Sept 30 Flashcards
Dr Rich Lee on Racial Trauma
how families respond to racial trauma = critical to health and wellbeing and to addressing racism
silence is often how families respond to disc - but this isn’t a good coping strategy
social support as a moderator for effects of racial trauma
what component does the DSM-5 require in order to diagnose someone with PTSD?
a criterion A stressor
criterion A stressor
A. exposure to ACTUAL or THREATENED DEATH, SERIOUS INJURY, or SEXUAL VIOLENCE in one (or more) of the following ways:
A1: DIRECTLY experiencing
A2: WITNESSING in person as it occurred to others
A3: LEARNING they occurred to close fam member or friend
A4. EXPERIENCING REPEATED/EXTREME EXPOSURE to aversive details of traumatic events
- ie. first responders collecting human remains
- police repeated exposure to child abuse details
NOTE: criterion A4 doesn’t apply to exposure through electronic media, tv, movies, pictures, UNLESS this exposure is work related
important note regarding DSM 5’s Criterion A stressor
A4 - doesn’t apply to exposure through ELECTRONIC MEDIA, TV, MOVIES, or PICS
UNLESS this exposure is WORK-RELATED
PTSD symptoms
physical symptoms develop after traumatic event
don’t fade, may get worse with time
4 groups of symptoms
4 groups of PTSD symptoms
- intrusive
- avoidance
- altered mood & cognition
- altered reactivity & arousal
how does racial trauma FIT or NOT FIT within the DSM 5?
more serious major discrimination events may qualify outright as criterion A stressor
but MANY experiences DON’T
ie. DSM says criterion A trauma can’t be an ONLINE EXPOSURE (unless work related)
- inconsistent with trauma symptoms reported by people who see frequent examples on TV and media of ingroup members being exposed to violence or police brutality
criterion A traumatic event - conceptual boundaries
many calls for DSM to EXPAND criteria to include TRAUMAS resulting from RACISM and MARGINALIZATION
these are often lower level, MORE CHRONIC
but have LARGE CUMULATIVE effects across lifespan
racism leads to many of the symptoms listed for PTSD
criterion A traumatic event - can lead to possible mis…
MISDIAGNOSIS
of depression or anxiety
instead of PTSD symptoms
criterion A traumatic event - argument against expanding criterion A
argument that expanding the definition will reduce INTEGRITY/VALIDITY of the diagnosis
ICD-10 (international classification of diseases - system used in Europe) doesn’t restrict the types of experiences that can result in PTSD
stress sensitization and stress proliferation are additional…
aspects of cumulative effects
stress sensitization
exposure to earlier life adversity DYSREGULATES physiological and neural systems
makes individuals MORE SENSITIVE to negative impacts of later adverse experiences
stress proliferation
stress exposure leads to MORE & DIFFERENT TYPES of stress exposure
ie. get fired at work (stressor)
now experience family problems because of this (new stressor)
and also are accruing debt (new stressor)
and experiencing food insecurity (new stressor)
historical trauma definition
cumulative emotional and psychological wounding ACROSS GENERATIONS and OVER LIFESPAN
emanating from MASSIVE GROUP TRAUMA experiences
those with historical trauma exposure may start life…
more sensitized to stress
because of marks on epigenome (think back to DNA methylation and histone acetylation)
how many generations back can historical trauma be rooted?
unsure
at least 3 generations
epigenetics of historical trauma
trauma influences epigenome of GERM CELLS (sperm/egg)
if during pregnancy baby is a girl, will also influence BABY’s OWN germ cells (XX chromosome)
leads to GENES in offspring being turned ON or OFF
epigenetics evidence
some evidence of NEUROENDOCRINE DIFFS among children of Holocaust survivors versus “non-exposed” Jews
historical trauama is also spread through…
culture
narratives, beliefs, practices
parenting, family environment, parental behaviours
historical trauma - survivors passing down narratives of their experiences
- often draw parallels between past events and present
- memory lives on as representation of group-lived trauma
historical trauma - cycle of intergenerational transmission - A repeat
racism impacts parental mental health and parenting practices
related to youth mental and physical health
ie. parental mental health, undesirable parenting, negative affect of parent
leads to child/youth distress
SUMMARY historical trauma
historical trauma has LASTING IMPACTS across generations from traumatized groups
- mixed but promising evidence for EPIGENETIC IMPACTS
- clear unequivocal impacts on PARENTING, FAMILY ENVIRONMENT
- premature birth and BIRTH COMPLICATIONS
all of the above impact YOUTH MENTAL HEALTH and predispose them to INCREASED RISK (via sensitization) for PTSD and other MH problems following trauma exposure
how is discrimination related to ACTUAL TRAUMA SYMPTOMS
racist events >
- re-experiencing intrusion
- avoidance
- negative mood & cognition
- psychological arousal
Kirkinis et al - SYSTEMATIC REVIEW of racial discrimination & trauma literate - SETUP
28 studies - not meta-analysis but compiled a bunch of studies and looked at trends
100% from the US - need to expand beyond
50% of studies came out since 2011 - only recent data
93% cross-sectional
7% longitudinal
Kirkinis et al - SYSTEMATIC REVIEW of racial discrimination & trauma literate - FINDINGS
moderate to strong positive correlations between DISC and TRAUMA symptoms
found consistently across traditional PTSD measures and Race-Based Traumatic Stress Symptom Scale
glimpse at Race-Based Traumatic Stress Symptom Scale - instrusion subscale
as a consequence of the memorable encounter I had with racism:
…I can’t seem to get the event out of my mind even I try
…I experience mental images of the event
…I feel emotionally upset when I’m reminded of the event
LOTS OF OVERLAP WITH PTSD SYMPTOMS
glimpse at Race-Based Traumatic Stress Symptom Scale - hyperviligance subscale
as a consequence of the memorable encounter I had with racism:
…I become easily frightened (for example, when you hear subtle noises)
…I feel worried a lot (for example, walking down the street)
…I feel easily intimidated (as if someone is going to hunt you as they walk passed you in the street)
…I feel nervous (for example, when others approach you)
LOTS OF OVERLAP WITH PTSD SYMPTOMS
glimpse at Race-Based Traumatic Stress Symptom Scale - other subscales
depression, anger, physical symptoms, low self-esteem, and avoidance subscales
ACE
adverse childhood experience
Bernard - Impact of Racial Discrimination and ACES makes a case for…
making a case for racial discrimination as an ACE
Bernard - Impact of Racial Discrimination and ACES QUESTION
- how is racial discrimination associated with other ACEs?
