A West African woman trafficked for sexual exploitation Hope’s memory is fragmented, as she struggles to answer questions, her level of anxiety rises. She becomes frightened as she is confronted with her inability to remember. Her anxiety and confusion leads to a state of near collapse. At times she is incoherent and somewhat inappropriate in her replies, in that her answers are not always closely linked to the question. Many victims of trafficking also suffer from lack of sleep and sleeping disorders which are caused by their experiences. Studies in sleep-deprived people have demonstrated impaired cognition and recall as well as impaired facial recognition even when they have been given caffeine.65 Sleep deprivation, especially lack of REM 66 phase sleep, impairs long-term memory.67 An Eastern European woman trafficked for sexual exploitation Tania’s memory and concentration are subjectively impaired. She gave examples such as pinning notes to her curtains to remind herself of appointments, often buying the same item twice and having to cook quick simple meals as she cannot concentrate on more complex recipes. A 2006 study of women who had been trafficked 68 found that during the travel and transit stage they may experience an “initial trauma” that is usually acute, and triggers survival responses that engender symptoms of extreme anxiety that can inhibit later memory and recall. They may have difficulty providing details of their experience and inconsistencies in their statements and gaps where they are unable to describe what happened to them. In HBF’s clinical experience this applies to trafficked men and children also. The Quarterly Journal of Experimental Psychology, Stress and Fatigue in Human Performance Stolen smiles: a summary report on the physical and psychological health consequences of women and adolescents trafficked in Europe In consideration of the prevalence of head injuries among victims of trafficking, it is worth noting that Dr. Juliet Cohen in her study Errors of Recall and Credibility 69, states, “A head injury that does not involve prolonged loss of consciousness may nevertheless have significant effects on health and in particular on cognitive function and memory. More major head injury usually has similar, though more serious effects [however] the consequences of minor head injuries have tended to be over-looked. Research has shown that memory for dates and times is notoriously unreliable, probably because there are fewer links for this kind of information to other knowledge.” 5.8 Self-harm Self-harm is a form of coping with overwhelming emotion, particularly anxiety. It is common amongst survivors of interpersonal violence including sexual abuse/assault.70 Self-harm can be an expression of low self-esteem, distress, a need for help and/or an actual wish to die. Sometimes a person will feel some relief from intense anxiety after they have harmed themselves, for example by burning or cutting their skin.71 However this relief is temporary and self-harm will be repeated when the person feels compelled to do it again. People who have suffered interpersonal violence may selfharm in a way that relates to that history, for example directing harm against a particular scar or part of the body that was the site of ill treatment. For raped women, excessive vigorous cleaning and washing or even harming of genitalia may be part of the clinical picture. Medico-Legal Journal, Self-harm: The shortterm physical and psychological management and secondary prevention of self-harm in primary and secondary care, Self-harm, suicide and risk: helping people who self-harm, Final report of a working group, “People who harm themselves not only do so in varying ways, but the background to their behaviour and their motivations differ as well. Self-harm is a manifestation of emotional distress. It is not necessarily the case that an act of self-harm is an attempt or even indicator of intent to die by suicide (Swales, 2005); indeed, it can be seen as a form of self-preservation. An individual may be strongly motivated to end their life or may be ambivalent … An act of self-harm is often described by service users as a coping mechanism or as a distraction that brings relief, in most cases accompanied by a complex set of feelings, self-disgust and shame also being among them (Klegg, 2005; Chapman et al, 2006). Studies interviewing people who have harmed themselves show remarkable consistency, at least for repeated self-harm, with the desire being to manage unbearable pain or unbearable situations, including the wish to die (Hjelmeland et al, 2002; Mental Health Foundation, 2006; O’Connor et al, 2009a)”. International Journal of Mental Health Nursing, 81