13.4 Race-Based Traumatic Stress
Post-traumatic stress disorder (PTSD) is a diagnosis that is given to individuals who have experienced a traumatic event and suffer significant distress and dysfunction as a result of the event. The latest edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5; APA, 2013) defines a traumatic event as one in which a person was exposed to actual or threatened death, serious injury, or sexual violence. Exposure can take the form of being the direct target of the trauma, witnessing the trauma, or learning that a traumatic event happened to a close relative or friend. Exposure may also be indirect, which usually occurs in the course of professional duties (for example, first responders). The diagnostic criteria then describe the resulting symptoms: (1) intrusion—unwanted re-experiencing of the traumatic event through upsetting memories, nightmares, flashbacks, and so on; (2) avoidance—efforts to avoid trauma-related stimuli; (3) negative alterations in thoughts or feelings, such as decreased self-esteem or mood; and 4) hyperarousal or hypervigilance.
What the DSM acknowledges as a traumatic event has shifted over time with each iteration. For example, in the DSM-IV-TR (2000), being diagnosed with a life-threatening illness was listed as a potentially traumatic event, but it was removed as an example in the DSM-5. Currently, the examples of traumatic events listed in the DSM-5 include various forms of abuse in childhood, physical or sexual assault, kidnapping, severe motor vehicle accidents, and kidnapping. These changes illustrate the evolution of the field’s conceptualization of trauma, which naturally shifts with advances in science and understanding (North et al., 2016).
Although the DSM covers a wide range of potentially traumatic events, the current criteria fail to acknowledge racism and discrimination as experiences that are sufficiently distressing to “qualify” as trauma (Holmes et al., 2016). Scholars have contended that this omission represents an exclusion of BIPOC populations and a broader lack of acknowledgement of the deleterious impact of oppression (Butts, 2002).