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Evidence for Race-Based Traumatic Stress Injury: Race-Based Traumatic Stress Assessment

Racism and its Psychological Consequences: Race-Based Traumatic Stress Injury

Research in the area of racial harassment and racial discrimination demonstrates that harm can result in debilitating stress for people who have racial encounters that are memorable, out of their control, sudden and are deeply emotionally painful – i.e. race-based traumatic stress injury (RBTSI).

People who encounter racism have had a range of experiences, from physical assaults to subtle behavior such as avoidance and neglect. The consequences of acts of racial discrimination and racial harassment can also vary from economic (e.g., financial loses) to emotional harm (e.g., psychological impairment). People have reported being subject to acts that were essentially avoidant, hostile or aversive-hostile all of which were or are intended to demean or communicate the person’s low social status. 

In legal cases the focus has more often then not been on the concrete consequences of racial inequalities or violations of anti-discrimination laws. Some plaintiffs include emotional and psychological harm in their claims yet many do not in spite of the considerable scientific evidence that shows psychological and emotional harm from race-based encounters or racism.

Research Evidence Supports Adverse Mental Health From Exposure to Racism
Numerous scholars (e.g., Carter, 2007: Carter & Sant-Barket, 2015) have contended that reactions to race-related encounters result in symptoms that reflect race-related stress and traumatic stress symptoms.  

Studies have reported adverse mental health symptoms from exposure to racial discrimination and racism. For instance, Pieterse, Todd, Neville, and Carter’s, (2012) meta-analyses of 66 studies examined the effects of racism on the mental health of Black Americans and Lee and Ahn’s (2011, 2012) meta-analyses of 23 studies dealt with the mental health impact of racism on Asian Americans and Latino’s (50 studies).  Pascoe and Richman’s meta-analysis of 134 studies examined generic discrimination’s effects on mental and physical health. Carter, Lau, Kirkinis, and Johnson’s (2015) meta-analyses of 105 studies found that racial discrimination was related to adverse mental and physical health outcomes for racial minorities. 

However, researchers have not focused on exposure to racism and traumatic reactions. Yet evidence from trauma research suggest that race and racism are involved in the elevated levels of Post-Traumatic Stress Disorder (PTSD, APA, 2013) found in people of Color, even when race was not a consideration in the investigation.  For instance, trauma and stressful life-event investigators have reported, that people of Color, both as veterans and citizens, have elevated levels of PTSD (15% to 45%) compared to Whites (5% to 15%) not explained by the event or other factors.

Scholars and researchers argue that racism-related stress can be traumatic. Loo et al., (2001) measured race-related stress in Asian American veterans. They found that 37% of the Asian American veterans had PTSD. Race-related stress was a stronger predictor of PTSD than exposure to combat.

Race-Based Traumatic Stress Injury: Empirical Research Evidence
Racism is associated with race-based traumatic stress injury. The framework presented by R.T. Carter is centered on types of racial encounters defined as classes of racism (hostile, avoidant, and aversive-hostile).

Carter, et al (2013) developed the Race-Based Traumatic Stress Symptom Scale (RBTSSS), with 381 participants, which provides empirical evidence for race-based traumatic stress. The Exploratory Factor Analysis (EFA) found 52-items and seven scales consistent with the conceptual model proposed by Carter. The initial study was followed by Carter and Sant-Barket’s study (2015) supporting other components of the RBTSS scale structure.

Carter (2007) proposed that specific types of racial encounters defined as classes of racism, hostile, avoidant, and aversive-hostile racism were associated with race-based traumatic reactions. In a recent study Carter, et al., (2015) found empirical evidence for the classes of racism using EFA and Confirmatory Factor Analyses (CFA) within a Structural Equation Modeling (SEM) framework.  The analyses resulted in two scales for classes of racism, the first for frequency of racial experiences and the second for the stress reactions to racial experiences. The two scales were used as predictors of race-based traumatic stress reactions (RBTSSS).

The analyses showed that Hostile Racism was associated with Anger and Intrusion RBTSS scales. Aversive-Hostile Racism was related to Depression, Anger, Avoidance and Hypervigilance symptoms, while Avoidant Racism frequency was related to Depression, Anger, Physical symptoms, Hypervigilance, and Low Self-Esteem. Overall, the seven RBTSS symptoms were related to frequency of racial experiences with Hostile Racism frequency having the strongest effect size. Aversive-Hostile and Avoidant Racism frequency were associated with numerous symptoms. This could be explained by the settings (i.e. work and school) in which Aversive-Hostile racism is likely to occur, thus greater frequency and intensity of reactions. Such visceral reactions cause psychological distress. Hostile and Avoidant Racism frequency were found to be less impactful, perhaps because the racial experiences occurred less often and may not be central to ones’ daily life.

