5.3 Hyper-Vigilance and Altered Arousal/ Perception Many victims of trafficking suffer “hyper-vigilance”, which is a condition of being constantly “on guard” reflecting their experiences of control and enslavement. The state of entrapment in which danger and fear are constant features can cause a persistent state of hyper-vigilance which endures long after the victim has escaped the physical confines of their trafficking situation. Victims may also have an exaggerated startle response, and “jump” more readily at certain trigger noises or situations because they have previously been entrapped in situations of abuse and/or violence. In HBF’s experience, people who have been trafficked frequently express fears that they are being watched/surveyed or followed by other people, or that they are being spoken about, mocked and laughed at by casual acquaintances or strangers. This is compounded by feelings of shame and low self-esteem, particularly in those who have suffered sexual abuse who may perceive that others can instinctively “see” or “know” what has happened to them. This can result in social isolation and an inability to form positive relationships. An East Asian woman trafficked for sexual exploitation When Zhi is in her flat, the slightest noise makes her jump. She feels suspicious that people are following her and feels on her guard, thinking that strangers may be about to harm her. A Southern European woman, trafficked for sexual exploitation Natasha avoids outings as much as possible and only goes shopping when it is necessary. She feels very vulnerable. She particularly fears any attention from men and on one occasion when a man spoke to her she says she was so terrified of him that she tried to hide in a nearby shop. She is anxious most of the time, particularly when she is outside. authorities in their country of origin, or the country to which they have been trafficked, together with a profound dread of confinement or fear of being forcibly returned to their country of origin, can also cause people to suffer re-traumatization when they are apprehended or interviewed. Some HBF clients describe being unable to sleep, eat, “calm down” or concentrate for days or weeks prior to any scheduled contact with the authorities, for example regular “reporting” requirements.57 In cases where victims of trafficking act as witnesses in prosecutions, this process can be seriously re-traumatizing, even when the outcome is successful. A South East Asian woman trafficked for sexual exploitation, after her appearance in court as a prosecution witness. Kanya gave evidence at the trial of the three men accused of raping her. She was cross-examined for several days and was questioned closely about her experiences of being held in sexual exploitation. She found the cross-examination extremely traumatic. When the verdicts were returned and only two of the men were convicted of rape, she became even more distressed. In subsequent weeks she became overwhelmingly anxious and panicked whenever she saw men in the street. She felt unable to leave the house at all. On one occasion she disappeared from her accommodation and was subsequently found in a confused state, extremely distressed. A Southern European woman trafficked for sexual exploitation When Aleksandra came for her appointment at HBF today she was agitated. She said that seeing the underwear on mannequins in a lingerie shop had made her remember the outfits that she was forced to wear while she was held in forced prostitution. She was obviously upset but able to cope. However she said that on a “bad day” when she was not coping well, this would have a huge impact on her and she would cry and feel like ending her life. 5.4 Re-traumatization British Journal of Clinical Psychology, Victims of trafficking are frequently referred to HBF from immigration detention or prison. Clinicians find that they suffer cumulative trauma and/or re-traumatization from this experience 56. Previous negative experiences of the Policy and legislative recommendations towards the effective implementation of the nonpunishment provision with regard to victims of trafficking , Im- The British Journal of Psychiatry, migration Act 1971 77