“Dissociation is an unconscious defensive mechanism for coping with trauma. It can be difficult to recognize because it can take different forms and can last between a few seconds and several hours. “Dissociation can be as dramatic as a person appearing to ‘re-live’ traumatic experiences. For example, I have worked with a woman who cried out and shielded her face while she was dissociated, as if she were trying to ward off a remembered assault which she was ‘re-living’ in the present moment. “Alternatively, it can appear very subtly, for example as ordinary inattentiveness, a lapse of attention that makes a person appear to be daydreaming, or a sudden staring expression that passes after a moment. “Sometimes when people dissociate, their eyes may appear dark and difficult to read. Perhaps this is because their pupils dilate, so there is more ‘blackness’ to the eye. Often there is fear involved in the dissociation and the person’s eyes may widen so that they seem to be staring hard and their face and neck muscles become tense. “I talk to the person calmly and try to help them focus on a ‘here and now’ sensation such as their breathing, or the feeling of their feet touching the floor. This is called ‘grounding’. A person coming out of a dissociative state can be distressed and may need time to recover. They can be 5.2 Intrusive Symptoms: Thoughts, Memories, Flashbacks, and Panic Attacks Victims of trafficking often suffer from intrusive thoughts and memories. These can take the form of a continuous, anxious pre-occupation, or be experienced as a series of mental images and emotions that suddenly arise and feel beyond their control. Memory triggers that remind victims of traumatic experiences may give rise to intrusive thoughts which can increase at times of stress. They may go to great lengths to try and avoid these intrusive thoughts, and in doing so their condition may worsen. A West African woman trafficked for sexual exploitation Mimi tries, but frequently fails to stop herself thinking about her traumatic experiences. She often feels like “someone is about to grab me. My therapist says it doesn’t exist but it’s real to me.” She got up and showed how when she is walking she has to stop and look behind her because she feels someone grabbing her … She has frequent feelings of guilt “as though I am the architect of what has happened.” Flashbacks differ from intrusive thoughts and memories because they feel to the person experiencing them as though they are occurring in the present moment and are associated with subjectively real sensory experiences. Nightmares and flashbacks are a function of the mind’s 76 disoriented on recovery and this will impact on their ability to then answer questions accurately or in sequence. “If an interviewer is taking notes, looking at a computer screen or simply concentrating on the verbal content of the answers, they can easily miss brief but significant moments when the person’s behaviour may reflect absence from or unawareness of the interview. When dissociation is observed objectively, it can be a strong indicator of trauma and it forms part of the clinical picture. It is particularly difficult to feign convincingly. However it is easily missed or misinterpreted where the interviewer lacks the necessary clinical experience.” Dr. Naomi Hartree, HBF General Practitioner (GP) way of processing a traumatic event. Memories of trauma that have been encoded as intense emotional or physical sensations may erupt into the consciousness in the form of flashbacks, panic attacks or physical pain. An East African woman trafficked for sexual exploitation Esther suffers flashbacks which consist of seeing the men who abused her, sensing their smell of cigarettes or alcohol, or hearing their voices. She tries to avoid these memories by keeping busy. She avoids conversations, images or films that are concerned in any way with violence or torture. There are several stimuli that are capable of evoking the unwanted memories. For example, the smell of tobacco or alcohol can be powerful triggers of these recollections. An Asian woman trafficked for sexual exploitation Lei sometimes has brief episodes of intense panic lasting about a minute. At these times “I have difficulty breathing. My heart beats fast. My brain throbs, the blood all goes up there.” She was very restless during the interview, fiddling constantly with a tissue and a plastic water bottle. Her speech was interrupted by stammering which was more marked when she was talking about her traumatic experiences.