By Dr. Reginald K. Riggins, PhD, MPH, Licensed Clinical Psychologist. Dr. Riggins worked as a PTSD psychologist for the U.S. Department of Veterans Affairs and, since 2013, has assessed, diagnosed, and treated hundreds of veterans. He now runs a telehealth practice in Bellaire, Texas.
Racial trauma rarely announces itself. It shows up as a tight jaw in a meeting, a habit of scanning every room you walk into, or exhaustion after a day of being “the only one.” For many Black Americans it is simply part of the background of life.
During my years at the VA, I saw something that is still not talked about enough. For Black service members and veterans, racial trauma is often already in place before the first deployment. Wartime trauma does not replace it. It lands on top of it. The two can tighten into one knot that follows a veteran home and into a marriage, into parenting, and into a whole community.
This article explains what racial trauma is, how it shows up in everyday life, why it matters so much for Black veterans in particular, and what helps.
What Is Racial Trauma?
Racial trauma, sometimes called race-based traumatic stress, is the psychological and physical toll of experiencing racism. That can mean direct discrimination or threats. It can also mean watching racial violence happen to people who look like you, or the slow buildup of slights and barriers over years.
Racial trauma is not currently a formal diagnosis on its own. But its effects look a lot like traumatic stress: hypervigilance, avoidance, intrusive memories, anger, and a body that stays on alert. Unlike a single traumatic event, it is usually cumulative. It does not end; it keeps getting renewed.
How Racial Trauma Shows Up in Daily Life
In the body
- Muscle tension, headaches, and jaw clenching that flare in certain settings
- Trouble falling or staying asleep, especially after a distressing incident or news cycle
- Stomach problems and fatigue tied to chronic stress
- A heart rate that jumps during traffic stops, store security checks, or job interviews
In the mind and emotions
- Vigilance: constantly reading a room for danger or disrespect
- Code-switching fatigue: the energy it takes to manage how you are perceived
- Anger that has nowhere safe to go, which often turns into irritability at home
- Self-doubt: wondering whether an incident “really” happened or whether you are overreacting
- Emotional shutdown: learning not to show pain because showing it was never safe
In behavior
- Avoiding certain neighborhoods, businesses, or institutions
- Delaying medical or mental health care because of past experiences of being dismissed
- Overworking to prove you belong
- Pulling away from people, including the people you love most
The Numbers: Black Americans Serve at a Higher Rate
Black Americans have served in every American war, and they continue to serve at a rate above their share of the population.
- Black Americans make up about 12.4% of the U.S. population (2020 Census, Black alone).
- In 2022, about 17.3% of active-duty service members (roughly 226,000 people) identified as Black or African American, according to Department of Defense demographic data.
- That is roughly 1.4 Black service members for every 1 you would expect based on population share alone.
- In the Army, the share is about 21%.
- The gap is even wider for women. In 2016, about 30% of active-duty enlisted women were Black, compared with about 17% of enlisted men.
Those numbers mean the overlap between racial trauma and combat trauma is not a small or niche issue. It touches a very large number of Black families, and Texas, home to some of the country’s largest military installations and veteran populations, feels it directly.
When Racial Trauma Meets Wartime PTSD
Here is the pattern I saw again and again at the VA. A young Black man or woman enlists, often already carrying years of racial stress: being watched in stores, being treated as a threat, growing up with “the talk” about police. Then comes training, deployment, and combat, with all the danger and loss that brings.
The research backs up what clinicians see:
- Higher PTSD screening rates. Among veterans who had left active duty within the previous 90 days, Black veterans screened positive for PTSD more often (36.3%) than any other racial or ethnic group, including White veterans (22.5%).
- Discrimination is part of the explanation. In a national sample of 3,060 veterans, the gap in PTSD, depression, and anxiety symptoms between Black and White veterans was explained in part by everyday discrimination and by income.
- Discrimination can make PTSD worse over time. In a study following trauma-exposed veterans for six months, stress from discrimination was linked to increases in PTSD severity. That link was stronger for Black women than for Black men.
- Treatment results have lagged. In a national study of 2,870 veterans in VA residential PTSD programs, Black veterans improved, but their PTSD symptoms dropped less during treatment than White veterans’ did. They were also more likely to see depression return four months after discharge.
Why the two kinds of trauma compound each other
The symptoms overlap and reinforce each other. Combat PTSD trains the nervous system to scan for threats. Racial trauma has often trained the same habit since childhood. When a veteran comes home, the “threat detector” never gets the message that the war is over, because everyday life keeps supplying reasons to stay on guard.
Trust gets damaged twice. Trauma from war can shatter a person’s sense that the world is safe. Racism can shatter the sense that institutions will be fair. For a Black veteran, that can include the very systems meant to help: the military, the VA, the justice system, or a doctor’s office.
Help-seeking gets harder. Military culture prizes toughness. Many Black families also learned to keep struggles private as a form of protection. Put those together and a veteran may wait years before telling anyone what is going on.
Experiences inside the military can add to the load. For some Black service members, racial harassment or unequal treatment happened during service itself. When that happens, racial trauma and military trauma are not two separate stories. They are the same story.
How This Affects Relationships and Families
PTSD is never just one person’s problem. It moves through a household. When racial trauma is part of the picture, the strain often looks like this:
- Emotional distance. Numbing helps a person survive combat and racism, but at home it can feel to a partner like coldness or rejection.
- Irritability and conflict. Anger that cannot be expressed at work or in public often comes out with the people who feel safest.
- Hypervigilance as a parent. Many Black parents already worry intensely about their children’s safety in the world. Add PTSD and that protectiveness can become control, constant alarm, or difficulty letting children take normal risks.