- how are they associated with INTERNALIZING SYMPTOMS among Black youth?
Bernard - Impact of Racial Discrimination and ACES - what did they look at?
national survey of children’s health
nationally representative US survey of children 0-18 (US census bureau)
8672 black youth from 2016-2019 surveys
Bernard - Impact of Racial Discrimination and ACES - FINDINGS
- racial discrimination POSITIVELY ASSOCIATED with all other ACEs studied
- most highly related to neighbourhood violence exposure and living with someone with mental illness - controlling for impacts of other ACEs, racial discrimination was associated with more DEPRESSION and ANXIETY
- racial disc effects were stronger than many other ACEs (ie. death of a parent or a parent in jail, living with a substance user, seeing adults beat each other)
racial discrimination POSITIVELY ASSOCIATED with all other ACEs studied - most highly related to…
neighbourhood violence exposure
living with someone with mental illness
racial discrimination, adverse childhood experiences, and behaviour problems among racial-ethnic minority youth: a systematic review - GOAL
investigate how strongly racial discrimination and ACEs are related to
internalizing and externalizing symptoms
among ethnically/racially minoritized youth and adolescents
racial discrimination, adverse childhood experiences, and behaviour problems among racial-ethnic minority youth: a systematic review - REQUIRED…
required 2 literature reviews
racial disc > outcomes & aces > outcomes
racial discrimination, adverse childhood experiences, and behaviour problems among racial-ethnic minority youth: a systematic review - FINDINGS
“racial disc ranked 5th largest adverse experience for externalizing behaviours (out of 10)”
…“ranked 6th largest for internalizing symptoms (out of 12)”
…“association of racial disc [with behaviour problems] is greater than ACEs including neglect, family conflict, domestic violence, and abuse”
racial discrimination, adverse childhood experiences, and behaviour problems among racial-ethnic minority youth: a systematic review - SUMMARY
- racial discrimination UNIQUELY PREDICTS negative outcomes over and above ACES
- actually MORE STRONGLY related to harmful outcomes than many ACEs, even ones societally regarded as very serious like child abuse and domestic violence exposure
- in prof’s opinion: discrimination should be recognized as an ACE and more resources and policy attention put towards reducing it as is done with other ACEs
does prof think discrimination should be recognized as an ACE?
yes
he thinks that more RESOURCES and POLICY ATTENTION should be put towards reducing it
as is done with other ACEs
Galan et al - INTERSECTIONAL approach to racial trauma - setup
builds on Bernard et al 2020
to better incorporate intersectional experiences
paper referencing black youth
but these ideas cut across many marginalized groups
Galan et al - INTERSECTIONAL approach to racial trauma - sexual abuse to prison pipeline
sexual abuse to prison pipeline
31-81% of girls in justice system report history of sexual abuse
reaction to trauma (ie. truancy, substance use) gets them involves in justice system
Galan et al - INTERSECTIONAL approach to racial trauma - law enforcement
- popular media highlights black men being killed by police
- black women experience similar levels of excessive force as black men
- not highlighted because of INTERSECTIONAL INVISIBILITY
- black women disproportionately impacted by police-perpetrated sexual violence
Galan et al - INTERSECTIONAL approach to racial trauma - general takeaways
- be generally aware of factors at play at diff levels
- understand that exposure to diff forms of racial taruma may differ across racial x gender lines (and other marginalized identity statuses)
lecture main points
- racism can be a traumatic experience/cumulate into racial trauma
- racial trauma can be passed down through generations
- racial trauma is associated with trauma symptoms
- racial trauma is associated with other negative mental and physical health symptoms
