Expanding criterion a for posttraumatic stress disorder: Considering the deleterious impact of oppression.

Abstract

The latest edition of the Diagnostic and Statistical Manual of Mental Disorders (5th edition) includes edits to Criterion A for posttraumatic stress disorder in an attempt to capture a wide variety of potentially traumatic events. However, despite criticism by scholars in the field (e.g., Kira, 2001;Gilfus, 1999;Helms, Nicolas, & Green, 2012) and overwhelming evidence documenting the negative impact of oppression on the mental health of its targets (e.g., Carter, 2007), the way in which Criterion A is written fails to include the insidious trauma of oppression. There is a small but compelling literature base that has demonstrated oppression to be a form of trauma by examining the relationship among various forms of oppression (e.g., racism, sexism, heterosexism) and trauma-related symptoms (e.g.,

Ketamine-Assisted Psychotherapy for PTSD Related to Racial Discrimination

“…Microaggressions include a wide range of verbal and nonverbal communications, intentional and unintentional, that portray insensitivity, disrespect, and/or negligent attention to another person due to their marginalized heritage or identity. Due to the many ways in which people of color may be exposed to traumatic events that do not always neatly fall under the "Criterion A" DSM-5 PTSD qualifier, this has led to arguments about the legitimacy of racism and oppressive acts as worthy of a PTSD diagnosis (Holmes et al, 2016). Supporting evidence from the quantifiable impacts of microaggressions, to discriminatory racial climates and social inequalities, has demonstrated the negative implications that racism has on mental health leading to symptoms of trauma (Williams et al, 2018c).…”

The Threshold Non-linear Model for the Effects of Cumulative Stressors and Traumas: A Chained Cusp Catastrophe Analysis

“…It may also include the proliferation of early adolescence systemic trauma such as discrimination leading to subsequent traumas (Al-Ibraheem, Kira, Aljakoub, & Al-Ibraheem, 2017;Kira, Alawneh, Aboumediene, Lewandowski, & Laddis, 2014;Szymanski & Balsam, 2011). The inclusion of social identity systemic traumas (collective identity traumas) that are continuous and intersecting, such as different discrimination and oppression (e.g., refugees, minority groups experience, gender discrimination), have been identified as severe trauma types that proliferate to subsequent traumas (Holmes, Facemire, and DaFonseca, 2016;Reisner et al, 2016;Kira et al, 2018a).…”

Intersectional insights from an MDMA-assisted psychotherapy training trial: An open letter to racial/ethnic and sexual/gender minorities

“…However, certain experiences outside of the Criterion A umbrella can still cause a traumatic reaction and can potentially exacerbate an individual's ability to cope with and recover from conventional Criterion A events (e.g., Williams & Leins, 2016). These non-Criterion A stressors include exposure to racist acts (i.e., racial trauma) and additional forms of oppression based on, or at the intersection(s) with, gender, sexuality, and other stigmatized identities (Chae, Lincoln, & Jackson, 2011;Ching, Lee, Chen, So, & Williams, 2018;Holmes, Facemire, & Da Fonseca, 2016;Pieterse, Carter, Evans, & Walter, 2010;Williams et al, 2014;Williams, Kanter, & Ching, 2018;Williams, Peña, & Mier-Chairez, 2017). For example, sexual/gender minorities of color are at risk of experiencing structural stressors such as homophobia or transphobia in their ethnic communities, as well as racism in the lesbian, gay, bisexual, transgender, queer, intersex, and asexual+ (LGBTQIA+) community (for an intersectional conceptual model, see Ching et al, 2018).…”