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Dissertation Diary Part 3: Sex Trafficking’s Impact on the Psyche

Part 3 of Project Dissertation (For more context- please refer to Dissertation Diary Part 1)

<Please note that this “Dissertation Diary” 5 part blog post series is formatted very differently than the rest of my articles– much longer and more academic than the others…For other articles, please refer the right navigation panel of the site.>

Silent Killer

The horror of sexual abuse and trafficking is not limited to the body only.

Sex trafficking includes captivity and often psychological brainwashing and emotional abuse that no doubt impacts the mental health of the victim in a myriad of ways (Clawson et al., 2008). Researchers, such as George Hu, have found across the board that the psychological consequences of those raped or battered are shared by those who have survived sex trafficking (Hu, 2011). Similar to Hu, Lois Carey concludes in her book, Expressive and creative arts methods for trauma survivors, that these consequences are predicated on the premise that multiple exposures to interpersonal trauma, such as abandonment, betrayal, physical or sexual assaults have consistent and predictable outcomes that impact functioning (Carey, 2006). When examining the effects of psychophysical expression on health and ‘dancing out trauma,’ Krantz found that depression, eating disorders, anxiety and panic attacks, conflictive relationships, and addiction are some of the lasting physical and emotional health problems produced by sexual coercion and abuse (Krantz, 1994). Meanwhile, Pearlman and Courtois discovered in their work with attachment framework and complex trauma that complex trauma adaptations can also interrupt an individual’s perception of self, aptitude to recognize and regulate emotions, modifications in consciousness and self-awareness, trouble preserving personal safety, somatic and medical concerns (Pearlman & Courtois, 2005).

Mind Games

In his work examining the treatment of sexual exploitation in human trafficking, Black categorizes the psychological consequences of sex trafficking into five common areas: substance-related disorders, depressive disorders, anxiety disorders (include PTSD, panic disorders), childhood disorders, and dissociation (DID) (Black, 2007).

The list of psychological symptoms that arise from this type of trauma is quite daunting:

  • Both Black and Carey discovered that mental illnesses would include anxiety disorder, bipolar disorder, insomnia, attempted suicides, schizophrenia, major unipolar disorder, dual diagnosis, cultural readjustment disorder, acute stress disorder, oppositional defiant disorder, dissociation, guilt, anger, generalized anxiety disorder, conduct disorder (Black, 2007) (Carey, 2006).
  • Michaelson shares that disturbed interpersonal relationships and higher risk of suicidal behavior were common (Michaelson, 2006) (Pretorius & Pfeifer, 2010)  as well as disordered eating behaviors and clinical eating disorders (Michaelson, 2006) (Spinazzola, Rhodes, Emerson, Earle, & Monroe, 2011).
  • Like Michaelson’s work with women adult survivors of child sexual abuse, Pretorius and Pfeifer saw a trend in post-traumatic stress disorder in sexually abused girls (Michaelson, 2006) (Pretorius & Pfeifer, 2010). Spinazzola et al replicated similar results when they found patterns of flashbacks, memories, and hyper arousal among traumatized youth in 2011 (Spinazzola, Rhodes, Emerson, Earle, & Monroe, 2011).
  • Spinazzola et al, in their study on yoga with traumatized youth, identifies flashbacks, memories, hyper arousal, and attachment impairments (Spinazzola, Rhodes, Emerson, Earle, & Monroe, 2011)
  • Meanwhile, paying particular attention to the depressive symptoms of sexual abuse particularly in sexually abused girls receiving psychiatric services, Goldston et al described that depressed mood, sleep disturbance, suicidal ideation, suicide attempts, self-damaging acts are a part of the symptom manifestation (Goldston, Turnquist, & Knutson, 1989). These are also results that were replicated by Pretorius and Pfeifer’s study of sexually abused girls, as well as Michaelson and Spinazzola, Rhodes, Emerson, Earle, and Monroe in their studies of women sexually abused as children and traumatized youth (Michaelson, 2006) (Pretorius & Pfeifer, 2010) (Spinazzola, Rhodes, Emerson, Earle, & Monroe, 2011).

