It Is Time to Formally Recognize Racial Trauma

By Annika Olson, MA, MPP

For those of us in the behavioral health field, DSM is a familiar acronym. It stands for the Diagnostic and Statistical Manual of Mental Disorders, a handbook long used by health care professionals as a detailed guidebook of standards for rendering official diagnoses.

The manual has been updated seven times since its first publication in 1952 when the first DSM-I classified 106 disorders. The most recent edition, published in 2013, includes 365 afflictions. Yet, one well-documented form of emotional injury has not been included: racial trauma. Four hundred years after the first slave ship arrived in Virginia from Africa, 155 years after Emancipation, and 65 years after Emmett Till’s murder, it’s time for that to change.

Currently, racial trauma—the mental injury caused by encounters with racial bias, discrimination, and racism—is not acknowledged in the DSM-5. Yet, it’s a phenomenon that has been extensively researched and painstakingly documented and is widely regarded by both mental and physical health practitioners as a serious public health issue.

We know that racism causes physical and emotional trauma, and that members of racial and ethnic minority groups suffer the most deleterious effects of discrimination. Black Americans report poorer mental health after experiencing or witnessing police violence, and, in the past year alone, anxiety and depression have more than tripled in the Black community—jumping from 8% in January 2019 to 35% in June of 2020. Studies have shown that Black adolescents average more than five racial discrimination experiences per day, both online and offline, greatly contributing to depressive symptoms. Depression can precede suicide; the rate of suicide among Black youth has been increasing faster over the past decade than among any other racial/ethnic group. Perhaps most disturbingly, Black elementary school–aged children—youngsters between the ages of 5 and 12—have begun taking their own lives at twice the rate of same-aged whites. In 2020, as racism and police brutality have intensified, suicide in the Black community has become what some officials refer to as another deadly crisis.

Racism has also negatively affected the mental health of Asian Americans. Pew recently reported that, since the onset of the COVID-19 pandemic, 4 in 10 Asian adults say that people have acted uncomfortable around them because of their race or ethnicity, and they have been subject to racist slurs and jokes. There have been nearly 1,500 reported incidents of anti-Asian racism in the form of physical and verbal attacks, and one-half of these took place at private businesses.

Other vulnerable groups, such as Native and Indigenous Americans, have suffered systemic oppression since the inception of our nation, and adults in this community have long endured the highest rate of mental illnesses of any race group. Late last year researchers found that nearly 40% of Native Americans have experienced violence or have been harassed, and more than 1 in 5 Native Americans has experienced discrimination even in clinical encounters. For the Latinx community, verbal attacks soared in 2018, with almost 40% of Hispanics reporting being verbally attacked for speaking Spanish, being called a racial slur, or being treated unfairly by others. Hate crimes aimed at Latinx individuals increased 9% from 2018 to 2019, and roughly one-half of all hate-motivated killings were attributed to the August 2019 mass shooting in an El Paso, TX, Walmart, where the gunman was motivated by anti-Latinx bias.

So, given all of this racial trauma—both historic and recent—and the extensive psychological research on the subject, it does not make sense that there is still no consideration for this within the DSM.

It’s time to change that.

Coalitions of researchers have called for the DSM to update its information regarding racism and trauma, and it is important now, more than ever, that racial trauma is included within the PTSD framework.

At the moment, a person must meet several criteria to be diagnosed with PTSD. The first is the traumatic event (Criterion A), which includes exposure to actual/threatened death, serious injury, or sexual violence. The DSM recognizes racism as a form of trauma only when an individual meets this criterion in relation to a discrete racist and violent event (e.g., an assault during a hate crime). This is problematic given that many minorities experience dozens of acts of racism, not just a single “event.” They may experience structural and institutional racism (policies and systems of power that have led to discrimination in the workplace, health care, and so on) and individual or interpersonal racism that occurs between people (racial slurs, hate crimes, etc.)—all of which culminate into significant trauma that is overarchingly racial in nature.

Additionally, some of the symptoms of PTSD may emerge when people of color experience race-specific traumatic stressors such as hypervigilance when being pulled over by a police officer, or physiological arousal when reminded on television of racial violence. Within the DSM’s existing framework for PTSD, there is no way to capture this. And, as a health care community, we are failing to measure a problem we know is there.

It is more important now than ever that the American Psychiatric Association update the DSM. It must include racial trauma as a unique consideration within the PTSD diagnosis. As mental health professionals, it is past time to formally acknowledge in clear language the trauma that too many of our patients have already endured for so long.

— Annika Olson, MA, MPP, is the assistant director of policy research at the Institute for Urban Policy Research and Analysis at the University of Texas and a Public Voices fellow of The OpEd Project.