A number of studies have identified the serious and often complex mental health needs of victims of human trafficking. The majority of research related to the mental health needs of this population focuses on the significant levels of posttraumatic stress disorder (PTSD) (International Organization for Migration, 2006; Pico-Alfonso, 2005; Zimmerman et al., 2006). Victims of human trafficking have often experienced, witnessed, or [been] confronted with an event or events that involved actual or threatened death or serious injury, or a threat to the physical integrity of self or others and their response to these events frequently involves intense fear, helplessness, or horror. This exposure and common reaction are two of the main criteria for PTSD (American Psychiatric Association [APA], 2005, p. 467). While there is some evidence that preexisting conditions related to social supports, history, childhood experiences, personality variables, and preexisting medical disorders can factor in the diagnosis of PTSD, exposure to trauma is the most important feature in the development of PTSD. An official diagnosis requires that symptoms be present for more than 1 month, before which a differential diagnosis of acute stress disorder may be made (APA, 2005). PTSD often presents itself within the first 3 months after a traumatic event; however, it can also have a delay in presentation for months or even years (APA, 2005). While both adults and children can be diagnosed with PTSD, studies have demonstrated that women tend to be more vulnerable than men to developing PTSD upon exposure to life-threatening events (Seedat, Stein, & Carey, 2005). In about half of patients, a complete recovery occurs within 3 months (APA, 2005); however, PTSD has been shown to last significantly longer in women than men (Breslau et al., 1998).
|Recurrent thoughts/memories of terrifying events||75%|
|Feeling as though the event is happening again||52%|
|Unable to feel emotion||44%|
|Jumpy, easily startled||67%|
|Feeling on guard||64%|
|Feeling irritable, having outbursts of anger||53%|
|Avoiding activities that remind them of the traumatic or hurtful event||61%|
|Inability to remember part or most of traumatic or hurtful event||36%|
|Less interest in daily activities||46%|
|Feeling as if you didnt have a future||65%|
|Avoiding thoughts or feelings associated with the traumatic events||58%|
|Sudden emotional or physical reaction when reminded of the most hurtful or traumatic events (Zimmerman et al., 2006)||65%|
In addition to PTSD, victims of human trafficking have been found to suffer from other anxiety and mood disorders including panic attacks, obsessive compulsive disorder, generalized anxiety disorder, and major depressive disorder (Alexander, Kellogg, & Thompson, 2005; APA, 2005; Family Violence Prevention Fund, 2005; Zimmerman et al., 2006). One study found that survivors of human trafficking reported the following anxiety and depression symptoms: nervousness or shakiness inside (91%), terror/panic spells (61%), fearfulness (85%), feeling depressed or very sad (95%), and hopelessness about the future (76%) (Zimmerman et al., 2006).
Individuals with traumatic histories of physical and/or sexual abuse have also been found to be at increased risk for the development of dissociative disorders (International Society for the Study of Dissociation, 2004). The correlation between dissociation and human trafficking has been demonstrated through both research and the testimony of mental healthcare providers (Williamson, Dutch, & Clawson, 2008; Zimmerman, 2003). Dissociative disorders are characterized as a disruption in the usually integrated functions of consciousness, memory, identity, or perception (APA, 2005, p. 519). One study conducted in Europe found that 63 percent of victims of trafficking have memory loss (Zimmerman et al., 2006). Dissociative disorders can present themselves suddenly or gradually and can be either transient or chronic (APA, 2005). Some victims may simply not be able to recall certain events or details of events while others may continue to disassociate in an effort to prepare for future threats (Zimmerman, 2003). When making a diagnosis of dissociative disorders, mental healthcare providers should assess dissociative states through a cross-cultural perspective as they are common and accepted in many societies. For example, in some societies dissociative states such as voluntary trances are not pathological and do not cause clinically significant distress or functional impairment. Local instances of culturally normative dissociative states vary cross-culturally in terms of the behaviors exhibited during altered states, the presence or absence of dissociative sensory alterations (e.g., blindness), the various identities assumed during dissociation, and the degree of amnesia experienced following a dissociative state. By assessing dissociative states through a cross-cultural perspective, providers can identify whether individuals are undergoing culturally normative dissociative states that align with their cultural beliefs or whether they are experiencing states causing clinical distress or impairment (APA, 2005).
Substance-related disorders are often found to be co-morbid in victims of human trafficking (International Organization for Migration, 2006; Zimmerman, 2003). While a few victims of trafficking reported prior substance addictions, the majority of victims who reported alcohol and drug use said they began using after they were in their trafficking situations (Raymond et al., 2002; Zimmerman, 2003). Some victims reported using alcohol and drugs to help them deal with their situations; however, others reported being forced or coerced to use drugs or alcohol by traffickers (Raymond et al., 2002; Zimmerman, 2003).
Complex trauma, defined as a type of trauma that occurs repeatedly and cumulatively, usually over a period of time and within specific relationships and contexts (Courtois, 2008, p. 86) is receiving increasing attention in the mental health field. While this disorder is not currently incorporated into the fourth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV), mental healthcare providers, particularly those working in the field of child trauma, are advocating for its inclusion in the DSM-V (Moran, 2007). Complex trauma has been linked to trauma endured during periods of extended captivity and has been directly associated with human trafficking (Courtois, 2008). Victims suffering from complex trauma often experience depression, anxiety, self-hatred, dissociation, substance abuse, despair, and somatic ailments. Individuals exposed to this type of trauma are also at heightened risk for self-destructive and risk-taking behaviors as well as re-victimization, and tend to experience difficulty with interpersonal and intimate relationships (Courtois, 2008). Future incorporation of this diagnosis into the DSM-V may have significant implications for the diagnosis and treatment of victims of human trafficking.
While victims of human trafficking can suffer from a range of mental health problems, the most prominent and those for which there is significant research documenting their presentation tend to be anxiety disorders, mood disorders, dissociative disorders, and substance-related disorders. While the future diagnosis of complex trauma in this population is possible, the uncertainty of its inclusion in the DSM-V prohibits extensive examination of evidence-based research regarding the treatment of this disorder.