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Letters   |    
Did Microinsults and Microaggressions Play a Role?: In Reply
Marc I. Rosen, M.D.; David Afshartous, Ph.D.; Brian P. Marx, Ph.D.
Psychiatric Services 2013; doi: 10.1176/appi.ps.640703
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Copyright © 2013 by the American Psychiatric Association

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In Reply: Dr. Bell asks whether we know if “microinsults” and “microaggressions” were related to the finding that ratings of PTSD examiners were less favorable among African-American veterans than among Caucasian veterans. It is noteworthy that African Americans rated examiners lower on both the quality of the examination provided and the examiners’ “interpersonal qualities,” which would be consistent with the idea that some aspects of the interpersonal encounter were especially off-putting to African-American veterans. However, the overall ratings of examiners were high among both African-American and Caucasian veterans, so the effect of any possible “microinsults” was apparently not strong enough to result in low ratings on average.

The question Dr. Bell asks is important. If examiner behaviors are disparaging, better examiner training would be one approach to correct this. The examinations were audiotaped, and we hope to conduct a qualitative analysis of exchanges between veterans and examiners to better understand what transpires during these important and often highly charged examinations.

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