Across the board, the literature research clearly shows us that sexual trauma and abuse (and that includes sex trafficking!) have devastating aftereffects for the victim. This provides further support for the case that effective interventions are absolutely needed for holistic healing for the victim. Medical attention to alleviate the physical symptoms of the victim isn’t enough. Without attention to the psyche of the victim, half of the problem is unresolved…

 

Acting out

Any of these psychological issues can cause explicit behavioral misbehavior:

  • Specific conduct disturbances found in sexually abused girls receiving psychiatric services by Goldston et al include physical and verbal aggression, delinquent behavior, alcohol abuse, drug abuse, running away from home, deterioration in school performance (Goldston, Turnquist, & Knutson, 1989).
  • Michaelson describes the accidental fatal drug overdoses found in women who have been sexually abused as children (Michaelson, 2006).
  • Similar to Michaelson, researchers Spinazzola, Rhodes, Emerson, Earle, and Monroe found self-mutilation and alcohol and substance disorders among traumatized youth (Michaelson, 2006) (Spinazzola, Rhodes, Emerson, Earle, & Monroe, 2011).
  • In Kirmayer et al’s study on biological, clinical, and cultural perspectives of trauma, they found intense affects such as rage, betrayal, fear, resignation, defeat, and shame among victims (Kirmayer et al., 2007).
  • Not only did Spinazzola et al found constriction–avoidant, numbing, dissociative responses among traumatized youth, they identified relational difficulties with self-monitoring, behavioral control, interpersonal attunement, limit-setting, establishment of healthy boundaries (Spinazzola, Rhodes, Emerson, Earle, & Monroe, 2011). Michaelson’s results concur with Spinazzola et al’s in that sexual trauma seems to cause disturbed interpersonal relationships (Michaelson, 2006)

It is clear to me that healing for victims of sexual abuse has to come from the inside out. Without it, the acting out and treatment of the behavioral acts out will serve merely only as a bandage of sorts and not systematically effective.

 

She’s only a child

All sexual abuse is damaging no matter how old the victim is but for a moment, let me separate the difference between victimization as a child (CSA= Child Sexual Abuse) and as an adult. CSA can be particularly emotionally/psychologically damaging and ruthlessly traumatizing because it may generate long-term negative after-effects because the abuse occurs during a critical time when the victim’s brain is at the core neurobiology development stage and very malleable (Carey, 2006) (Neumann, Houskamp, Pollock, & Briere, 1996). Furthermore, in their work on “Trauma through a Child’s Eyes,” Levine and Kline offer that the manifestation of symptoms in children differ from what is seen in adults because of many different factors –brain maturity, level of reasoning, perceptual development, partial personality formation and dependency, attachment to their adult caregivers, limited motor and language skills, and incomplete capacity to respond or cope, a limited behavioral repertoire to deal with life’s stresses and difficulties (Levine & Kline, 2007). It is clear that sexual abuse at this vulnerable age is particularly destructive.

I found the findings interesting but not surprising by researchers such as Michaelson and Whiffen and MacIntosh– often times, the disturbances of CSA emerge later in the adulthood of survivors as “sleeper effects” as more severe dysfunction, and play a role in adult personality and psychological patterns (Michaelson, 2006) (Whiffen & MacIntosh, 2004). Often, it takes time for the symptoms to manifest which makes it critical that we do an ample thorough job as possible when restoring victims of sex trafficking after they are rescued. In their 20 year study of trauma, Whiffen ad MacIntosh describes this manifestation–the depressive symptoms, interpersonal difficulties, and dissociative symptoms from childhood trauma may also increase the likelihood of alcohol abuse, interpersonal problems, and revictimization and pose a risk factor for adult emotional distress, including symptoms of depression, anxiety, dissociation, and trauma (Whiffen & MacIntosh, 2004). Similarly, in his 2008 study on counselors’ perspectives about effective treatments for adult survivors of sexual assault and abuse, Ross discovered that fear, anger, hostility, guilt, shame, depression, anxiety, feelings of isolation and stigma, difficulty trusting others, inappropriate sexual behavior, tendency of revictimization, and substance abuse  are among the range of long term consequences of CSA in adulthood (Ross, 2008).

 

Sexual Abuse results in Sexual Disorders

Because sexual abuse for young victims happens at a critical time when the victim should be developing their sense of sexuality in a healthy, normal way, it is not surprising to me that sexual abuse disrupts that normal process and can cause behavioral problems. In essence, sexual abuse can cause a great level of confusion. At the very time they should be learning what sexuality is and what’s right and normal/healthy, they are being violated and their personal space if infringed upon, their rights to their own body, stripped away. What should of not been awakened at that time, was awakened prematurely.

The result? Mayhem.

