sexualized behaviour and posttraumatic stress, anxiety or depressive symptoms were among the most frequently mentioned. In addition, this thesis showed that adults with mild ID who were sexually abused, compared to individuals with mild ID who were not sexually abused, seemed to be more aware of their body signals, but less able to adequately attend to, tolerate, and interpret these signals. Lastly, an instrument for measuring the body experience in individuals with mild ID, known as the Body Experience Questionnaire for adults with mild ID or borderline intellectual functioning, was introduced.