PTSD After Human Trafficking Mental Health awareness for human trafficking victims By : Chelsey, Tiffany and Zoey Survivors of human trafficking Although men, women, and children are trafficked and exploited in such economic sectors as construction, farming, fishing, textiles, and mining, the trafficking of women and girls for forced prostitution is among the most well-recognized forms of trafficking. Because of the often extreme sexual, physical, and psychological abuses associated with this form of gender-based violence, women and girls who are trafficked and sexually exploited through forced sex work or in other circumstances such as domestic servitude, are a population of particular concern for mental health specialists. Survivors who escape trafficking live with physical and psychological scars. While medical treatment helps restore survivors’ physical health, many continue to grapple with emotional wounds long after their bodies heal. Journals.lww.com. 2022 Effects of human trafficking on psychological health ● The psychological trauma experienced by survivors of trafficking may be considered as potentially devastating to their mental health. ● Many professionals who work with individuals who have been trafficked agree on the limitations of the terms like posttraumatic stress disorder (PTSD), depression, and anxiety to describe their psychological and psychiatric problems. ● Complex trauma actually changes the way our brains are organized ● Treating complex PTSD often involves addressing interpersonal and relational difficulties and specific symptoms of chronic and devastating interpersonal trauma. David Okech, Nathan Hansen, Waylon Howard, John K. Anarfi & Abigail C. Burns (2018) PTSD and “more” in human trafficking victims ● In a study of persons trafficked into or within the United States, high rates of depression (71%) and PTSD (61%) were found. ● It is interesting to note that, although only 61% met full criteria for PTSD, 91% of the sample (N = 131) endorsed various symptoms of PTSD; 45% reported suicidal ideation, and 59% endorsed comorbidity of PTSD and depression. ● The mental disorders experienced by sexual trafficking victims are comparable to those experienced by prisoners of war. ● Extensive and persistent health problems are associated with complex trauma and PTSD Journals.lww.com. PTSD and “More” cont’d Human trafficking vitims also suffer from: ● ● ● ● ● ● Depression (88.7%) Anxiety (76.4%) Nightmares (73,6%) Flashbacks (68.0%) Low self-esteem (81.1%) Feelings of shame and guilt (82.1%) Poorer mental health outcomes were found for women with histories of previous violence, abuse, and neglect and for those who were trafficked for 6 months or more. Journals.lww.com. 2022 Common characteristics of survivors of complex trauma ● Depressive disorders ● Anxiety disorders ● Substance abuse disorders ○ addiction can be used as a control mechanism by traffickers to coerce and force their victims into engaging in commercial sex against their will. ● PTSD ● Panic disorders ● Stockholm Syndrome ○ feelings of closeness and sympathy with their traffickers, tending to rationalize or minimize the abuse to which they were subjected. While they are being trafficked, this allegiance may help trafficking victims survive their enslavement. However, once they escape their trafficking situation, an over-identification with their trafficker may prevent survivors from seeking the help they need or cooperating with authorities to bring the perpetrator to justice Journals.lww.com. 2022 Nursing Assessments of human trafficking victims ● 85% of trafficked victims have contact with health care providers in any year, nurses are critical to: the identification of trafficked persons; and effective promotion of their physical, mental, and cognitive health. Emergency nurses are often the first health care professionals to interact with victims because the brutal nature of the business frequently leaves these victims with lifethreatening injuries. As frontline caregivers, these nurses are also the link between victims and other service providers, making it necessary for the nurses to be skilled in identifying victims, providing appropriate interventions, and working collaboratively with other agencies to protect victims from further harm. Speck, P. M. (2018). Signs\Symptoms of Victims ● Branding or tattoos indicating ownership ● Bald patches on the head where the hair has been pulled out ● Bite marks ● Strangulation marks on the throat ● Petechiae in various locations such as the wrist ● Wounds in various stages of healing ● Vaginal or rectal trauma ● Sponges or cloths stuffed in the vaginal canal ● Untreated infections ● Broken bones ● Burn marks Speck, P. M. (2018). Risks for complications: ● ● ● ● ● Many victims leave the healthcare system are unrecognized and return to being victims of sex trafficking. Sex trafficking victims have often endured not only sexual abuse but physical and psychological trauma, enslavement, substance abuse. Because they have been taken from their families, it may be difficult for victims to go back to their “old” lives. They may be ashamed or feel that no one understands, which may cause social isolation. They may resort to drugs or alcohol to cope with their feelings Sex trafficking vitims may have lasting physical affects, such as sexually transmitted diseases, some of which may have no cure. This could also lead to depression, and possible suicidal ideations. Speck, P. M. (2018). Medication treatment for PTSD ● Sertraline ○ Zoloft ■ SSRI ● Paroxetine ○ Paxil ■ SSRI ● Fluoxetine ○ Prozac ■ SSRI ● Venlafaxin ○ Effexor ■ SNRI Townsend, M.C., & Morgan, K.I. (2020) Evidence Based Therapeutic Treatment Options for PTSD Cognitive Therapy Aims to challenge dysfunctional thoughts based on irrational or illogical assumptions. Cognitive-Behavioral Therapy Combines cognitive therapy with behavioral interventions such as exposure therapy, thought stopping, or breathing techniques. Exposure Therapy Aims to reduce anxiety and fear through confrontation of thoughts (imaginal exposure) or actual situations (in vivo exposure) related to the trauma. Eye Movement Desensitization and Reprocessing Combines general clinical practice with brief imaginal exposure and cognitive restructuring (rapid eye movement is induced during the imaginal exposure and cognitive restructuring phases). Stress Inoculation Training Combines psycho-education with anxiety management techniques such as relaxation training, breathing retraining, and thought stopping. Townsend, M.C., & Morgan, K.I. (2020) Resources for Victims of Sex Trafficking: ● ● ● If an adult victim does not with to leave their situation the nurse should discreetly provide the victim with information for the National Human Trafficking Hotline. (888373-7888) Anti-Trafficking International (ATI) Community Resources in Virginia -Avalon Center for Women and Children - ACTS SAVAS Sexual Assult Victims Advocacy Services - Empower House - The Butterfly House (Virginia Department of Criminal Justice Services, 2022) References Journals.lww.com. 2022. Journal of the American Association of Nurse Practitioners. [online] Available at: <https://journals.lww.com/jaanp/pages/default.aspx> [Accessed 14 June 2022]. David Okech, Nathan Hansen, Waylon Howard, John K. Anarfi & Abigail C. Burns (2018) Social Support, Dysfunctional Coping, and Community Reintegration as Predictors of PTSD Among Human Trafficking Survivors, Behavioral Medicine, 44:3, 209-218, DOI: 10.1080/08964289.2018.1432553. Speck, P. M. (2018, July 01). Nursing Outlook, 66(4) Virginia Department of Criminal Justice Services. (2022). Retrieved from Human Trafficking: https://www.dcjs.virginia.gov/humantrafficking/virginia-human-trafficking-resource-guide References: U.S. Department of State. (2022, January 19). About human trafficking - united states department of state. U.S. Department of State. Retrieved June 12, 2022, from https://www.state.gov/humantrafficking-about-human-trafficking/ Ink, S. (2021, August 31). Because human trafficking is a health issue. HEAL Trafficking: Health, Education, Advocacy, Linkage. Retrieved June 13, 2022, from https://healtrafficking.org/ Human trafficking education: #HelpERASE child trafficking. ERASE Child Trafficking. (2016, May 6). Retrieved June 13, 2022, from https://www.erasechildtrafficking.org/human-trafficking-education/ Lisa Waugh, K. B. (n.d.). Human trafficking and the Health Care System . Human Trafficking and the Health Care System. Retrieved June 13, 2022, from https://www.ncsl.org/research/health/human-trafficking-and-the-health-care-system.aspx Human trafficking. Fight Human Trafficking With Covenant House. (n.d.). Retrieved June 13, 2022, from https://www.covenanthouse.org/homeless-issues/humantrafficking References: Williamson, Erin, Dutch, Nicole M., And Clawson, Heather J. Caliber, An ICF International Company. (2010). EvidenceBased Mental Health Treatment for Victims of Human Trafficking. ASPE. https://aspe.hhs.gov/reports/evidencebased-mental-health-treatment-victims-human-trafficking-0
