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Human Trafficking
Commercial Sexual Exploitation:
clinical issues and considerations
by Ana L. Nogales, Ph.D.
Psychologist – PSY 11317
Casa de la Familia
www.casadelafamilia.org
213-384-8494
714-667-5220
Human Trafficking
Involves the movement of people against
their will, by means of force, for the purpose
of labor or commercial sexual exploitation.
Examples include: forced labor, abduction for
sexual service (including boys), forced
prostitution, and commercial sexual
exploitation of children.
(US Dept. of State, 2008)
Definition
Human trafficking of individuals used for
commercial sexual exploitation, involves the
recruiting, transporting, harboring, or
receiving of victims for the purpose of
prostitution, pornography, or sexual
exploitation.
By: threat, coercion, fraud, abduction,
deception, and/or abuse of power.
Commercial Sex
Encompasses street prostitution,
escort services, online pornography,
and work in strip clubs.
It is estimated that 1.39 million
people are trafficked each year into
the sex trade industry.
(Geneva-based International Labor Organization)
Trafficking victims
According to the Congressional Research
Service (CRS) and the U.S. State Department,
700,000 to 2 million people, the majority of
them women and children, are trafficked each
year across international borders
("Human Trafficking Exposed," Population Today).
Trafficking into the US
The Department of Justice
estimates that 20,000 people are
trafficked into the United States
each year and forced into sexual
slavery for little or no pay.
Worldwide
United Nations estimates that there
are between 20-27 million people
who are held in slavery, through
violence, against their will, and for
no pay
(National MultiCultural Institute (NMCI)).
HT as business
Human trafficking is the second most
prolific industry within the criminal world
(drug trafficking is first), producing
approximately 9.5 billion dollars annually
(Department of Health and Human Services, Rescue and
Restore, Victims of Human Trafficking).
Control of victims
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Debt bondage - financial obligations, honor-bound to satisfy debt
Isolation from the public
Isolation from family members, members of same community
Confiscation of passports, visas and/or identification documents
Use or threats of violence toward victims and/or families of victims
Threats of shaming victims by exposing circumstances to family
Telling victims they will be imprisoned or deported for immigration
violations if they contact authorities
• Control of the victims' money, e.g., holding their money for "safe-keeping"
Fears of escaping
Once submersed in sexual
exploitation, children and victims
find it extremely difficult to escape
for fear of being brutalized, arrested,
or deported
Minor victims: can they willingly
choose to prostitute themselves?
If the age of an individual has been verified to
be under 18, and the individual is in any way
involved in the commercial sex industry, or has
a record of prior arrest for prostitution (or
related charges), then he or she is a victim of
commercial sexual exploitation, no matter
what the minor may declare.
“Pimps”
“Pimps” promise protection, and in
some cases speak to them lovingly,
convincing these girls that the task
they fulfill is ideal for any young
person, and that they are the
privileged girls.
“Pimps”
95% of underage people who dedicate
themselves to prostitution have “pimps” who
control them. They end up accepting this form
of life, respecting their “protector”, and,
ultimately, feeling gratitude towards them.
The majority even harbor feelings of
responsibility and guilt, in spite of their being
viewed as victims who never wanted a life of
prostitution.
Stockholm Syndrome
• Some victims develop feelings of loyalty and
gratitude towards their kidnappers and will
seek their approval.
• Emotionally bonding with an abuser is actually
a strategy for survival for victims of abuse and
intimidation.
Stockholm impact
• Positive feelings by the victim toward the pimp
• Negative feelings by the victim toward family, friends,
or authorities trying to rescue/support them or win
their release
• Support of the pimp's reasons and behaviors
• Perceived possible positive feelings by the pimp toward
the victim
• Supportive behaviors by the victim, at times helping
the abuser
• Inability to engage in behaviors that may assist in their
release or detachment
Victimization: human trafficking
and domestic violence
• Emotional dependence on the trafficker as the intensity
and distinctiveness of the relationship can create a bond
• Blaming own behavior for trafficker’s violence against them
• Coping mechanisms: prefer to stay with the known,
regardless of how bad it is, rather than venture into the
unknown
• Lack of survival resources (housing, income, employment,
life management skills, etc…)
• Potential drug dependence
• Psychological trauma and depression
“Johnnies”
Slaves of sexual trafficking would
not exist if it were not for the outside
demands of those who desire these
victims.
