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Racial trauma, also known as race-based traumatic stress, is the psychological and emotional harm caused by experiences of racism, discrimination, and systemic oppression. Despite overwhelming evidence of its mental health impacts, the American Psychiatric Association (APA) has yet to formally recognize racial trauma as a distinct diagnosis in the Diagnostic and Statistical Manual of Mental Disorders (DSM). This omission has significant clinical, cultural, and societal implications. As conversations around racial justice continue to evolve, it is imperative that the APA acknowledges racial trauma in the DSM to ensure more accurate diagnosis, appropriate treatment, and equitable mental health care. The arguments for this crucial inclusion are compelling and rooted in extensive research and clinical observations.

The Unique Nature and Pervasiveness of Racial Trauma: Research over the past two decades has shown that racism is not merely a social issue—it is a public health crisis. It stems not only from overt hate crimes but also from daily microaggressions, systemic discrimination, institutional biases, and vicarious exposure to racial violence through media. Studies have linked chronic exposure to racial discrimination with symptoms consistent with Post-Traumatic Stress Disorder (PTSD). This includes hypervigilance, intrusive thoughts, emotional numbness, and avoidance behaviors. However, unlike PTSD, racial trauma is ongoing, not tied to a single event, and often lacks the societal recognition necessary for validation and support. These insidious and persistent stressors can erode an individual’s sense of safety, self-worth, and belonging, leading to a distinct constellation of psychological symptoms.

Current DSM criteria for PTSD does not capture the full scope of this ongoing, pervasive harm. This is because the DSM requires a single “Criterion A” event of threatened death or severe injury to constitute PTSD. (Williams et al., 2018). Until there is inclusion in the DSM, these symptoms will be misdiagnosed, underdiagnosed, and pathologized as generalized anxiety, depression, or conduct disorders—especially in Black, Latino, Indigenous, Asian communities.

The DSM’s Eurocentric Bias Undermines Equity: The DSM has long been critiqued for its Western-centric and racially biased framework. Historically, it has failed to contextualize how social determinants such as race, poverty, and systemic oppression contribute to mental health issues. By not recognizing racial trauma, the APA perpetuates a medical model that centers white norms and pathologizes non-white experiences. Inclusion would challenge this bias and reflect a more culturally competent and inclusive understanding of psychological distress.

Distinct Symptomatology and Impact: While racial trauma can certainly manifest with symptoms akin to PTSD (e.g., intrusive thoughts, avoidance, hypervigilance, negative alterations in mood and cognition), it also presents unique characteristics. These can include:

• Internalized racism: Adopting negative beliefs about one’s own racial group (Mental Health America, n.d.).
• Identity confusion or distress: Struggling with one’s racial identity in a discriminatory society.
• Chronic stress-related physical ailments: The constant vigilance and physiological arousal can lead to hypertension, sleep disturbances, headaches, and other somatic complaints (Heard, as cited in The Atlanta Voice, 2023).
• Impaired relationships: Difficulty forming trusting relationships due to experiences of discrimination.
• Grief and loss: Grieving the loss of opportunities, safety, or a sense of belonging due to racism.
• Intergenerational trauma: The passing down of racial trauma responses across generations, as seen in descendants of enslaved people or Holocaust survivors (Mental Health America, n.d.).

These symptoms, while overlapping with existing diagnoses, often require a specific lens for understanding and treatment that a standalone racial trauma diagnosis would provide.

Lack of DSM Recognition Limits Access to Treatment and Resources: A diagnosis in the DSM often serves as the gateway to insurance coverage, disability accommodations, and formal treatment plans. When racial trauma is not acknowledged, those suffering from its effects may not qualify for services or may receive interventions that fail to address the root cause of their distress. This can deepen mistrust between communities of color and mental health systems, especially when providers overlook or minimize the role of racism in their clients’ suffering.

Enhanced Clinical Assessment and Treatment: A formal diagnosis of racial trauma would equip clinicians with a much-needed framework for accurate assessment and culturally competent treatment. Without it, mental health professionals often misdiagnose or pathologize normal reactions to racist experiences, or worse, fail to inquire about racial experiences altogether (Williams et al., 2018). This can lead to ineffective interventions and perpetuate cycles of distress. A specific diagnosis would:

• Increase awareness: Encourage clinicians to explicitly screen for and identify and racial trauma.
• Guide treatment protocols: Allow for the development of targeted, evidence-based interventions that address the unique dynamics of racial trauma, such as strategies for coping with microaggressions, addressing internalized racism, and fostering racial identity development (Williams, 2024; Williams, Holmes et al., 2023).
• Reduce misdiagnosis: Prevent individuals from being diagnosed with other disorders (e.g., depression, anxiety) when racial trauma is the underlying cause.

