DSM 5 TR: The Impact of Racism and Discrimination on Mental Disorders

Mental health care has made significant strides, yet the impact of racism and discrimination on mental health has often been overlooked. The text revision of the Diagnostic and Statistical Manual of Mental Disorders, the DSM-5-TR, published by the American Psychiatric Association in 2022, set out to change that by explicitly addressing how these factors shape diagnosis and treatment.

The DSM-5-TR emphasizes the social construction of race, introduces the term “ethnoracial,” and avoids language that reinforces social hierarchies. These changes are more than semantic adjustments; they are steps toward mental health care that is more accurate and equitable for everyone.

This post covers the DSM-5-TR’s language updates, what research shows about racism and mental health, strategies for culturally responsive care, and how these topics show up on the ASWB exam. You’ll also find practice questions with rationales.

Learn more about the ASWB exam and create a personalized ASWB study plan with Agents of Change. We’ve helped more than 100,000 Social Workers pass their ASWB exams and want to help you next!

Jump to: DSM-5-TR Language Updates · Racism and Mental Health · Culturally Responsive Care · On the ASWB Exam · Practice Questions · FAQs

1) How the DSM-5-TR Addresses Race and Discrimination

The DSM-5-TR is the first edition of the DSM to systematically review its text for the influence of racism and discrimination. A work group reviewed the manual’s language to reduce bias and better reflect how social context affects mental health. Key changes include:

• “Racialized” instead of “race/racial” in many places, to highlight that race is a social construct rather than a biological category.
• “Ethnoracial” to describe U.S. Census categories such as Hispanic, African American, or White, which combine ethnic and racialized identifiers.
• Avoiding “minority” and “non-White”, which describe groups in relation to a presumed majority and reinforce social hierarchies.
• “Latinx” in place of Latino/Latina, as a gender-inclusive term.
• Not using “Caucasian”, which is based on outdated and inaccurate ideas about race.
• Including prevalence data for specific ethnoracial groups only when research provides reliable estimates from representative samples.
• Attention to misdiagnosis risk when evaluating people from socially oppressed ethnoracial groups.

Why the Social Construction of Race Matters

Treating race as a social construct shifts the focus from assumed biological differences to the social experiences, such as discrimination, exclusion, and unequal access to resources, that shape mental health. For clinicians, this means looking at a client’s context rather than attributing symptoms to group membership.

Reducing Misdiagnosis

People from marginalized ethnoracial groups face a higher risk of misdiagnosis. Research has long shown, for example, that Black Americans are more likely than White Americans to be diagnosed with schizophrenia and less likely to be diagnosed with mood disorders, a pattern linked in part to clinician bias and cultural differences in how distress is expressed. The DSM-5-TR encourages clinicians to consider culture and context throughout assessment, supported by tools like the Cultural Formulation Interview (CFI), which helps clinicians understand how a client views their problem, its causes, and helpful sources of support.

Agents of Change packages include video and audio lessons, hundreds of practice questions, a personalized study plan, and 2 live study groups each month so you’ll be ready for test day!

2) The Impact of Racism and Discrimination on Mental Health

The relationship between racism, discrimination, and mental health is complex. It involves historical context, ongoing stress, and barriers to care.

Historical Context

• Unequal care: Historically, people of color often received segregated or substandard mental health care.
• Mistrust of medical institutions: Abuses such as the Tuskegee Syphilis Study contributed to lasting mistrust among many communities of color.
• Underrepresentation in research: Limited representation in research and clinical trials has meant less culturally relevant data and treatment approaches.

Racism as a Chronic Stressor

Racism is often not a single event but an ongoing stressor that includes interpersonal discrimination, microaggressions, and systemic inequities. Large research reviews have found that experiences of racism are associated with poorer mental health, including higher levels of depression, anxiety, and psychological distress. Discrimination has also been linked to physical health effects, such as higher blood pressure. Some people describe the effects of racism as racial trauma, and repeated or severe experiences can contribute to trauma symptoms.

Discrimination Across Systems

• Workplace discrimination is linked to job stress, anxiety, and depression.
• Housing discrimination can contribute to unstable living conditions and chronic stress.
• Educational inequities can affect students’ mental health and academic opportunities.

Internalized Racism

Internalized racism occurs when people come to believe negative societal messages about their own racial or ethnic group. It can contribute to lower self-esteem, identity distress, and coping through harmful behaviors.

Barriers to Care

Barriers vary by community and may include cost, lack of insurance, language access, a shortage of clinicians who share or understand clients’ cultural backgrounds, stigma, and, for some immigrant families, fears related to immigration enforcement. Understanding these barriers helps Social Workers design more accessible services.

3) Strategies for Culturally Responsive Care

Culturally responsive care means understanding and respecting clients’ cultural backgrounds, values, and experiences, and incorporating that understanding into every part of care.

Cultural Awareness, Sensitivity, and Humility

• Cultural awareness: Recognizing cultural differences within and between groups, supported by ongoing training.
• Cultural sensitivity: Respecting clients’ traditions and avoiding assumptions based on their background.
• Cultural humility: An ongoing process of self-reflection, recognizing the limits of your own understanding and treating clients as the experts on their own experiences.

Assessing With Culture in Mind

• Ask clients how they understand their concerns and what they believe would help, using tools like the Cultural Formulation Interview.
• Consider how distress may be expressed differently across cultures, including physical symptoms.
• Ask directly and respectfully about experiences of discrimination and their impact.
• Reflect on how your own identity and biases may influence your assessment.

