Racism Doesn't Just Suck - It Causes PTSD

Post-Traumatic Stress Disorder, also known simply as PTSD, is a long-term condition that can set in after any traumatic event. It transforms the victim's life in such a way that the trauma continues to dominate them, and sucks joy while promoting anger and depression.

When we think about PTSD, we usually immediately imagine combat veterans, rape victims, and survivors of natural catastrophes such as earthquakes. But proposed changes in the recently published Diagnostic Manual of Mental Disorders (the DSM-5) change the diagnostic criteria for PTSD in such a way that recognizes the condition can be caused by racism.

The previous version of the DSM, the “Bible of mental disorders”, recognized that racism could lead to PTSD only in case of an identifiable incident. The DSM-5 acknowledges that racism is so bad that being exposed to it over a lifetime can actually cause Post-Traumatic Stress Disorder.

PTSD In The DSM-5

The American Psychiatric Association frequently updates its diagnostic criteria for mental disorders, in line with the latest research in the field. The DSM-5 came out in May 2013, and PTSD is now part of a new chapter titled “Trauma- and Stressor-Related Disorders”. The diagnostic criteria for PTSD were altered, and a new sub-type of the disorder was introduced for children under six.

So, what has changed? Before we look at the diagnostic criteria, it should be pointed out that the DSM-IV contained three symptom clusters. Those have now been divided into four to facilitate the separation of avoidance and numbing into two: avoidance (Criterion C) and negative alternations in cognition and mood (Criterion D).

Three new PTSD symptoms were added to the list. Persistent and distorted blame of self or others and a persistent negative emotional state appear under Criterion D. Reckless and destructive behavior was added under Criterion E.

A clinical subtype of PTSD in which the victim experiences dissociative symptoms was also added.

There are now eight separate diagnostic criteria. Under each of these criteria, one or more symptoms are required for PTSD to be diagnosed, depending on the individual criterion. These diagnostic criteria are as follows in the DSM-5:

• Criterion A: Exposure to death, threatened death, actual or threatened serious injury, or actual or threatened sexual violence. This can be through direct exposure, experienced in person. It can also be indirect, by learning that a friend or relative was exposed to trauma, or acquired during the course of professional duties (think of police officers and medical professionals dealing with emergencies).

• Criterion B: The traumatic event is, or the traumatic experiences are, persistently relived — commonly through intrusive memories, flashbacks, nightmares, or distress after exposure to triggers that remind the victim of the event(s).

• Criterion C: The victim must make a persistent effort to avoid stimuli that remind them of the trauma. This includes avoiding trauma-related thoughts or feelings and avoiding places, people, objects, and conversations that may remind the person of the trauma.

• Criterion D: “Negative alterations in cognition and mood” that can involve the inability to feel positive emotions, feeling alienated from others, and negative feelings about self or the rest of the world. Not being able to recall parts of the traumatic event also falls under this heading, as does a diminished interest in activities previously significant to the person.

• Criterion E: Irritable or aggressive behavior, reckless of self-destructive tendencies, hypervigilance and an exaggerated startle response, sleep difficulties and concentration problems.

• Criterion F: Persistence of required symptoms from previous categories for more than one month.

• Criterion G: “Significant symptom-related distress or functional impairment” — in order words, the experienced symptoms have to disrupt the victim's life significantly.

• Criterion H: The symptoms aren't due to substance abuse, medication, or other illnesses.

How Racism Leads To PTSD

Researchers found that “chronic exposure to racism” has an effect on people that is similar to the pressure soldiers face on a battle field in 2011. Through a survey, it became clear that African Americans who reported more instances of racial discrimination had a markedly higher risk of being diagnosed with Generalized Anxiety Disorder (GAD).

The GAD diagnosis was apparently fitting, because these people could not identify a single traumatic event that may “earn” them the diagnosis of Post-Traumatic Stress Disorder.

Indeed, chronic exposure to racism within an environment in which racial hatred is persistent has cumulative effects on a person. In other words, racist events can build on one another in such a way that the victim ends up with Post-Traumatic Stress Disorder.

This is more than a feeling, of course. Racist behavior and comments may indicate the perpetrator's willingness to carry out racial attacks, or may in fact lead to racist attacks. Even if no physical harm is done, the mental harm inflicted is becoming increasingly apparent.

Under the previous DSM (the DSM-IV) there was a requirement that the person experience fear, helplessness, and horror following adverse events. Now that this requirement has been eliminated, the full consequences of frequent exposure to racism can be recognized.

PTSD: Different Causes, Same Effects

Imagine. You are an American Muslim woman who wears a hijab. Your physical appearance provokes negative reactions in people all the time, so much so that you feel like a walking outcast. 

You're subjected to uncomfortable pat-downs and intrusive questions about why you are flying. You're going to Jamaica on a medical mission? Are you sure? Who would go to Jamaica on a medical mission? The interrogation leads you to nearly miss your plane. For the third time in the month.

In the end, you start arriving at the airport earlier than other people in anticipation of “random” searches. The treatment you are subjected to at airports is only one example of the discrimination you face on a daily basis. While it's not the worst by any means, it does give you the impression that the racism you face is somehow government-mandated. Stares and comments about terrorists are an integral part of leaving the house, and PTSD is the result.

This is not a theoretical scenario — it's something one of my friends calls “daily life”. The effects are real, and not at all dissimilar to the symptoms I experienced after years of childhood sexual abuse (a euphemism, really, for something that should just be called “rape”). Perhaps, she'll be able to receive the counseling that she needs and that I did benefit from enormously, because unlike her, I could point to identifiable traumatic events. In short, the changes introduced by the DSM-5 have the potential to make big positive changes in people's lives.