In the analysis for the three classes of racism for stress of racial experiences, the relationships found were more numerous and robust. Hostile Racism stress was associated with three RBTSS symptoms: Anger, Avoidance and Intrusion. And Avoidant Racism stress was associated with six of the seven RBTSS symptoms: Depression, Anger, Physical Symptoms, Avoidance, Hypervigilance, and Low Self-Esteem. The stress related to Aversive-Hostile Racism stress was associated with four of the seven RBTSS symptoms Depression, Anger, Physical Symptoms, and Low Self-Esteem. Stress from racial experiences was connected to thirteen symptoms, while frequency was related to seven symptoms. Additionally, there were more symptoms from Avoidant and Aversive-Hostile Racism stress than from Hostile Racism stress. The variation of RBTSS symptoms suggests that the classes of racism were emotionally and psychologically harmful, and supports the predictive validity of the two measures. Yet, regardless of the class or type of racism one encounters, stress and frequency were associated with psychological harm.


Carter, Muchow, Sant-Barket, and Slotts (2015) examined the construct validity of the RBTSSS by utilizing Confirmatory Factor Analyses (CFA) and a second-order Structural Equation Model (SEM).  Findings indicated that the factor structure reported by Carter et al (2013) was further supported in a new multi-racial participant group of 619 adults from the community. More importantly the theoretical construct of “Race-Based Traumatic Stress” was substantiated by the second order SEM in that a model fit was found. They also reported findings from a multiple regression analyses that supported the predictive validity of the RBTSSS.  

Carter, Pieterse, and Munchow (2015) also used SEM with only Black participants and found support for the RBTSSS scale and the  “Race-Based Traumatic Stress” construct.

The empirical evidence showed that racial encounters and racism are associated with emotional trauma that can be acted on through the courts, and that RBTSI as a basis for pursuing legal redress that has not been utilized as often as it legitimately could be. Moreover, we advocate for a legal strategy in racial harassment and racial discrimination legal claims that includes tort law – specifically negligent or intentional infliction of emotional distress (in addition to Title VII in the employment context) – to achieve redress for race-based traumatic stress injury.  Such an approach is needed given the limited and often stifling avenues of redress that are currently available. (See publications on this webpage)


Carter, R. T., & Sant-Barket, S. M. (2015). Assessment of the impact of racial discrimination and racism: How to use the Race-Based Traumatic Stress Symptom Scale in practice. Traumatology, 21(1), 32.
Carter R. T., and Lau M. Y., Kirkinis, K., & Johnson, V., (2015) Racial Discrimination and Health Outcomes Among Racial-Ethnic Minorities: A Meta-Analytic Review Manuscript submitted for publication
Carter, R.T., Pieterse, A, Munchow, C. (2015) Construct and predictive validity of the RBTSSS with Black Americans –Manuscript Submitted for publication
Carter, R.T., Johnson, V., Munchow, C. Galgay, C., Lyons, J., & Forquer, E., (2015) The development and validation of the classes of racism scales. Manuscript Submitted for publication
Carter, R.T., Sant-Barket, S., Muchow, C., & Slotts, S., (2015) Construct and predictive Validity of the Race-based traumatic stress scale – Manuscript Submitted for publication
Lee, D. L., & Ahn, S. (2011). Racial discrimination and Asian mental health: A meta-analysis. The Counseling Psychologist, 39(3), 463-489.
Lee, D. L. & Ahn, S. (2012). Discrimination against Latina/os: A meta-analysis of individual-level resources and outcomes. The         Counseling Psychologist, 40, 28-65.
Loo, C. M., Fairbank, J. A., Scurfield, R. M., Ruch, L. O., King, D. W., Adams, L. J., & Chemtob, C. M. (2001). Measuring exposure to racism: Development and validation of a Race-Related Stressor Scale (RRSS) for Asian American Vietnam veterans. Psychological Assessment, 13(4), 503.

Pieterse A. L., Todd, N., Neville, H.A., & Carter, R.T., (2012) Perceived racism and mental health among Black Americans: A Meta-Analytic Review Journal of Counseling Psychology, 59(1), 1-9.

Robert T Carter