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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.

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Presentation on theme: "Human Trafficking Commercial Sexual Exploitation: clinical issues and considerations by Ana L. Nogales, Ph.D. Psychologist – PSY 11317 Casa de la Familia."— Presentation transcript:

1 Human Trafficking Commercial Sexual Exploitation: clinical issues and considerations by Ana L. Nogales, Ph.D. Psychologist – PSY 11317 Casa de la Familia 213-384-8494 714-667-5220

2 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)

3 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.

4 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)

5 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).

6 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.

7 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)).

8 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).

9 Control of victims 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"

10 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

11 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.

12 “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.

13 “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.

14 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.

15 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

16 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

17 “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.

18 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.

19 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.

20 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.

21 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.

22 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.

23 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:

24 Hopelessness Fear- Most victims have been coerced, threatened, or abused. Threats to family members in home country- Oftentimes, 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.

25 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.

26 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.

27 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.

28 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.

29 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.

30 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.

31 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.

32 Trauma response According to Hiley et al. (1993): Emotional Cognitive Biological Behavioral Characterological

33 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.

34 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.

35 Trauma: biological response Fatigue, sleeplessness (insomnia), nightmares, hyperarousal, startle response and psychosomatic complaints.

36 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).

37 Trauma: Behavioral Reaction 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

38 Trauma: Characterological consequences Survivors of prolonged abuse develop characteristic personality changes including "deformations of relations and identity" (Herman,1992).

39 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.

40 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

41 Possible symptoms 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

42 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.

43 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.

44 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.

45 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.

46 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

47 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.

48 Reorganization Phase: up to 6 months 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.

49 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

50 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.

51 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.

52 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.

53 Psychotherapy Cognitive-behavioral therapy, with anxiety- management 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

54 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.

55 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.

56 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.

57 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.

58 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.

59 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.

60 Physical symptoms Physical trauma Autonomic hyperactivity Skeletal muscle tension Gastrointestinal irritability Genitourinary disturbance Other psychosomatic reactions

61 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.

62 Other suggested interventions: Journaling Goal oriented therapy to create new goals Grounding techniques Neurofeedback Sensorimotor Psychotherapy Yoga Journaling Religious/spiritual interventions Emotional support Parenting skills.

63 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).

64 Child Pornography in the US 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. 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.

65 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.

66 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."

67 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.

68 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).

69 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.

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