Many ethnic and racial groups experience higher rates of posttraumatic stress disorder (PTSD) as compared to White Americans. One explanation for this is the experience of racism, which can itself be traumatic.
When traumatization is due to experiences of racism it is sometimes called racial trauma. Racial trauma can result from major experiences of racism such as workplace discrimination or hate crimes, or it can be the result of an accumulation of many small occurrences, such as everyday discrimination and microaggressions.
An article by Williams and colleagues, published in Practice Innovationsopens in new window, aims to provide a context for understanding how racism can lead to a diagnosis of PTSD according to the 5th edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5).
Racial trauma may merit a DSM-5 diagnosis of PTSD when there is an identifiable index trauma (Criterion A), re-experiencing of the trauma (Criterion B), avoidance of trauma reminders (Criterion C), negative mood/cognitions (Criterion D), and hyperarousal (Criterion E). However, all symptoms of PTSD may be present due to racial trauma, even if a Criterion A event cannot be identified.
The DSM-5 limits what is defined as a traumatic experience to direct exposure to physical and sexual violence up to and including actual death, repeated exposure to traumatic information in a work setting, and indirect exposure by way of receiving news of a traumatic event involving a close friend or loved one.
This may preclude a PTSD diagnosis, even if all symptoms are present. However, if the nature of the trauma does not meet DSM-5 criteria, PTSD may still be diagnosed based the ICD-10 criteria (International Classification of Diseases), because it does not explicitly restrict the types of traumas that may result in a diagnosis of PTSD.
Sometimes bona fide Criterion A events are missed by mental health service providers because they are unaware of the impact of discrimination, fail to recognize experiences of racism as traumatic, or fail to inquire about experiences of racism at all. For example, being bullied at school for being "different," racial profiling by police, and workplace racial harassment can all be DSM-5 Criterion A events, but these are rarely included in conventional checklists and batteries for trauma.
Further, assessing discriminatory distress in patients of color during a clinical encounter may be uncomfortable for therapists who have not had practice discussing racial issues. Many White people are socialized to demonstrate non-racist values by not talking about race. However, this approach leaves such clinicians ill-equipped to have conversations about race with their clients of color, and so it is even less likely they will be able engage in productive conversations surrounding traumatic experiences of racism.
One solution to this problem is the UConn Racial/Ethnic Stress & Trauma Survey (UnRESTS), a clinician administered semi-structured interview designed for clients who are part of stigmatized racial and ethnic groups.
In terms of the structure of the UnRESTS, it collects information about a client's racial and ethnic group and ethnic identity, and then guides the clinician in asking about experiences surrounding explicit and obvious racism, racism experienced by loved ones, being vicariously impacted by racist experiences that were learned about, and experiences with subtle forms of racism or microaggressions.
The end of the UnRESTS is a checklist designed to determine if symptoms are present in each of the critical areas delineated by the DSM-5 as indicative of PTSD. The UnRESTS is also available in Spanish.
The UnRESTS is useful to clinicians as an aid to uncovering racial trauma, developing a culturally-informed case conceptualization, and including experiences of racism into the diagnosis of PTSD when warranted.
Three case examples are provided in the article that describe the impact of racial stress and trauma and the role of the UnRESTS in understanding their experiences.
Citation
- Williams, M. T., Metzger, I. W., Leins, C., & DeLapp, C. (2018). Assessing racial trauma within a DSM–5 framework: The UConn Racial/Ethnic Stress & Trauma Survey. Practice Innovations, 3(4), 242–260. https://dx.doi.org/10.1037/pri0000076
Note: This article is in the Clinical Psychology topic area. View more articles in the Clinical Psychology topic area.