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What is Dual Diagnosis?
People with intellectual disabilities are at increased risk of health problems in general, in
particular in the area of mental health.
Dual Diagnosis is a complex concept that is interpreted in different ways around the world; in
general, it always relates to a combination of two types of disability, with the disabilities
included under this heading varying from place to place. In Israel, Dual Diagnosis relates to a
combination of intellectual developmental disability (IDD) and psychiatric disorder. When
intellectual disabilities and severe psychiatric disorders appear together, this has a critical and
negative impact on the people themselves, their families, therapists, friends, and service
providers.
The disorder may be manifested in a wide range of difficulties with adaptive functioning, the
most noticeable of them being: aggressive behavior, verbal and physical violence, withdrawal as
a result of depression, eating disorders – mainly not eating, severe difficulty with basic everyday
functioning, and poor reality testing.
Psychiatric and mental disorders are more common among people with intellectual disabilities
than in the general population (Schalock R.L., Buntinkx W., Brothwick-Duffy S., Luckasson R.,
Snell M., Tasse M.J., Wehmeyer M. 2007).
Dykens (2000) presents a number of studies that have found that relative to their peers,
children and adolescents with intellectual deficiencies are at higher risk of psychopathology.
These children have a broad spectrum of problems, including psychiatric problems (such as
psychosis or depression), faulty behavior (such as attention disorder or hyperactivity), adaptive
difficulties (such as anxiety or impulsiveness), and in addition, symptoms such as self-harm.
Because of the paucity of research into the subject, the scale of the phenomenon is not known
for certain; Werner S., Stawski M., Polakiewicz Y. & Levav I. (2013) found that people with IDD
have double the risk of psychiatric illness compared with the regular population, and Bernard &
Turk (2009) found that around one third of children and adolescents with slight intellectual
disability or reduced cognitive ability also suffer from mental health problems.
The most common explanation for mental disorders among people with intellectual disabilities
is based on two types of factor – those relating to the brain damage of people with IDD, and
those relating to the range of emotional implications of being a person with IDD (Day & Dosen,
2002).
1. The organic brain damage related to IDD indicates a damaged neurological infrastructure.
This damage can be the basis for mental disorders.
2. IDD is often accompanied by motor and sensor disabilities, and communication problems.
These problems can lead to psychiatric disorder.
3. The beginning of life of a person with IDD is undoubtedly accompanied by a family crisis
that relates to coping with the diagnosis of a child with disabilities. In light of the
importance of the first years of life in a person’s emotional development, there is no doubt
that this family crisis can have significant implications for the person’s mental structure.