• Minors are solicited by pedophiles
of every race that exist at all levels of
society.
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Operations
Women and children are transferred,
under strict monitoring, from one brothel
to another one under usually the
influence of drugs. Sometimes, they are
not even aware of what city they are in.
Drugs and alcohol allow the sex
traffickers to control the enslaved
women and children.
Dependency on “pimps”
Because the majority of victims are foreigners,
they are scared of local authorities, believing
that they will be arrested for prostitution.
Eventually, they become emotionally
dependent on their captors, who in turn
promise them money and security.
REPETITIVE TRAUMA
Documented cases have uncovered victims
being raped as many as 40 times per day.
Months, and even years, after being rescued,
victims may still experience emotional
problems, which can lead to significant
distress in all areas of functioning. As is
different from sexual assault or rape, there is
no time for recovery as the victim is
repetitively traumatized, threatened, and
given a perception of fatality.
No escape
They live tormented lives, distrusting everyone
because they cannot distinguish between
their allies and their captors. They become
robot-like and devoid of feelings. Emotional
detachment and a dissociative process are
common defense mechanisms to cope with
devastation. In many cases, suicide is the only
option they consider.
About the victims
Approximately 80 to 90% of the
victims have been sexually molested
during childhood. Most of them are
the products of devastatingly
impoverished environments, and are,
therefore, easy targets into
prostitution.
Helplessness
Upon rescue, many victims may not
be cooperative even though they
wish to end their slavery.
A Community Member’s Guide to Fighting Human Trafficking and Slavery.”
Free the Slaves, 2004, as cited in Anti-Trafficking Training Program,” The
Salvation Army, 2007:
Hopelessness
• Fear- Most victims have been coerced,
threatened, or abused.
• Threats to family members in home countryOftentimes, traffickers threaten to abuse or
murder family members if a victim refuses to
work or attempts to run away.
• Sense of shame- Some victims feel such an acute
sense of shame about the activities they have
been forced into that they fear exposing
themselves and their secrets to anyone.
Hopelessness
• Sense of obligation- Some victims feel obligated top
pay off their “debt,” even though the debt is false and
illegal.
• Sense of loyalty to the abuser- This may take place as
a result of brainwashing or traumatic bonding. Some
victims are made to feel that they themselves have
done something wrong, and that the trafficker
deserves to punish them.
• Language and social barriers- Extremely limited
contact with the outside world leaves many victims
isolated and many times without any understanding of
the language of their location.
Fear of police
and immigration officers
Police corruption experienced in
the victim’s home country is
often exploited by traffickers who
terrify their victims with stories
of what the police in the U.S. may
do to them.
Dissociative Fugue
DSM IV-TR (300.13).
To cope with trauma: sense of traveling away
from the moment and geographic location,
followed by difficulties recalling the
occurrence. They may even be confused about
their former identity and may assume a new
identity.
Depersonalization Disorder
DSM IV-TR (300.6 )
Persistent or recurrent episodes of depersonalization,
characterized by a feeling of detachment or
estrangement from one’s self. Victims may feel like an
automaton or as if they are living in a dream or a
movie. There may be a sensation of being an outside
observer of one’s mental processes, one’s body, or
parts of one’s body. Various types of sensory
anesthesia, lack of affective response, and a sensation
of lacking control of one’s actions, including speech,
are often present. Still, the victim may maintain intact
reality testing and remain aware that this is only a
feeling and that they are not really an automaton.
Dissociation continues
Within hours of rescue, there may be a sense
of disbelief, and possible dissociation. It is very
confusing for the victims, as they may not
know who to trust. They report that they do
not know how to think by themselves, as their
ability to make decisions has been affected.