- Intimacy problems. Sleep disruption, nightmares, and feeling “on edge” make closeness hard to sustain.
- Silence across generations. When a parent cannot talk about what happened, children often sense the pain without understanding it. That is one of the ways trauma passes from one generation to the next.
Partners carry a heavy load too. Many Black spouses of veterans are managing their own experiences of racism while supporting a partner with PTSD. That can lead to caregiver burnout, resentment, and loneliness.
The Ripple Effect on Black Communities
Because Black Americans serve at higher rates, combat-related PTSD is concentrated in Black neighborhoods and Black families. When PTSD goes untreated, it can show up as lost work, money problems, substance use, health problems, and broken relationships. Those losses affect children, extended family, churches, and whole communities.
The same research that found discrimination helps explain veterans’ symptom gaps also found that income matters. Financial strain and racial stress feed each other. That is why healing has to address the whole person, not just a checklist of symptoms.
What Helps: Healing Is Possible
None of this means outcomes are fixed. Black veterans and their families heal every day, and good treatment makes a real difference.
- Evidence-based PTSD therapy. Cognitive Processing Therapy (CPT) and Prolonged Exposure (PE) are among the best-supported treatments for PTSD.
- Making room for race in the therapy room. These treatments work best when racial experiences are part of the conversation, not set aside as “off topic.” For many veterans, the “stuck points” CPT works on include beliefs shaped by racism as well as by combat.
- Treating the couple and the family. Couples therapy can help partners understand PTSD symptoms instead of taking them personally, and rebuild trust and closeness. See also how to support a partner with military PTSD.
- A therapist who understands. Many clients find it easier to open up with a clinician who understands both military culture and the Black experience. Read more about the benefits of having a Black therapist.
- Care that fits your life. Telehealth removes the commute, the waiting room, and some of the stigma. It is one way veterans across Texas can get care when VA wait times are long or the nearest clinic is far away.
When PTSD Affects Your Life: VA Disability Claims and DBQs
Healing is one part of recovery. For many veterans, getting their service-connected conditions properly recognized by the VA is another. A fair disability rating can mean steady monthly compensation, access to care, and some financial breathing room for the whole family. That matters, because money stress and racial stress tend to feed each other.
The VA rates PTSD, depression, anxiety, and most other mental health conditions on one scale: 0, 10, 30, 50, 70, or 100 percent. The rating depends on how much your symptoms affect your work, your relationships, and your daily life. The key document behind that decision is often a Disability Benefits Questionnaire (DBQ), a standardized VA form a clinician fills out to describe your condition in the language VA raters use.
This is where the compounding effect of racial trauma and combat trauma can get lost. A veteran who has spent a lifetime learning to stay composed and not show pain may understate how much they are struggling. When the evaluation does not capture how symptoms show up at work, at home, and in your marriage, the rating may not match what you are actually living with.
Because of my years as a VA PTSD psychologist, I know how these evaluations work from the inside. Through my VA disability evaluation services, I offer thorough, independent mental health evaluations and can complete the mental health DBQs that VA allows private providers to submit:
- Mental Disorders (other than PTSD and eating disorders): for conditions such as depression, anxiety, and bipolar disorder.
- PTSD Review: for veterans who are already service connected for PTSD and whose symptoms have gotten worse.
- Eating Disorders.
A few honest points every veteran should know:
- The Initial PTSD DBQ is not available to private providers. If you are claiming PTSD for the first time, the VA’s own examiner or a VA contract examiner completes that form. Your private treatment records still count as evidence. If anyone offers you a private “initial PTSD DBQ,” ask more questions.
- A private DBQ is never required. Many veterans are rated fairly on their VA Compensation and Pension (C&P) exam alone. The VA does not reimburse the cost of a private DBQ, and it may still schedule its own exam. If it does, go.
- I will tell you plainly if I think a private evaluation is unlikely to help your situation.
For a plain-English walkthrough of how these forms work, read my guide: What Is a DBQ? A Psychologist’s Plain-English Guide for Veterans.
Signs It May Be Time to Reach Out
- You feel on guard most of the time, even at home
- Your partner or children say you have changed, or seem to walk on eggshells around you
- Anger, drinking, or isolation are increasing
- Sleep is regularly broken by nightmares or racing thoughts
- News coverage of racial violence or war brings back memories you cannot shake
Working With Dr. Riggins
I am a Black licensed clinical psychologist and former VA psychologist. I treat PTSD, military trauma, racial trauma, and the relationship strain that comes with them, and I provide VA disability evaluations and mental health DBQs for veterans. I offer secure telehealth sessions across Texas and in participating PSYPACT states. Learn more about my PTSD therapy for veterans, or contact my office to schedule a consultation.
If you are in crisis: call or text 988 and press 1 for the Veterans Crisis Line, or text 838255. In an emergency, call 911.
Sources
- U.S. Department of Defense, 2022 Demographics Profile of the Military Community (summary via USNI News); Army figure via USAFacts.
- U.S. Census Bureau, 2020 Census, Black or African American alone population share.
- American Legion, 10 facts about African-American military service (2016 enlisted figures).
- Racial disparities in clinical outcomes of VA residential PTSD treatment between Black and White veterans, Psychiatric Services.
- The impact of perceived everyday discrimination and income on racial and ethnic disparities in PTSD, depression, and anxiety among veterans, PMC.
- The impact of discriminatory stress on changes in posttraumatic stress severity at the intersection of race/ethnicity and gender, Penn State.
This article is for general education and is not a substitute for individual diagnosis or treatment.