Validation and Destigmatization for Sufferers: For individuals who have endured the psychological toll of racism, a formal diagnosis would offer profound validation. It would affirm that their experiences are real, their pain is legitimate, and their suffering is not a personal weakness but a consequence of systemic injustice. This validation can be a crucial step in destigmatization and encouraging help-seeking behavior within communities that may already experience mistrust of the healthcare system (Rutgers University, 2025). Including racial trauma in the DSM would signal that the psychological and social work professions recognizes the impact of racism on mental health and stands with marginalized communities in the pursuit of justice and healing.

Advancing Research and Public Health Initiatives: Official recognition in the DSM would spur critical research into the prevalence, mechanisms, and effective treatments for racial trauma. This increased focus would lead to:

• Improved epidemiological data: A clearer understanding of the burden of racial trauma on public health.
• More funding for research: Resources directed towards understanding and mitigating this widespread issue.
• Informed public policy: Data-driven advocacy for policies that address systemic racism and its mental health consequences.

Recognition in the DSM would catalyze more rigorous research into racial trauma’s causes, prevalence, and treatment outcomes. It would also support policy change, from mental health funding to education and criminal justice reform. For example, schools and workplaces could adopt trauma-informed practices that specifically account for racial harm, leading to more supportive environments and improved outcomes for people of color.

The APA has already acknowledged the impact of racism in the DSM-5-TR, noting its contribution to the manifestation of various mental disorders (APA, n.d.). This was a crucial step, but it is not enough. The cumulative and distinct nature of racial trauma demands its own diagnostic category. By taking this bold and necessary step, the APA can demonstrate its commitment to equity, dismantle barriers to effective mental healthcare, and contribute significantly to the healing and well-being of racialized communities across the nation. The time for recognizing the unseen wounds of racism is now.

Clinicians Need Better Tools to Address Race-Based Harm: Mental health professionals are increasingly called upon to address racial issues in therapy, yet many lack the language, training, or frameworks to do so effectively. Without formal diagnostic criteria, clinicians may feel uncertain or unprepared to treat racial trauma. Adding it to the DSM would encourage the development of standardized assessment tools, evidence-based interventions, and continuing education focused specifically on race-based stress.

In conclusion, the inclusion of racial trauma in the DSM is not just a clinical necessity—it is a moral and ethical imperative. As the APA acknowledges its own history of racism and the mental health field strives to become more inclusive, recognizing racial trauma is a vital step toward equity and justice. The lived experiences of millions demand that we evolve our diagnostic frameworks to reflect the realities of all people—not just the privileged few. The time is now for the DSM to include racial trauma, not as an abstract concept, but as a legitimate and diagnosable condition worthy of understanding, treatment, and healing.

References:

• ABCT. (n.d.). Treating Race-Based Traumatic Stress. Retrieved from https://www.abct.org/fact-sheets/race-based-traumatic-stress-rbts/
• American Psychological Association. (2021). Apology to People of Color for APA’s Role in Promoting, Perpetuating, and Failing to Challenge Racism. APA. Retrieved from https://www.apa.org/about/policy/racism-apology
• American Psychological Association. (2019, February 13). Uncovering the Trauma of Racism. Retrieved from https://www.apa.org/pubs/highlights/spotlight/issue-128
• https://mhanational.org/resources/racial-trauma/
• PTSD: National Center for PTSD. (n.d.). Racial Trauma. U.S. Department of Veterans Affairs. Retrieved from https://www.ptsd.va.gov/understand/types/racial_trauma.asp
• Rutgers University. (2025, February 3). Understanding How Racial Trauma Impacts Mental Health. Retrieved from https://www.rutgers.edu/news/understanding-how-racial-trauma-impacts-mental-health
• The Atlanta Voice. (2023, February 17). Understanding racial trauma, the mental and emotional injury of racism. Retrieved from https://theatlavoice.com/understanding-racial-trauma-the-mental-and-emotional-injury-of-racism/
• Williams, D. R., Lawrence, J. A., & Davis, B. A. (2019). Racism and health: Evidence and needed research. Annual Review of Public Health, 40, 105–125.
• Williams, M. T. (2024). A Clinician’s Guide to Healing the Wounds of Racial Trauma. PESI Publishing.
• Williams, M. T., Holmes, S., Zare, M., Haeny, A. H., & Faber, S. C. (2023). An evidence-based approach for treating stress and trauma due to racism. Cognitive and Behavioral Practice, 30(4), 565–588.
• Williams, M. T., Metzger, I. W., Leins, C., & DeLapp, C. (2018). Assessing racial trauma within a DSM–5 framework: The UConn Racial/Ethnic Stress & Trauma Survey. Practice Innovations, 3(4), 242–260. Retrieved from https://psycnet.apa.org/manuscript/2018-37737-001.pdf