Post Traumatic Stress Disorder
Response to trauma involves intense fear,
helplessness, or horror (or in children, the
response must involve disorganized or agitated
behavior):
• persistent re-experiencing of the traumatic event.
• persistent avoidance of stimuli associated with
the trauma and numbing of general
responsiveness.
• persistent symptoms of increased arousal .
Prolonged trauma
Associated to PTSD, prolonged
torture experiences or early trauma
exposure may impair personality
formation by enhancing the effects
of cognitive, affective and behavioral
vulnerabilities.
Trauma response
According to Hiley et al. (1993):
• Emotional
• Cognitive
• Biological
• Behavioral
• Characterological
Trauma: Emotional Response
• shock, disbelief, anger, rage, terror, guilt, grief,
vulnerability,
• irritability, helplessness, fears, anxiety,
depression, sadness, disgust, hostility,
• despair and anguish. Fears of abandonment, fear
of being alone, and wary of
• others. Unable or have difficulty with “loving"
feelings (feel detached/estranged).
• Angers easily, explosive temper.
Trauma: Cognitive responses
• impaired concentration, confusion, self-blame,
disorientation,
• intrusive thoughts, avoidance and decreased
self-esteem and lowered self efficacy,
• heightened fear of losing control, and fear of
reoccurrence of the trauma.
Trauma: biological response
Fatigue, sleeplessness
(insomnia), nightmares,
hyperarousal, startle response
and psychosomatic complaints.
Trauma: Sleep patterns
They experience less time in deep sleep, have
more awakenings, more abnormalities during
rapid eye movement sleep periods and spend
less total time sleeping.
Reduced REM latency, and increased sleep
movements, respirations and heart rate. Mild
to significant sleep apnea (breathing blockage)
is also evident.
(Engdahl, 1994).
Trauma: Behavioral Reaction
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avoidance,
alienation,
social withdrawal,
increased stress within relationships (marital
relationships suffer--less able to trust and be
intimate),
• substance abuse,
• sensation-seeking behavior,
• vocational impairment
Trauma:
Characterological consequences
Survivors of prolonged abuse
develop characteristic personality
changes including "deformations of
relations and identity"
(Herman,1992).
Suicide ideation
PTSD patients are six times more
likely to attempt suicide than the
general population, with victims
of sexual exploitation at an even
higher risk.
Possible symptoms
• Fears of traffickers
• Fear of policemen and other authorities such like
immigration officers
• Loss of meaning for life
• Nightmares
• Clinical depression
• Suicidal behavior
• Shame
• Embarrassment
• Inappropriate guilt
• Feelings of powerlessness
• Feelings of estrangement
Possible symptoms
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Anxiety, despair, anguish, rage, terror
Paranoia
Anger
Disbelief
Denial
Explosive outbursts
Sleep disturbance
Bond with perpetrators: Stockholm Syndrome
Emotional numbness
Loss of trust
Hyper-sexuality
Self-injurious behavior: to manage what feels unbearable at the moment.
Suicidal ideation
Symptoms as adaptation tools
They are an attempt to continue with
life, but are not manipulations.
Consequently, they create faulty
control methods such as self-blame,
passivity, addictive behaviors, and
potential self harm.
DRUGS/ALCOHOL
• Many victims are exposed to multiple drugs and
become dependent on them, often returning to
their traffickers because they are aware that
those drugs are available through them.
• Many victims have disclosed that they were
allowed to consume cocaine only with the pimp,
but not with anybody else, creating dependence
on the pimp and gratitude for the supply. Meth
consumption also creates a dependency for
which victims will return to their pimps for a
supply.
INTERVENTION
The victim’s safety is the top priority, which
may take placing them in a shelter, and, more
than likely, in another state. It is imperative to
develop a safety plan, placing special attention
towards protecting their anonymity by
preventing internet use and visitations to
known addresses, regular places, or people.
INTERVENTION
Restoration and recovery is a slow
and gradual process interfered by the
difficulty to trust. The victim may
need to learn how to confront and
control fears of threats, whose origin
was based in real danger, a task that
may be difficult as they may not
know who to trust.
