Assessing racial trauma within a DSM–5 framework: The UConn Racial/Ethnic Stress & Trauma Survey.

Abstract

Many ethnic minority groups experience higher rates of posttraumatic stress disorder (PTSD) compared to their European American counterparts. One explanation for this is the differential experience of racism, which can itself be traumatic. This article aims to provide a theoretical basis for the traumatizing nature of various forms of racism within the 5th edition of the Diagnostic and Statistical Manual of Mental Disorders’ framework for PTSD. PTSD caused by racism, or racial trauma, is likely to be underrecognized due to a lack of awareness among clinicians, discomfort surrounding conversations about race in therapeutic settings, and a lack of validated measures for its assessment. We review the literature and existing measures for the assessment of racial trauma and introduce the UConn Racial/Ethnic Stress & Trauma Survey (UnRESTS), a clinician-administered interview. The UnRESTS is useful to clinicians as an aid to uncovering racial trauma, developing a culturally informed case conceptualization, and including experiences of racism in the diagnosis of PTSD when warranted. Three case examples that describe the impact of racial stress and trauma and the role of the UnRESTS in understanding the experiences of those impacted by racism are included.

The psychedelic renaissance and the limitations of a White-dominant medical framework: A call for indigenous and ethnic minority inclusion

“…The minimal inclusion of people of color in such empirically supported studies may partially explain the lacking in understanding of trauma experienced by people of color, which is often composed of encounters unique to them such as cultural and historical trauma, everyday racism, and discrimination (Williams, Printz, Ching, & Wetterneck, 2018). Furthermore, the conventional screening methods and assessment measures used in clinical settings do not address or capture these aspects of trauma (Williams, Metzger, Leins, & DeLapp, 2018). As such, people of color are largely absent from the development of potentially helpful treatments, and do not adequately benefit from scientific advances of the field.…”

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“…These experiences of discrimination are insidious and pervasive across multiple systemic domains; they range from everyday discrimination and microaggressions, such as low‐quality service at restaurants, to institutional racist incidents, such as being denied a job because of race or ethnicity (Beck et al, 2020). Racial discrimination is conceptualized as a form of trauma that can affect both mental and physical health outcomes (Williams, Metzger, Leins, & DeLapp, 2018). Racially motivated violence, racial profiling, hate crimes, and historical traumas all contribute to increased anxiety and hypervigilance, boosting the likelihood of a diagnosis of post‐traumatic stress disorder (PTSD) and other stress‐related disorders (Williams et al, 2018).…”

“…Racial discrimination is conceptualized as a form of trauma that can affect both mental and physical health outcomes (Williams, Metzger, Leins, & DeLapp, 2018). Racially motivated violence, racial profiling, hate crimes, and historical traumas all contribute to increased anxiety and hypervigilance, boosting the likelihood of a diagnosis of post‐traumatic stress disorder (PTSD) and other stress‐related disorders (Williams et al, 2018).…”

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“…This is limiting given that many people of color experience cumulative experiences of racism as traumatic (Butts, 2002). In addition, people of color may not share experiences of discrimination when asked about traumas they may have experienced unless they are told explicitly that racism counts as a trauma (Williams, Metzger, Leins, & DeLapp, 2018).…”

“…To ensure that traumas due racism and to other forms of oppression were captured, a modified version of the UConn Racial/Ethnic Stress & Trauma Survey (UnRESTS; Williams, Metzger, et al, 2018) was added to the source documents used for collecting information about participants by study therapists. The UnRESTS is a semi-structured interview designed to assess racial trauma in clients who are part of stigmatized ethnic and racial groups.…”