How does human trafficking affect mental health?

The physical and mental health impacts of human trafficking are severe.

One study by Loyola University found that 98% of trafficking survivors surveyed reported at least one diagnosable mental illness. 

In addition to mental illnesses that present at clinically significant levels, exploitation of any kind can also have long-term effects on trafficking survivors’ self-worth, relational well-being, and ability to function in the world. As a result, in Polaris’s National Survivor Study, mental healthcare was the top need that U.S. survivors themselves reported.

Here are some of the ways trafficking, for either sex or labor, can impact mental health.

The majority of individuals with lived experience of human trafficking live with mental health problems, and many of them had mental health struggles before their exploitation. In fact, mental illness is a major risk factor for trafficking. 

Here are some of the most common mental health challenges survivors of trafficking face.

Depression

“Depression (major depressive disorder) is a common and serious mental disorder that negatively affects how you feel, think, act, and perceive the world.”

— psychiatry.org

One study of both sex and labor trafficking survivors found that 71% experience symptoms of depression. That rate is likely to vary based on location, length of exploitation, cultural understanding of mood, and the ability to report. Regardless, most studies show that the vast majority of survivors, regardless of gender or type of exploitation, experience one or more symptoms of depression. Those symptoms can include a lack of interest in life, insomnia or sleeping too much, and feelings of hopelessness.

PTSD

“Post-traumatic stress disorder (PTSD) is a mental health condition that’s caused by an extremely stressful or terrifying event — either being part of it or witnessing it. Symptoms may include flashbacks, nightmares, severe anxiety and uncontrollable thoughts about the event.”
— Mayo Clinic

“Complex post-traumatic stress disorder (CPTSD) can result from experiencing chronic trauma, such as prolonged child abuse or domestic violence.”
— Cleveland Clinic

PTSD (and the variation CPTSD) has historically led alongside depression as being most ubiquitous in the lives of survivors. PTSD is a natural response to the circumstances of profound trauma that trafficking creates. Trauma itself is widely understood as “an event, series of events, or set of circumstances that is experienced by an individual as physically or emotionally harmful or threatening and that has lasting adverse effects on the individual’s functioning and physical, social, emotional, or spiritual well-being” (SAMHSA). All trafficking experiences can fall into this category.

One U.K. study found that about 78% of women trafficked for sex presented symptoms of PTSD. Similar prevalence has been noted among male survivors. Although data varies based on location and cultural norms, meta-analyses show that we can likely assume that at least two-thirds of survivors are likely to experience PTSD. 

In practice, according to a report from the Department of Health and Human Services, that means that the majority of survivors are experiencing avoidance of anything reminding them of their trafficking, recurrent memories or disturbing dreams about the events, feelings of detachment or dissociation, and hypervigilance. All of these symptoms are life-disrupting.

Substance Use Disorder

“Substance use disorder (SUD) is a treatable mental disorder that affects a person’s brain and behavior, leading to their inability to control their use of substances like legal or illegal drugs, alcohol, or medications.”
— National Institute of Mental Health

Substances such as drugs and alcohol are often deeply embedded in the trafficking process. They may be used to control an individual being trafficked, keeping them disoriented, compliant, and reliant on the trafficker for a supply to avoid withdrawal.

This means that once an individual leaves trafficking exploitation, they are often left with substance dependency or addiction. This can present a significant barrier to reentering normal life and holding down alternative employment. Even accessing services as a survivor can be difficult if they need to detox first. 

Dissociative Identity Disorder

“Dissociative disorders are characterized by an involuntary escape from reality characterized by a disconnection between thoughts, identity, consciousness and memory. People from all age groups and racial, ethnic and socioeconomic backgrounds can experience a dissociative disorder.”
— National Alliance on Mental Illness

More than half of trafficking survivors experience memory loss. For many, that escalates to the pattern of dissociation known as DID (Dissociative Identity Disorder). The research on this correlation is much newer and less developed, but it is increasingly evident that DID is an observably common outcome for trafficking survivors.

In DID, the brain essentially fragments to protect itself from extremely distressing memories and emotions. This can cause intense disruption to daily life. Because this has historically been an especially stigmatized mental illness, systems often fail to adequately support survivors living with this adaptive trauma response.

Suicidal ideation

“Suicidal ideation (suicidal thoughts) are thoughts or ideas centered around death or suicide. Experiencing suicidal ideation doesn’t mean you’re going to kill yourself, but it can be a warning sign.”
— Cleveland Clinic

Thoughts of suicide and suicide attempts are common among survivors of trafficking. In fact, some studies have shown that as many as 41% of survivors have attempted suicide at some point.

Experts have often explained that those who attempt suicide do not really want to die; they simply want the suffering to end. In this light, it’s clear when a survivor of trafficking might struggle with thoughts of suicide. It can seem like the only way out of the unbearable trauma that they have experienced.

This is by no means an exhaustive list of all mental health challenges faced by survivors of trafficking. Survivors may also experience eating disorders, self-harm, personality disorders, OCD, and generalized anxiety.