RESCUE: Acute Phase – Disorientation
• They do not know who to trust.
• They are afraid of disclosing information that may hurt
themselves or others who are still under the control of
the traffickers.
• They are afraid of retaliation.
• They are afraid of immigration officers if they are
undocumented in the country.
• They are confused and report that they cannot think by
themselves.
• They may be able to provide testimony for others, but
not themselves
Intermediate Phase - first weeks or
months
• They are apprehensive and cautious.
• They may say that they understand they are
safe, but they are still very afraid of being
found by traffickers.
• They may continue experiencing sleeping
disorders that affect alertness.
Reorganization Phase: up to 6 months
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Anxiety and fear continue.
Disturbance of eating and sleeping may still be present
Impaired social functioning and intimacy difficulties.
Guilt for not preventing being victimized, or being
unable to leave on time.
• Guilt for contributing to the traffickers life (eg:
preparing their meals, attending their domestic chores)
• Shame for becoming a prostitute.
Intermediate effects – approx.1 year
• Depending circumstances, the following goals
may achieve:
• Change in lifestyle – eg: move house, find a
job.
• Re-establish contact with family members
• Increased self reliability.
• Sexuality – eg: improved body image.
However, sexual difficulties may still be
present
Issues still present may include:
• "Damaged" goods – eg: thinks others
can tell.
• PTSD symptoms usually stay active.
• Difficulty in relationships expressed
in isolation, fears and/or acting out.
Long-term effects
• Anger and fear towards the traffickers
• Diminished capacity to enjoy life.
• Hyper vigilance to danger – e.g.: fearful of
new and risky situations.
• Continued sexual dysfunction
• Interpersonal skills deficits.
• Prolonged PTSD symptoms as experience vivid
memories, nightmares and flashbacks.
Re-entry to society:
• They feel they do not fit in society because they have been
living in a world with its own structure and rules that they
were supposed to comply with 24/7.
• They lack social skills: they learned through manipulation,
and do not know how to act otherwise. They need role
models.
• They have difficulty going from chaos to structure and are
at risk of digressing or creating chaos.
• They sabotage programs if there is no continuance.
• They fear failure in society because of their own shame and
embarrassment.
• Victims need non-judgmental acceptance rarely obtained
by society.
Psychotherapy
• Cognitive-behavioral therapy, with anxietymanagement exercises such as breathing,
relaxation training, and cognitive restructuring.
• Logotherapy, created by Dr. Viktor E. Frankl, to
help victims of traumatic events find meaning in
life, and discover a will to persevere.
• Narrative therapy
• Dialectic therapy
• Art therapy
• Grief therapy
Short term goals of treatment:
– Understanding and believing that sexual slavery is
a crime against humanity
– It is not their fault and that they did nothing to be
shameful.
– Develop a sense of control over life, even in minor
daily tasks.
– Decrease symptoms associated with post
traumatic stress in order to become functional on
a daily basis.
– Find new meaning in life.
Bio-neurological model of trauma
Memory of a particular trauma is governed by
one’s biological system, rather than by one’s
own will, making it nearly impossible for the
individual to control.
Frontal lobe of the brain: traumatic information
remains in a kind of neurological limbo, being
repeated again and again in the mind.
Onset of stress response
Is associated with specific physiological actions in
the sympathetic nervous system, both directly and
indirectly through the release of epinephrine and to
a lesser extent norepinephrine from the medulla of
the adrenal glands. The release is triggered by
acetylcholine released from pre-ganglionic
sympathetic nerves. These catecholamine hormones
facilitate immediate physical reactions by triggering
increases in heart rate and breathing, constricting
blood vessels in many parts of the body and
tightening muscles.
Autonomic Nervous system
under intense-prolonged stress
Locus ceruleus activates the sympathetic
division of the autonomic nervous system.
The activation of the sympathetic nervous
system leads to the release of norepinephrine
from nerve endings acting on the heart, blood
vessels, respiratory centers, and other sites.
