Allen was a young African American man working at a retail store. Although he enjoyed and valued his job, he struggled with the way he was treated by his boss. He was frequently demeaned, given menial tasks, and even required to track African American customers in the store to make sure they weren’t stealing. He began to suffer from symptoms of depression, generalized anxiety, low self-esteem, and feelings of humiliation. After filing a complaint, he was threatened by his boss and then fired. Allen’s symptoms worsened. He had intrusive thoughts, flashbacks, difficulty concentrating, irritability, and jumpiness – all hallmarks of posttraumatic stress disorder (PTSD). Allen later sued his employer for job-related discrimination, and five employees supported his allegations. Allen was found to be suffering from race-based trauma (from Carter & Forsyth, 2009).
Epidemiology of PTSD in Minorities
PTSD is a severe
and chronic condition that may occur in response to any traumatic event.
The National Survey of American Life (NSAL) found that African
Americans show a prevalence rate of 9.1% for PTSD versus 6.8% in
non-Hispanic Whites, indicating a notable mental health disparity (Himle
et al., 2009). Incresed rates of PTSD have been found in other groups
as well, including Hispanic Americans, Native Americans, Pacific
Islander Americans. and Southeast Asian refugees (Pole et al., 2008).
Furthermore, PTSD may be more disabling for minorities; for example,
African Americans with PTSD experience significantly more impairment at
work and carrying out everyday activities (Himle, et al. 2009).Racism and PTSD
One major factor in understanding PTSD in ethnoracial minorities is the impact of racism on emotional and psychological well-being. Racism continues to be a daily part of American culture, and racial barriers have an overwhelming impact on the oppressed. Much research has been conducted on the social, economic, and political effects of racism, but little research recognizes the psychological effects of racism on people of color (Carter, 2007).Chou, Asnaani, and Hofmann (2012) found that perceived racial discrimination was associated with increased mental disorders in African Americans, Hispanic Americans, and Asian Americans, suggesting that racism may in itself be a traumatic experience.PTSD in the DSM-IV
Currently, the DSM recognizes racism as trauma only when an individual meets DSM criteria for PTSD in relation to a discrete racist event, such as an assault. This is problematic given that many minorities experience cumulative experiences of racism as traumatic, with perhaps a minor event acting as “the last straw” in triggering trauma reactions (Carter, 2007). Thus, current conceptualizations of trauma as a discrete event may be limiting for diverse populations. Moreover, existing PTSD measures aimed at identifying an index trauma typically fail to include racism among listed choice response options, leaving such events to be reported as “other” or squeezed into an existing category that may not fully capture the nature of the trauma.This can be especially problematic as minorities may be reluctant to volunteer experiences of racism to White therapists, who comprise the majority of mental health clinicians. Clients may worry that the therapist will not understand, feel attacked, or express disbelief. Additionally, minority clients also may not link current PTSD symptoms to cumulative experiences of discrimination if queried about a single event.
Implications for Treatment
Bryant-Davis and Ocampo (2005) noted similar courses of psychopathology between rape victims and victims of racism. Both events are an assault on the personhood and integrity of the victim. Similar to rape victims, race-related trauma victims may respond with disbelief, shock, or dissociation, which can prevent them from responding to the incident in a healthy manner. The victim may then feel shame and self-blame because they were unable to respond or defend themselves, which may lead to low self-concept and self-destructive behaviors. In the same study, a parallel was drawn between race-related trauma victims and victims of domestic violence. Both survivors are made to feel shame over allowing themselves to be victimized. For instance, someone who may have experienced a racist incident may be told that if they are polite, work hard, and/or dress in a certain way, they will not encounter racism. When these rules are followed yet racism persists, powerlessness, hyper vigilance, and other symptoms associated with PTSD may develop or worsen (Bryant-Davis & Ocampo, 2005).
Changes in the DSM-5
Proposed changes to PTSD criteria in the DSM-5 have been made to improve diagnostic accuracy in light of current research (Friedman et al., 2011). The first section involving the experienced trauma has changed moderately, reflecting findings in clinical experience as well as empirical research. If a person has learned about a traumatic event involving a close friend or family member, or if a person is repeatedly exposed to details about trauma, they may now be eligible for a PTSD diagnosis. These changes were made to include those exposed in their occupational fields, such as police officers or emergency medical technicians. However, this could be applicable to those suffering from the cumulative effects of racism as well.The requirement of responding to the event with intense fear, helplessness, or horror has been removed. It was found that in many cases, such as soldiers trained in combat, emotional responses are only felt afterward, once removed from the traumatic setting.
The most notable change to the criterion is from a three to a four-factor model. The proposed factors are intrusion symptoms, persistent avoidance, alterations in cognition and mood, and hyperarousal/reactivity symptoms. Three new symptoms have been added – persistent distorted blame of self or others, persistent negative emotional state, and reckless or self-destructive behavior. All of these symptoms may be also seen in those victimized by race-based trauma.
I was just diagnosed with possible urban ptsd last week by my new jazz playing,calm talking, african American(colored)temporary doctor. My(the)symptoms that I described was more like the ones described on this page than the urban ptsd that he analized for me, which was more of fear of young minorities in the hood with guns and knives rat packing innocent blacks. while the whole time telling me to just forget about it(racial injustices etc...)-and go for self. Sound familiar. In other words, black on black classism. He's also ask me for names of medications that might help me relax and deal with my anxiety, like I should know!(which is how I ended up on your website)- End story is, the doctor says goodbye, walks me to the lobby and starts making those faces that you often see from judgemental conservatives etc... Ok I sensed this about him, but what made my old anger rise up(now called urban ptsd)was that he made these faces for the whole lobby area - from his older black buddy-to the younger female latina security officer(a Zimmerman?)-But this is the expected disrespect when you're poor. My anger builds,so for amerikkka, I hope that I get my medication choices correct- well back to my guesses? thanks for your time. beast of burden 1966-
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