5 Psychological Trauma Symptoms This section provides an outline of the psychological trauma symptoms that HBF clinicians have observed and documented in their work with victims of trafficking. It is important to acknowledge that in keeping with the scope of this chapter, the symptoms covered are not exhaustive and there are some key issues (for example, those related to eating disorders, substance dependency and pregnancy/ childbirth) which are not covered. The true clinical picture may only emerge when victims are enabled, with therapeutic support, to “let go” of these defences. Clinicians should carefully observe signs and symptoms of trauma that victims may have become used to concealing or “managing” while in discussion with them, and avoid making any assumptions about initial outward appearances. Psychological trauma symptoms can interfere with victims’ normal functioning and coping mechanisms, affecting their daily life. However these symptoms are not always immediately obvious during the early stages of contact. In order to cope with threatening situations or exploitative, arduous and degrading work, people who have been trafficked have often built up psychological defences which help them to appear to function in superficially normal and competent ways, including when they are in stressful situations. Psychological trauma symptoms Zara has flashbacks of being raped and beaten. The flashbacks are so powerful that she is scarcely able to distinguish them from reality. She has daily intrusive memories of traumatic experiences and suffers nightmares at night, and when she tries to sleep during the day. She describes symptoms of persistent arousal, including disrupted sleep, and only sleeps for approximately 3-4 hours at night. She describes emotional and physical reactivity when she encounters reminders of her past trauma, for example if she hears the word “stupid” or if she makes a mistake. As an example she describes a recent occasion when she had got off a train at the wrong station. She became highly anxious, confused and tearful and described a strong sense of fear that she would be punished. 74 Zara persistently avoids thoughts relating to her traumatic experiences and tries to “push away” memories of what happened to her by keeping busy. She used to watch TV in an attempt to block out memories but she no longer has a TV set. She avoids social contact, particularly with men she doesn’t know, and finds it difficult to trust people. She has problems with concentration and is unable to focus on tasks such as reading. She reports increased irritability if she perceives rudeness in others or hears swearing; she becomes angry and shouted at a woman who had been swearing. She feels frightened when she is outside after dark and is particularly nervous and hypervigilant around strange men. She does not feel completely safe, even in her bedroom. She also reports an enhanced or exaggerated startle response, for example, jumping when there is a knock at her door. She feels sad and low for most of the day and has little interest or enjoyment in any activities. She also suffers from loss of appetite, poor sleep, little energy and feelings of worthlessness and guilt. She describes past suicidal ideation and self-harm at a time when she was homeless. She cut her arms with a razor. A further suicide attempt was triggered by a negative decision made on her asylum case.