The experience of being trafficked can have a profound impact on someone’s self-worth. A person who has been reduced to a fee for the use of their body might come to see themselves through a similar transactional lens rather than understanding that their inherent human worth is priceless.

“I was bartered for a tank of gas, a six-pack of beer, and some cigarettes,” one Colorado survivor told The Exodus Road, explaining why she’d come to believe that she was not worth valuing.

“I felt I was useless. He told me that. And I had already heard that my whole life,” another survivor said.

Many survivors blame themselves for their exploitation, in part due to trauma-bonding and the false, manipulative narratives that traffickers repeat. Recent research has also reflected the challenge of moral injury, a phrase used to describe the experience of being forced to act in ways that violate your core values as a person. 

It can take a long time for a survivor to recover a sense of inner worth and begin seeing their strengths again after enduring that kind of crushing harm.

“Maybe some people could call me ‘dirty whore,’ but for others I might be a girl who can give them good advice,” one Moldovan survivor told researchers.

Human trafficking is an inherently relational crime, taking and perverting the basic boundaries of health connection. Human trafficking survivors are often left with a profound lack of trust in anyone around them. This may be especially true for those who have experienced familial trafficking, a deep betrayal by those closest to them. 

This wound to a person’s ability to connect with others (known as an attachment wound) can lead to people-pleasing, avoidance of others, hyper-independence, intense shame, fear around connection, and repeating patterns from past exploitative relationships. This disrupts romantic relationships, family relationships, friendships, and even the ability to trust future employers.

The lack of ability to connect with others just compounds other mental health issues. This is why anyone providing services to those who have been trafficked has a mandate to operate with care to avoid re-traumatization. Often, social workers, law enforcement, and clinicians are the very first people a trafficked person will have a chance to safely connect with. 

Looking at the range of potential mental health challenges for a trafficking survivor can be overwhelming and heartbreaking. The good news is that there is an increasing body of research proving that survivors can heal, especially if they receive appropriate care and resources.

Trauma-informed care and trauma therapy

Trauma-informed care for trafficking survivors is utterly essential to their healing. This means care that realizes the depth of the impact of being trafficked, recognizes the consequences, and responds to every situation by restoring a person’s autonomy as much as possible. The Exodus Road’s International Survivor-Centered Advisory Committee advises that even something as simple as offering a survivor a choice of where to sit, what to drink, and who to contact can be steps towards restoring the right to agency.

This approach requires a patient, non-judgmental lens that does not require survivors to fit the “perfect victim” stereotypes to receive care. Survivors may be operating in trauma responses that make them seem combative, disinterested, or totally disengaged. This way of being has been a survival skill for them. It’s critical not to push them to abandon those behaviors too quickly, since that way of being has historically been their safety and shield.

Evidence-based treatments for trafficking recovery

In general, research is still scarce on exactly what therapeutic interventions are best for people who have experienced trafficking. As a result, there is still not much standardization in trafficking aftercare.

However, from the anecdotal evidence and data that we do have, it’s clear that treatments that help with trauma recovery in general are helpful for trafficking survivors as well. Here are a few therapeutic modalities that have been proven for treating trafficking survivors:

• CBT (Cognitive Behavioral Therapy)
• Exposure therapy
• EMDR (Eye Movement Desensitization and Reprocessing)
• SIT (Stress Innoculation Training)
• Art therapy

Other effective methods for treating the mental health of people who have experienced trafficking include those that target their specific mental health diagnoses. For example, medications might be appropriate for many of the conditions listed above. Addiction recovery support groups may be a critical component for those who struggle with substance use.

Practical support and stability

The reality for many survivors is that caring for their mental health can seem like a luxury when they do not even have a stable place to stay or enough income to provide food and essentials for themselves. Working on healing from trauma requires physical safety and stability first.

This is an understanding that drives The Exodus Road’s Freedom Home programming in Thailand. Designed to serve young women and teenagers who have survived sex trafficking, Freedom Home has two houses: one to offer short-term, immediate care for those exiting exploitation and a second to provide long-term residential care for as long as two years. While in these homes, the survivors have housing, meals, childcare, and a monthly stipend to help rebuild financially. While these basic needs are being met, it becomes possible to provide effective trauma therapy.

Evidence also points to the value of Occupational Therapy for trafficking survivors. This refers to recovery through performing tasks and behaviors that restore a sense of normalcy and sanity to the world. For survivors at Freedom Home, this includes education, chore charts, job placement, and the crucial healing art of play. Trampolines in the yard ensure that survivors can actually feel the freedom returning to their bodies. The space to practice healthy relationships restores broken trust. Something as simple as dancing to music or sharing a movie can be a part of a return to health.

“I’m not stressed here because I get to have my own time,” one resident at Freedom Home explained. “I get to think, what is next for me? I’m so thankful to be free to think that.”

“Here at Freedom Home, I feel freedom, truly,” another survivor said.

You can participate in supporting more survivors on their mental health journey. Be part of our solution.