Goldston, Turnquist, and Knutson discovered sexual behaviors of increased surreptitious masturbation, public masturbation, sexual precocity, sexual promiscuity, sexual experimentation, seductive behavior, (Goldston, Turnquist, & Knutson, 1989) and Pretorius and Pfeifer found victims to be confused about sexual boundaries (Pretorius & Pfeifer, 2001). Kirmayer et al identified a pattern of these children tending to reenact their traumas either as perpetrators, in aggressive or sexual acting out against other children, or in frozen avoidance reactions (Kirmayer et al., 2007).

As victims grow up, Michaelson found that there was increased marital dissatisfaction, adolescent pregnancy and sexual problems, and high-risk sexual behaviors (Michaelson, 2006). Researchers Meston and Heiman (2000) discovered that sexually abused women more frequently used negative terms to describe themselves more often than attributing positive meanings to sexual behavior. Furthermore, Wenninger and Heiman (1998) found that sentiment among women with sexual abuse history projected that negative perspective onto their own bodies. They found their bodies less sexually attractive than did non-abused women and reported feeling angry at, and disconnected from, their own bodies during sexual activity. More recently in their work understanding the impact of childhood sexual abuse on women’s sexuality, Colangelo and Keefe-Cooperman confirmed that view when they observed that women with a history of sexual abuse showed more negative self-schemas than nonabused women (Colangelo & Keefe-Cooperman, 2012) and this mindset seemed to manifest in sexual dysfunctions that entailed an avoidance of intimacy and challenges with trust and openness in interpersonal relationships, with disorders of desire, arousal, orgasm, and less often dyspareunia (painful coitus) and vaginismus (Colangelo & Keefe-Cooperman, 2012). Kirmayer et al’s research claims that this avoidance of relationship is across the board– Often times a survivor’s unresolved sexual trauma can create a divided self that causes interpersonal conflict and unstable interpersonal relationships in multiple areas of functioning such as education, family, peer relationships, problems with the legal system, and problems in maintaining jobs (Dayton, 2010) (Kirmayer et al., 2007). The divided self in a survivor manifests a disparity between their private experience of coping and hiding the impact of traumatic memories that are often manifested in eating disorders, substance abuse problems, depression, sexual compulsivity, sexual disorders, intimacy disorders, and multiple personality disorders and images, and their public exterior hiding those symptoms (Dayton, 2010). The fear of returning to the trauma damages their relationships through negative self-attributions and failure of trust in the protection and safety of their caretakers. Rather, their relationships are marred by the expectation of abandonment or victimization through extreme clinging, acquiescence, oppositional disobedience, and distrustful conduct, or preoccupation with retribution (Kirmayer et al., 2007).

Dissociation, a condition in which the person experiences a situation as if watching from a distance, provides a coping mechanism for victims to numb themselves from the pain of the sexual abuse during the time of the attack or abuse. However, when the mechanism of dissociation continues long term, it can develop into an ongoing disconnection with the body, mind, and community, which produces challenges in life experiences (Dayton, 2010).

Now apply that to woman who grew up in brothels or starts the sex trafficking industry at age 12…fast forward several years in that and the blessing of rescue….but then what? Based on the research, it is unlikely this victim can operate healthily when they were wired the ‘wrong way’ at such a young age. It will take tremendous inner healing to help a woman from this past flourish and succeed in society –not just by herself -but within any type of social or romantic relationship!

 

PTSD: Broken record that won’t stop

The way I think of PTSD is it’s like a broken record that won’t stop playing– you take the victim out of sex trafficking trauma, but can you take the trauma out of the victim? The experience may of stopped on the outside, but how do you make the experience stop in the inside?

The disturbing after-effects of sexual abuse causes an overwhelming effect on survivors’ bodies, brains, and psyches. In his research on the embodied concepts of neurobiology, Homann notes that the brain grasps the massive amounts of simultaneous sensory information, sorting out and interpreting what is experienced based on past associations, and then coordinates a response to control interactions in daily life (Homann, 2010).  A therapist specializing in addiction treatment, Psychologist Tian Dayton holds that the body’s mental, emotional, and physical functions are impaired when the brain’s emotional center becomes activated and overwhelmed by trauma to the point where the brain cannot handle information (Dayton, 2010). Furthermore, according to Dayton as well as Solomon and Siegel’s work with neuroimaging scans, the left frontal cortex, which is related to speech and  language, becomes impaired when an individual recalls a traumatic memory and the experience delays the person’s ability to logically communicate (Dayton, 2010,) (Solomon & Siegel, 2003).