Building Trust

• Community engagement: Participate in community events and collaborate with community leaders.
• Transparent communication: Explain treatment options, risks, and benefits clearly as part of informed consent.
• Feedback: Invite and act on client feedback about their care.
• Language access: Offer services or qualified interpreters in clients’ preferred languages.

Advocacy and Systemic Change

• Policy advocacy: Support anti-discrimination policies and funding for services in underserved communities.
• Institutional change: Promote diverse hiring, culturally responsive policies, and accountability within organizations.
• Measuring outcomes: Track service use, outcomes, and satisfaction across groups to identify and address disparities.

4) How These Topics Show Up on the ASWB Exam

On the new ASWB exam, these concepts connect most closely to the Values and Ethics content area, which includes diversity and social justice and anti-oppressive practice, and to Assessment and Planning, which includes culturally informed assessment.

Learn more about the ASWB exam and create a personalized ASWB study plan with Agents of Change. We’ve helped more than 100,000 Social Workers pass their ASWB exams and want to help you next!

5) ASWB Practice Questions: Culture, Racism, and Assessment

Question 1: A client who recently immigrated describes frequent headaches, fatigue, and trouble sleeping, and says these problems began after “too much worry about my family back home.” What should the Social Worker do FIRST?

A) Refer the client to a physician to rule out a medical cause
B) Explore the client’s understanding of the problem and what they believe would help
C) Diagnose generalized anxiety disorder based on the client’s worry

Correct Answer: B) Explore the client’s understanding of the problem and what they believe would help

Rationale: Understanding the client’s own explanation of the problem, as in the Cultural Formulation Interview, is the foundation of culturally informed assessment. A medical referral (A) may be appropriate later, but exploring the client’s perspective comes first. Diagnosing immediately (C) skips assessment and risks misdiagnosis.

Question 2: A Black client tells a Social Worker that repeated racist comments from a supervisor have left them anxious and unable to sleep. What is the Social Worker’s BEST response?

A) Validate the client’s experience and assess how the discrimination is affecting their functioning
B) Suggest the client may be misinterpreting the supervisor’s comments
C) Recommend the client file a formal complaint right away

Correct Answer: A) Validate the client’s experience and assess how the discrimination is affecting their functioning

Rationale: Validating the client’s experience builds trust, and assessing its impact guides next steps. Questioning the client’s perception (B) is invalidating and can harm the relationship. Filing a complaint (C) may be an option later, but the decision belongs to the client after their needs and goals are explored.

Question 3: During supervision, a Social Worker realizes that they have been making assumptions about a client based on the client’s ethnic background. What should the Social Worker do?

A) Transfer the client to another Social Worker
B) Continue as usual, since the assumptions haven’t caused obvious harm
C) Reflect on the bias with the supervisor and adjust their approach with the client

Correct Answer: C) Reflect on the bias with the supervisor and adjust their approach with the client

Rationale: Cultural humility involves recognizing personal biases and working to address them. Supervision is the right place to do that work. Transferring the client (A) isn’t necessary when the issue can be addressed, and ignoring the bias (B) risks harm to the client and the relationship.

Want more practice? Agents of Change offers four full-length, 122-question practice exams built for the new exam, and you can start with our free ASWB practice questions.

6) FAQs: Racism, Discrimination, and the DSM-5-TR

What changed in the DSM-5-TR regarding race and racism?

The DSM-5-TR reviewed its text for the influence of racism and discrimination. It treats race as a social construct, uses terms like “racialized” and “ethnoracial,” avoids “minority,” “non-White,” and “Caucasian,” and highlights the risk of misdiagnosis in socially oppressed ethnoracial groups.

What is culturally competent care, and why does it matter?

Culturally competent (or culturally responsive) care means understanding and respecting clients’ cultural backgrounds and incorporating them into assessment and treatment. It helps reduce misdiagnosis, builds trust, and can improve engagement and outcomes for clients from diverse backgrounds.

How does racism affect mental health?

Research links experiences of racism and discrimination with higher levels of depression, anxiety, and psychological distress, and with physical health effects. Racism can act as a chronic stressor through interpersonal discrimination, microaggressions, and systemic inequities.

How can Social Workers build trust with marginalized communities?

Engage with the community, communicate transparently, provide services in clients’ preferred languages, invite feedback, and advocate for policies that reduce barriers to care.

7) Conclusion

The DSM-5-TR’s updates mark an important step in recognizing how racism and discrimination affect mental health. By using more accurate language and highlighting the risk of misdiagnosis, the manual encourages clinicians to consider each client’s social context.

For Social Workers, that means practicing cultural humility, assessing with culture in mind, building trust, and advocating for systemic change. For the ASWB exam, remember the core pattern: understand the client’s perspective first, avoid assumptions, and act in line with social justice values.

Agents of Change packages include video and audio lessons, hundreds of practice questions, a personalized study plan, and 2 live study groups each month so you’ll be ready for test day!

► Learn more about the Agents of Change course here: https://agentsofchangeprep.com

About the Instructor, Dr. Meagan Mitchell: Meagan is a Licensed Clinical Social Worker and has been providing individualized and group test prep for the ASWB for over 11 years. From all of this experience helping others pass their exams, she created the Agents of Change course to help you prepare for and pass the ASWB exam!

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Disclaimer: This content has been made available for informational and educational purposes only. This content is not intended to be a substitute for professional medical or clinical advice, diagnosis, or treatment.