Sex Trafficking: A Modern Day Dilemma

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Althea Stephens, PsyD

Sex trafficking, viewed as the modern day form of slavery is a worldwide problem with significant frequency in the U.S.   The United Nations estimates that sex trafficking is the third largest source of organized crime behind arms and drugs (Ernewein & Nieves, 2015).  Many would be surprised to learn that the U.S. remains the second largest consumer of sex trafficking in the world, with transit points occurring around trafficking hubs such as California, Texas, Florida, North Carolina and New York. Although it is estimated that approximately 200,000 American children are sexually trafficked annually (Ernewein & Nieves, 2015), the actual prevalence and incidence rate remain unknown due to lack of uniformity in data collection and the small amount of research addressing this issue.  Victims of sex trafficking face numerous challenges due to the stigma, complexity of the problem, and lack of awareness by mental health professionals and community members.  However, the drastic increase in victims and the violent nature of the problem requires intervention by mental health professionals .

In 2000, the U.S. passed the Trafficking Victims Protection Reauthorization Act which defined sex trafficking as “the recruitment, harboring, transportation, provision, obtaining, patronizing, or soliciting of a person for the purposes of a commercial sex act, in which the commercial sex act is induced by force, fraud, or coercion, or in which the person induced to perform such an act has not attained 18 years of age.”  Minors under the age of 18 are considered victims, regardless of whether the sex trafficking involved coercion, force or fraud (Polaris Project, 2014).  Despite legal protection at the federal and national levels, the number of victims continues to increase across the United States.  Between January 1, 2015, and December 31, 2015, the National Human Trafficking Hotline (NHTH) received 5,545 reports of potential human trafficking cases in the United States.  1,630 of these cases (29.4%) involved minor victims, who may have been recruited as young as 12 years old (Gerassi, 2015).  While sex trafficking affects individuals from diverse backgrounds and income levels, women and children are at an increased risk because of their marginalized and economic status (Basil, 2009).  Other risks include inadequate education, physical and sexual abuse, physical disabilities, substance abuse, family disruption, and/or poor family support and supervision.  No specific profile of traffickers exists, as they may be family members, a family acquaintance, an intimate partner or stranger.  They may promise love and wealth to victims whose families are experiencing financial difficulties.  Some children are runaways or cast out by their own families.  Regardless, once lured, traffickers coerce victims through violence, threats, lies, or debt bondage to engage in sex against their will. Victims live a life of continual violence and physical abuse such as burns, broken and fractured bones, and forms of torture such as having boiling water forced into their mouth (Cecchet & Thoburn, 2014).  Victims are viewed as commodities.  If they survive they are thrown away onto the street to survive on their own without adequate resources (Barnitz, 2001).  They may resort to alcohol or drugs in order to cope with the psychological trauma and repeated abuse plaguing their life.

Clinical Implications
Over the years of being trafficked, victims are often arrested, exposed and ostracized, while the purchaser and trafficker are typically inadequately punished and may continue their operations (Basil, 2009). As a result, victims may experience negative impact on their mental, emotional, behavioral and physical functioning, thereby requiring an increased need for healthcare, continued education, and training, as well as mental health services.  Following their re-entry into society, victims often experience feelings of low self-esteem, anxiety, anger, dissociation, suicidal ideation, addiction and elevated symptoms of trauma (Gerassi, 2015).  Similarly, their limited access to healthcare may result in an increased risk for somatic problems, HIV/AIDS, other STI’s and unwanted pregnancy (Ernewein & Nieves, 2015).  Typically, problems are compounded by social stigma, misidentification and limited understanding of the issues facing victims.  The lack of social support and stigmatization by friends, family, and social institutions can exacerbate victims’ mental health difficulties (Office for Victims of Crime, 1998).  Therefore, it is imperative that mental health providers increase their capacity to identify victims of sex trafficking while providing services in a culturally sensitive and safe environment.  Research aimed at addressing trauma shows that a single incident of trauma can have long-term psychological effects (Gerassi, 2015). The effects of sex trafficking are even more detrimental for victims who have experienced years of repeated and violent abuse.  Research indicates that mental health providers often fail to recognize victims of sex trafficking.  Treatment provided by mental health clinicians should be premised on recognizing the signs and understanding trauma-related issues as they present themselves in victims.  It is crucial to a victim’s recovery to address concerns related to family dynamics, housing instability and lack of financial resources (Gerassi, 2015), in order to prevent further victimization and exploitation (Ernewein & Nieves, 2015). Banks (2006) proposed that psychotherapists recognize the importance of rapport in changing the brain structures and functions responsible for mental illness.  Psychotherapists must also acknowledge that their work ideally exists in collaboration with other providers to assist with housing, finances, vocational and workforce skills development [American Psychological Association (APA), 2014].

