6 Understanding the Significance of “Complex Trauma” for Victims of Human Trafficking 6.1 Components of Trafficking-related Trauma “Complex Trauma” is a term used to encompass the complexity both of the traumatic experiences recounted to HBF clinicians by survivors of interpersonal violence72, and the resultant complexity of their mental and physical responses to those traumatic experiences. HBF believes that the identification of Complex Trauma in this client group enables clinicians to follow effective pathways for their treatment and sustained recovery. Trauma exposure occurs along a continuum of “complexity,” from a single, adult-onset incident (e.g., a car accident) where all else is stable in a person’s life, to the repeated and intrusive trauma “frequently of an interpersonal nature, often involving a significant amount of stigma or shame” to the effects of which an individual may be vulnerable in more complex ways. Victims of human trafficking, especially sex trafficking, can usually be placed at the further end of this continuum of complexity.73 As discussed earlier, in many (but not all) cases, victims of trafficking have suffered traumatic experiences that began in their childhood/developmental years, for example abuse, neglect, exploitation and/or social and economic deprivation which have made them specifically vulnerable to targeting for trafficking.74 These early traumatic experiences have then been compounded through the process of being trafficked for exploitation. The majority of victims of trafficking in the care of HBF have backgrounds of deprivation, however it is important to acknowledge that people of various ages and socio-economic backgrounds can become vulnerable to targeting by traffickers. The experience of having been trafficked and Treating the hidden wounds: Trauma treatment and mental health recovery for victims of human trafficking, The Health Risks and Consequences of Trafficking in Women and Adolescents: Findings from a European Study 84 subjected to prolonged interpersonal violence is devastating for all people, including those with previously relatively positive and stable histories. The trafficking experience profoundly undermines previous assumptions about human virtue and “trustability” as well as personal identity and sense of self. Although this group are more likely than people with adverse childhood experiences to possess the “building blocks” of early identity formation, and therefore some of the necessary tools for effective psychological recovery, their trauma symptoms can be equally complex. Perpetrators of interpersonal violence create conditions which mimic the very early stages of human development in a perverse and distorted way. The victim’s daily life and basic functioning are outside of their control and all key choices and decisions are made by the perpetrator. Victims become entirely reliant upon the trafficker for their survival through fulfillment of their most basic needs. This dependency may be intermittently re-enforced by the trafficker alternating between more “generous” actions and those which degrade, violate and humiliate; food and basic necessities may be withheld, increasing the desperation of the victim. All vestiges of adulthood are systematically and repeatedly assaulted and, in the face of this, well-established adult defences are broken down. The only escape for victims is to withdraw into their most primitive, defensive survival mechanisms, such as profound emotional withdrawal and/ or passive acquiescence to repeated degradation in order to avoid physical injury and/or punishment. Gradually, they lose their mental resilience and their sense of freedom and autonomy. In this regressed state, an adult victim of trafficking has much in common with a child in a household who is being brutalized or a person in a detention cell who is being repeatedly tortured. These circumstances evoke developmentally primitive neurological (particularly autonomic) and psychological responses akin to those of early childhood, thereby pre-disposing the victim to continue responding in this way even after they escape or are removed from the trafficking situation. Exposure to extreme stress of this kind affects people at many levels of functioning in terms of somatic, emotional, cognitive, behavioural and characterological responses. People who are trafficked across international borders usually have nothing familiar to hold on to; they are in a strange