When PTSD occurs, there is a simultaneous arousal in the amygdala, which is the part of the brain that is related to the person’s emotional states and autonomic arousal, and the automatic arousal response for perceiving threat (Dayton, 2010) (Solomon & Siegel, 2003). Different sensory smells, sights, images or sounds can trigger the brain and body to react as if it were reliving the trauma through PTSD. Various studies examined by Krantz recounts a myriad symptoms from PTSD among rape victims: depression, nervousness, anxiety, neurocirculatory symptoms, transformations in sexual satisfaction and behavior, somatization symptoms, physical complaints, disassociation, triggers, flashbacks, emotional numbness, avoidance, hyperarousal, hypervigilence, distractibility, and an identification with the trauma (Krantz, 1994).

According to the research on PTSD, there are higher levels of PTSD following sexual assault than in those who experienced bereavement or a motor vehicle accident (Van der Kolk, Roth, Pelcovitz, Sunday, & Spinazzola, 2005). Foote and Goodman-Delahunty found in the literature that contrasted to 1–1.3% of the general population, 35% of rape survivors and 23% of sexual molestation survivors suffer from PTSD at one point in their lifespan (Stockdale, Logan, & Weston, 2009). The comparatively higher levels of PTSD symptomatology for those with sexual assault seem to reflect the very personally intrusive, violating nature of this trauma (Van der Kolk, Roth, Pelcovitz, Sunday, & Spinazzola, 2005).

Trauma, dissociation, and disease specialist, Scaer, reports that long lasting, enduring changes in brain structure and chemistry, particularly for the young developing brain, can generate specific conflicts in personality and behavior, and even lead to a legacy of altered physiological responsiveness and vulnerability to an extensive range of chronic diseases for adult survivors (Scaer, 2007).

A gap in the realm of mental health makes a particular impact on sex trafficking victims because so many of them are young–Kirmayer et al, in their research on understanding the biological, clinical, and cultural aspects for trauma, asserted that the PTSD diagnosis for adult-onset trauma is often incorrectly applied to traumatized children, because it does not capture all the nuances accounting for their critical development process (Kirmayer et al., 2007).

Because young children can often experience delays in development in cognitive, language, motor, and socialization skills, they tend to display very complex disturbances such as multifaceted interruptions of affect regulation, unstable attachment patterns,  hasty behavioral regressions, loss of autonomy, destructive behavior against self and others, the inability to attain developmental competencies,  damage to bodily regulation in the areas of sleep, food, and self-care, multiple somatic problems such as gastrointestinal distress , headaches, self-hatred and self-blame (Kirmayer et al., 2007).

 

Hungry for love

Talk about psychological damage– one of the most suprising and horrifying learnings for me personally is the complex psychological consequence of sex trafficking from the intense shame and disenfranchisement termed the “Stockholm Syndrome.” This is where victims develop positive feelings towards their captors (Hu, 2011) and become loyal to traffickers (Jones et al., 2007). Along with this difficulty victims have with relationships and intimacy, there is also a social challenge faced by rescued victims and survivors of sex trafficking posed when reintegrating into society. In his study on Youth involved in prostitution, pornography and sex trafficking, researcher Barnitz describes the rejection, stigmatization, betrayal, powerlessness, and internalized feelings of shame and guilt that victims often face after their rescue (Hu, 2011) (Barnitz, 1998).

How heart-breaking is that?

The mind games, emotional abuse, psychological deception is so strong from the captors to the victims that maybe in a need for what they never received from their family or life before, victims find themselves falling in a twisted, abusive love relationship with their abusers! Sounds a lot like domestic violence… it doesn’t seem to make sense but there’s a draw there to the abusers that is unhealthy.

Also, it is so heart breaking to know that victims are so stigmatized when they return home from rescue. I bet that’s one of the biggest things that maybe lead them or keep them in sex trafficking– they don’t know any other life outside of that and their abusers tell them that noone will want them when they go home– they are just ‘too dirty.’

As I have been learning more about sex trafficking and prostitution, I have learned how surprisingly some women fell into sex trafficking or prostitution out of loneliness or a really bad home. I was naive in thinking that –they must of been from a loving home (think: the movie “Taken”) and then they were abducted against their will, and they were so happy to be rescued! Unfortunately this is not always the case for victims. Some didn’t know any other way so they fell into this lifestyle and sometimes it is very difficult to leave!

Wow, healing for the sex trafficking victim is much more than what meets the eye!

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