Women brains
The hypothalamic-pituitary-adrenal axis may
be more reactive in PTSD than is the case for
men. Some women with PTSD have been
found to release more adrenocorticotropic
hormone and cortisol. It is also thought that
fluctuations of estrogen and progesterone
may impact hormonal modulation in
neurotransmitter systems.
Hormonal changes
• The hypothalamic-pituitary-adrenal axis of
women's brains may be more reactive in PTSD
than is the case for men.
• Some women with PTSD have been found to
release more adrenocorticotropic hormone
and cortisol.
• Fluctuations of estrogen and progesterone
may impact hormonal modulation in
neurotransmitter systems.
Physical symptoms
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Physical trauma
Autonomic hyperactivity
Skeletal muscle tension
Gastrointestinal irritability
Genitourinary disturbance
Other psychosomatic reactions
Psychiatric intervention
To reduce symptoms of re-experiencing the trauma,
avoidance, numbing, and hyper-arousal.:
• Selective serotonin reuptake inhibitors (SSRIs) are the first
line of treatment for patients with PTSD because they are
especially "well tolerated and safe,“ and tricyclic
antidepressants have also been shown to be efficacious.
• In instances in which SSRIs don't work for patients with
PTSD, targeting specific symptoms with different
medications is suggested. For instance, anti-adrenergic
agents may work for hyper-arousal symptoms, and for
paranoia, an atypical antipsychotic is recommended.
Anticonvulsant medications may be helpful in reducing
labile mood or impulsive behavior.
Other suggested interventions:
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Journaling
Goal oriented therapy to create new goals
Grounding techniques
Neurofeedback
Sensorimotor Psychotherapy
Yoga
Journaling
Religious/spiritual interventions
Emotional support
Parenting skills.
Child pornography
The Internet and cell phones have facilitated
the victimization of minors. Sex traffickers
have created websites where people can use
their credit cards to view child pornography
International Center for Missing and Exploited Children, Trafficking in
Persons Report, U.S. Department of State, Publication 11407, Office of the
Under Secretary, Democracy and Global Affairs and Bureau of Public
Affairs, revised June 2007).
Child Pornography in the US
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55% of child pornography is created in the US
“Industry” makes $3 billion annually, with the
average age of children entering the porn
industry and prostitution being 12 years old.
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Internet ads promising "young girls," "barely
legal” females and other code words for
underage females got a much higher response
from potential customers than other ads.
Child prostitution
• In many countries, there is a myth that adults may be cured
of AIDS by having sex with a very young child, which then
promotes child prostitution for alleged health purposes.
• Many families in poverty-stricken countries are deceived by
traffickers who come to the parents with guarantees that
their children can make money as a “nanny.”
• The traffickers then give the parents a down-payment in
exchange for their children, often equivalent to half of the
parents’ yearly income, as a show of good faith.
Unfortunately, cases have uncovered victims who were as
young as 4 years old.
• Some parents sell their children as last resource.
Child prostitution in the United States
Approximated to be from 100,000 to 3 million,
according to a report prepared by cultural
anthropologist Debra Boyer in June 2008.
"There is wide disparity between police
reports, social service observations and global
estimates," said Boyer. "Given the
surreptitious and clandestine nature in which
prostitution is conducted, it is impossible to
arrive at an exact number of prostituted
youth."
Sex tourism
Sex tourism is a lucrative industry
that exists throughout the world,
very often in developing countries.
Sex tour “packages” are sold to
travelers who are taken to locations
where they can engage in sexual
activity with children or other
trafficking victims.
Trauma: children
Regressed behavior to early developmental
stages in children under age 7, and conduct
disorders. Symptoms will vary with the child's
age. Avoidance that may be a response to
intrusive stimuli may take various forms, for
example, avoidance of feelings (numbing),
avoidance of knowledge of the event
(amnesia),avoidance of behavior (phobic
response) and avoidance of communication
about the event (Schwarz & Prout, 1991).
Intervention - Children
Traumatized children have the dilemma
of having experienced both the
overwhelming arousal of sexual
exploitation and the absence of adequate
soothing and comforting support. Thus,
they are often in a state of hyper-arousal
and are particularly unskilled at self
regulation.