As a community, we can assist in combating sex trafficking by engaging in projects which bring education and awareness to the global problem of sex trafficking.  Beyond education, community-based approaches include media campaigns aimed at teenagers and young adults to publically raise awareness (APA, 2014).  Similar to many other businesses, sex trafficking is market-driven.  Women and children continue to be trafficked because of solicitors who demand services, which increase the need for traffickers to supply and reap the financial profit.  However, the “Swedish model” focuses on criminalizing the solicitor of sex trafficking but not the sexually exploited victim (APA, 2014).  In Sweden, the approach has proven to be effective in reducing sex trafficking on the street level as well as the demand.  The U.S. and other countries should develop similar programs which aggressively work to eradicate sex trafficking and the exploitation of women and children.  As a parent or guardian, you can help by talking to your child about healthy relationships. The internet allows children access into the seamy and sordid side of the world; parents have to get involved in teaching children online safety, restricting access to sites and monitoring their use.  Finally, parents should learn to recognize the “red flags” of sex trafficking, which may include an older boy/girlfriend, unexplained changes in behavior or attitude, unexplained money or clothing, being secretive about who they meeting and isolation from family and friends (Love146).

American Psychological Association Task Force on Trafficking of Women and Girls. (2014). Report of the task force on trafficking of women and girls. Washington, DC: American Psychological Association: Retrieved from:

Banks, A. (2006). Relational therapy for trauma. Journal of Trauma Practice, 5, 25-47.

Barnitz, L (2001). Effectively responding to the commercial sexual exploitation of children: A comprehensive approach to prevention, protection, and reintegration services.  Child Welfare, 80(5), 597-610.

Basil, Nwoke Mary (2009). Factors sustaining human trafficking in the contemporary society: Psychological implications. Ife Psychologia, 17(1), 161-175.

Cecchet, S., & Thoburn, J., (2014). The psychological experiences of child and adolescent sex trafficking in the United States: Trauma and resilience in survivors. Psychological Trauma, Theory, Research, Practice, and Policy, 6(5), 482-493.

Ernewein, C., Nieves, R., (2015). Human sex trafficking: Recognition, treatment, and referral of pediatric victims. The Journal for Nurse Practitioners, 11(8), 797 – 803.

Gerassi, L. (2015). From exploitation to industry: Definitions, risks, and consequences of domestic sexual exploitation and sex work among women and girls. Journal of Human Behavior in the Social Environment,25, 591-605.

Love146. Not A Number: A Child Trafficking and Exploitation Prevention Curriculum. (2017),

Polaris Project. Human Trafficking trends in the United States: National Human Trafficking Resource Center, (2014),

National Human Trafficking Hotline.Retrieved from:

Dr. Althea Stephens is a post-doctoral resident at The Woodlands Behavioral Health & Wellness and Houston C.O.P.E.S.  She provides clinical services to children and adolescents who have experienced trauma as well as those who display mood and behavioral concerns. She also conducts psychological assessments and provides supervision to Masters-level students. Her passion involves complex trauma, multicultural issues and empowerment for victims of sexual abuse.