country with a different culture among people whose language they may not understand. They are removed from family, home and personal belongings, and the trafficker may also threaten their loved ones. Their sense of time may be warped by sleep deprivation, confinement and overwork in forced labour/exploitation. They may fear seeking help from the authorities or from anyone else. Their experiences of interpersonal violence within trafficking make it difficult for them to believe that anyone would respond positively to their requests for help. They may feel alien and unable to communicate, to form attachments, or empathize with others. The personality changes observed in trafficking victims who have suffered prolonged inter-personal violence may be understood as an assault upon the connections between mind and body, and upon the victim’s relationships to other people. This is another area of commonality with victims of child abuse and torture survivors. The sense of attachment 75 (relationship) to others, which is developed over years from infancy, is disrupted, damaging a person’s future capacity to form and maintain relationships and to regulate internal states, except by resorting to primitive psychological coping mechanisms. This helps to explain the profound problems faced by victims of trafficking in rebuilding their lives after release or escape. The loss of safety, direction, and the ability to detect or respond to cues of danger, renders them vulnerable to subsequent and potentially repeated exposure to trauma or exploitation throughout their adult life. Prof. Cornelius Katona, HBF Medical Director and Consultant Psychiatrist Characteristic clinical features which HBF clinicians observe in survivors of interpersonal violence from trafficking include: – Lack of capacity to imagine a future at all or anything positive happening to them – A reduced or absent sense of autonomy (independence) and agency (ability to make choices/ take action) – Disturbances of sleep and/or appetite – A heightened risk of dangerous or self-destructive behaviours – Substance abuse (drugs/alcohol) in an attempt to deal with their distressing symptoms – Dissociation – Multiple somatic symptoms, for example headaches, backache, total body pain and episodes of loss of, or altered consciousness and/or sexual dysfunction – Increased vulnerability to becoming revictimized, trafficked and/or exploited because of trauma related behaviours. 6.2 Post Traumatic Stress Disorder: Diagnosis and Treatment Victims of trafficking who have suffered interpersonal violence frequently fulfil the standard diagnostic criteria for Post Traumatic Stress Disorder (PTSD), which is contained in the Diagnostic and Statistical Manual of Mental Disorders (DSM) and International Classification of Diseases (ICD).76 The diagnostic criteria for PTSD were derived primarily from the clinical experience of survivors of war trauma and from victims of relatively circumscribed trauma, such as road traffic accidents or natural disasters.77 Diagnostic and statistical manual of mental disorders: DSM-IV-TR – Fundamental loss of trust and loss of a coherent sense of “self” in relation to others – Depression, anxiety, self-hatred and despair – An overwhelming sense of defilement and low self-esteem – Loss of a sense of safety and self-worth - 85