Abstract
Defining profound intellectual disability remains a major clinical and conceptual challenge. Traditional approaches have sought criteria such as an estimated IQ below 20 or developmental-age equivalence under 24 or 36 months. However, these criteria are of limited utility when cognitive impairment is combined with severe motor, sensory, and health-related disabilities. In Francophone practice, the term polyhandicap describes individuals with a profound intellectual impairment and a severe motor disorder caused by the same cerebral dysfunction, resulting in extreme restrictions of autonomy, perception, expression, and relationships. In anglophone literature a parallel concept has emerged Profound Intellectual and Multiple Disabilities (PIMD). This editorial revisit the notion of polyhandicap/PIMD, highlights its clinical, familial, ethical and psychiatric implications, and argues for a multidisciplinary, human-centered approach. Recognizing the interdependence of impairments rather than their simple sum, the concept invites us to rethink autonomy, communication, relational capacity and dignity in populations often rendered invisible by conventional disability models. For psychiatry, polyhandicap prompts reflection on how we perceive personhood when speech is absent, autonomy minimal and cognition severely limited and how relational presence becomes therapeutic. By embracing this perspective, clinicians and researchers affirm that value and connection persist even in the most complex disabilities.
Keywords
Polyhandicap, Profound intellectual and multiple disabilities (PIMD), Ethics, Communication, Psychiatry