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Exposure to violence and trauma within the sex industry: PTSD and its psychological effects.

Individuals who have been victimized in the sex industry may experience biologically based reactions such as PTSD (Posttraumatic Stress Disorder) or other trauma-related symptoms.

“Posttraumatic stress disorder” refers to a group of symptoms that some individuals experience after overwhelming, frightening, or horrifying life experiences.

The Diagnostic and Statistical Manual of Mental Disorders describes three symptom clusters occurring in PTSD, including: reexperiencing the trauma through intrusive memories, dreams, and flashbacks; physical and mental distress in response to reminders of the event; avoidance of thoughts, feelings, and reminders of the trauma; loss of interest in activities; a general numbing of feeling; feelings of estrangement from others, and persistent symptoms of increased bodily arousal manifested in sleep problems, irritability and anger, concentration problems, hypervigilance and exaggerated startle responses.

Individuals working in prostitution who develop PTSD have been exposed to one or more extreme traumatic stressors, including threats of harm, physical assaults, sexual assaults, witnessing harm to someone else, or hearing about serious harm to someone close to them. Physical abuse and sexual abuse are common occurrences in the sex trafficking industry, as is psychological abuse.

Exposure to this sort of severe violence triggers an innate survival response that allows a rapid, instinctive response to danger.

During a physical or sexual assault, physiological changes in the body prepare the victim to deal with the threat by fighting, fleeing or freezing. The autonomic nervous system triggers a neurohormonal release of chemicals, activating survival responses. All of the body’s resources are directed toward dealing with the threat, while functions less important for survival are shut down. For many individuals, when the danger passes, the survival mode eventually turns off and the body settles back into its normal or steady-state level, called “homeostasis”; however, for some people, the survival response remains activated. This means that, with ongoing exposure to trauma, such as often occurs in situations of human trafficking and sexual exploitation, the same physiological responses that are initially protective become maladaptive and may lead to illness such as PTSD.

Individuals working in prostitution who have been exposed to chronic interpersonal victimization may experience more extensive reactions than are explained by PTSD alone. Their ability to self regulate may be impacted, with resulting emotional mood swings and problems with impulse control.

Some individuals develop substance abuse problems as a coping mechanism, either to avoid intrusive memories or to regulate their emotional states. Victims may dissociate or “space out” as a way of coping with overwhelming stress. They may experience physical manifestation of stress, including compromised immune system functioning and somatic symptoms such as gastrointestinal discomfort, headaches and muscular tension. Because trafficking victims are treated as commodities to be sold over and over, they may lack a positive sense of self and view themselves as property. Shame is also a widespread reaction in victims of sex trafficking: in many cases, shame about being seen as a prostitute or a criminal prevents victims from reconnecting with their families or from seeking help. In addition, the chronic interpersonal victimization that often occurs within the sex industry causes many of these individuals to have difficulties with interpersonal relationships, including issues with trust and boundaries.

There is a paucity of information regarding trauma-related symptoms in individuals who have been trafficked or victimized in the sex industry. Despite this fact, initial investigations indicate that individuals who have been victimized in the sex industry report a range of emotional, behavioral and psychological difficulties. Preliminary studies have found that the most trafficked and sexually exploited women have reported symptoms such as depression or sadness, guilt and self-blame, anger and rage, and sleep disturbances. Clinical experience indicates that depression and PTSD are primary problems for victims of sex trafficking.

There is clearly a link between exposure to violence within the sex industry, biologically based survival responses and trauma-related symptoms in individuals who have been victimized within the sex industry.