Racial Trauma: The African American Experience _ _______________________________________________
TRAUMA- AND STRESSOR-RELATED DISORDERS Racial trauma or race-based traumatic stress is the stressful effect or psychological distress resulting from an individual’s experience with racism and discrimination [23]. Stress responses to racial trauma involve heightened vigilance and suspicion, greater sensitivity to threat, sense of a foreshortened future, and maladaptive reactions to stress (e.g., violence, drug use). Aside from stress responses, racial trauma can also lead to adverse effects on physical and mental health. Stress is a natural, biological response (physiologic and cognitive) to circumstances identified as threats or challenges. Most stresses of daily life are manageable with appropriate coping skills and support networks. However, longstanding and extensive exposure to stressful and negative experiences, particularly without positive mitigating factors, can be harmful. When an individual receives or foresees a threat, the brain’s limbic system, or survival brain, delivers a distress signal that releases stress hormones [23]. This is the typical bodily reaction considered essential for survival. If an individual experiences chronic stress, there is a continuous stream of stress hormones and he or she remains hypervigilant to their environment. Due to the pervasiveness of racial discrimination, racial minorities usually experience this heightened stress. Systemic racism, routine racial discrimination, and the dread prior to racist incidents can cause minorities to live in a perpetual state of stress, leading to adverse physical effects such as hypertension, increased blood glucose levels, and cardiovascular disease. In the DSM-5, several trauma- or stress-related disorders are identified, including PTSD, acute stress disorder, adjustment disorders, reactive attachment disorder, and disinhibited social engagement disorder [24]. Aside from being triggered by exposure to real or threatened violence or injury/death, these disorders are characterized by hyper-arousal, intrusion, avoidance, and negative cognition/mood symptoms. Exposure to race-related trauma may be the originating factor in the development of an adjustment or stress disorder [23]. This effect is exacerbated by the increasing impact of multiple traumas, such as community violence, financial and/or housing insecurity, and victimization. Practitioners should take into account the adverse effects of racial trauma on their clients and use that as a mechanism for trauma-informed practice. Many mental health practitioners fail to acknowledge racism as a trauma unless a person encounters an overt racist event (e.g., a violent hate crime) [25]. This limits the effectiveness of interventions and can damage rapport with the client. (It is also a potential failure of the practitioner to practice culturally competent care.) It is vital to recognize that a minor event can elicit traumatic responses. If asked about an overt event,
The American Psychiatric Association recommends the following steps when providing services to oppressed minorities [16]: • Use the revised fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5-TR) to provide an assessment framework of an individual’s mental health, especially as it relates to sociocultural context and history. • Perform a Cultural Formulation Interview (CFI). This is a set of 16 questions that providers may use to obtain culturally relevant information during a mental health assessment. This instrument examines the impact of culture upon an individual’s clinical presentation. The CFI identifies four domains: cultural definition of the problem; cultural perception of cause, context, and support; cultural factors affecting self-coping and past help seeking; and cultural factors affecting current help seeking. • Consider using the CFI’s 12 supplementary modules to gain additional insights into specific patient groups. Modules exist for immigrants and refugees, children and adolescents, older adults, and other special populations. • Affirm the importance of cultural competency training for providers including (but not limited to) learning about implicit bias, microaggressions, trauma-informed care, and culturally sensitive treatment. • Consider the cumulative and overlapping impact of historical trauma and microag-gressions upon the mental health of people belonging to multiple marginalized populations, known as intersectionality. • Emphasize self-care for all patients by encouraging healthy routines for sleep, diet, exercise, and social activities. Consider the role of self-affirmations, vicarious resilience, meditation, yoga, and other forms of traditional, alternative, or complementary care in mental health. • Increase social supports for patients by engaging their family, social networks, and community in their care, as appropriate. • Stay abreast of current news and events, particularly those that may affect specific marginalized patient populations. At the same time, try to be mindful to avoid information overload, which may contribute to provider burnout. • Work with religious and spiritual leaders to provide faith-based mental health care, as appropriate.
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