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International Journal of Emergency Mental Health and Human Resilience
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Trauma-coerced Bonding and Victims of Sex Trafficking: Where do we go from here?

Chitra Raghavan, PhD1*, Kendra Doychak, BA2

1John Jay College of Criminal Justice, New York, USA

2Forensic Mental Health Counseling, John Jay College of Criminal Justice, New York, USA

*Corresponding Author:
Chitra Raghavan
E-mail: [email protected]

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Abstract

Although well documented across multiple abusive contexts, trauma bonding (here referred to as trauma-coerced bonding or trauma-coerced attachment) has yet to be systematically studied within the context of sex trafficking. The theory surrounding trauma-coerced bonding posits that victims of abuse can form powerful emotional attachments to their abusers, as a result of a complex interaction of abusive control dynamics, exploitation of power imbalances, and intermittent positive and negative behavior. The attachment is marked by a shift in internal reality, whereby the victim begins to lose her sense of self, adopts the worldview of the abuser, and takes responsibility for the abuse. We argue that first, trauma bonding be reconceptualized as trauma-coerced attachment to adequately reflect the abusive dynamics at play. Second, we highlight that relationships of sex-trafficking victims often involve complex dichotomies (e.g., romantic and coerced with enforcers and competitive and violent with peers) and warrant individual consideration. Finally, we suggest that the unique role of sex within this victim population be explored using an integrated mind-body approach. Effective victim outreach begins with a comprehensive and integrative understanding of victims’ personal experiences, as well as their physical and psychological responses to abusive environments. Directions for future research are offered.

Keywords

Victimization, sex trafficking, prostitution, trauma, abuse, control, coercion

Victims of abuse are vulnerable to a wide range of physical, sexual, and emotional consequences that can affect a multitude of domains including, somatic, cognitive, affective, behavioral, and relational functioning (Herman, 1992a; Matthews, 2015). The trauma literature offers explanations for these consequences and has broadened our understanding of victim psychology. However, despite abusive relationships being of particular interest to scholars, there is still much to learn about the complex dynamics and consequences—especially when those consequences involve victim pathology and emotional or internal responses to their continually abusive environments. One particular area of the trauma literature— trauma bonding (henceforth to be referred to as trauma-coerced attachment or trauma-coerced bonds)—remains underdeveloped. The goal of this work is to offer an explanation of trauma-coerced attachment and provide the theoretical underpinnings for furthering our understanding of this traumatic outcome within sex-trafficking contexts. Specific suggestions concerning systematic study (e.g., adopting a coercion framework) and relevant areas of inquiry (e.g., hybrid relationships and the role of sex) are provided.

Trauma-coerced attachment is hypothesized to be a dynamic, cyclical state in which victims form a powerful emotional attachment to their abusive partners (Dutton & Painter, 1981; Dutton & Painter, 1993; Herman, 1992a; Romero, 1985). What has been suggested of the pathways to these bonds includes a complex interaction of: (i) abusive control dynamics, (ii) the exploitation of power imbalances within the relationship, and (iii) intermittency in the doling of punishment and reward. While there are extensive data supporting this form of traumatic outcome (De Fabrique et al., 2007; Dutton & Painter, 1981; Dutton & Painter, 1993; Goddard & Stanley, 1994; Romero, 1985), systematic empirical data for how these bonds are formed, maintained, and subsequently sundered is lacking.

Despite this, the literature does offer a rich body of observational and clinical data drawn from case studies as varied as prisoners of war (Romero, 1985), hostages (De Fabrique, Van Hasselt, Vecchi, & Romano, 2007), child abuse victims (Goddard & Stanley, 1994), and intimate partners (Dutton & Painter, 1981; Dutton & Painter, 1993; Romero, 1985). These data, which are drawn from many different countries across the western world and include both men and women, support these contentions where victims who are subjected to these unpredictable, tense, and abusive tactics experience a host of characterological and affective consequences (Cantor & Price, 2007). These observed changes, for victims who form trauma-coerced bonds, are marked by a shift in their internal reality and change in cognition because the abuser’s persistent and invasive tactics have successfully deteriorated the victim’s sense of self (Dutton & Painter, 1981; Dutton & Painter, 1993; Herman, 1992a; Herman, 1992b; Romero, 1985).

Herman (1992a) describes this deterioration of the self, “All the structures of the self—the image of the body, the internalized images of others, and the values and ideals that lend a sense of coherence and purpose—are invaded and systematically broken down” (p. 385). The victim surrenders her will completely to her abuser. Herman (1992a) offers a useful analogy in the statements of women who have experienced one isolated traumatic event (e.g., “I am not my self anymore”), as compared to those who are exposed to chronic abuse and repeated traumatic experiences (e.g., “I do not have a self”). As a consequence of this cognitive shift and lost sense of self and meaning, the victim is forced to adopt a new worldview entirely dependent on the abuser’s perspective. She subsequently begins to take blame and responsibility for the abuse; she idealizes her abuser and strives to please him (Dutton & Painter, 1981; Dutton & Painter, 1993; Herman, 1992a; Mills, 1985).

While the construct of trauma-coerced bonding has been explored across different abusive relationships, one important abusive context—sex trafficking1—have been less well documented in research. In part, this neglect is due to the relative recency of research in sex-trafficking contexts. Sex trafficking has been recognized as a significant domestic and international social problem only in the last ten years or so. This neglect could also be due, in part, to the complexity of the phenomenon and the confusing presentation of its outcomes. That is, trauma-coerced bonds are marked by abuse, control, and dependency, but also by love, admiration, and gratefulness. As a consequence, these outcomes of trauma-coerced attachment have been misconceptualized as masochistic tendencies in the victim (Freud, 1924; Stein, 2011). Finally, the lack of a coherent theoretical framework has also discouraged researchers because trauma-coerced bonding may be misviewed as the latest flavor of the day due to the current domestic and international relevance of sex trafficking, rather than as a legitimate and concerning response to repeated traumatic experiences.

Trafficked victims exhibit many familiar consequences of chronic victimization. Media and clinical reports note that sex-trafficking victims often bear the legal consequences for their abusers. For example, victims often refuse to testify in court against their abusers even if it means the victims themselves will face charges. Many of these women even testify in defense of their traffickers despite evidence of long histories of abuse and exploitation. For example, a recently publicized case involved the victims testifying in court to being well taken care of and treated affectionately by their enforcer, despite wiretap evidence with threats of “beatings” if adequate money was not made (Crimesider Staff, 2013). Victims’ refusal to testify is viewed negatively as being complicit in their own abuse or guilty of trafficking themselves. Indeed, several cases have been reported where prosecutors have charge trafficked women with being traffickers themselves because of their roles vis a vis the trafficker (NBC, 2015).

To further the understanding of trauma-coerced bonds in sex trafficked women, we make a number of crucial suggestions. First, we suggest that trauma-coerced bonding should be redefined from its base—presenting a grounded theory that reflects the nature of a coerced attachment, rather than suggests a masochistic victim. Thus, we propose reframing the traumatic nature of the abuse as arising from chronic coercive control, a concept that recently garnered much interest in the intimate partner violence literature but has not been extended to trafficking. Second, we propose that the relationships of sex-trafficked victims and their abusers warrant individual attention within the inquiry of trauma-coerced bonding due to: the hybrid nature (e.g., romantic and intimate, yet coerced-working relationship) and the complexity of their roles with other victims (e.g., abusive and competitive, yet isolated from social support together).

Third, we introduce the unique role of sex within this victim population and suggest that its use both within the relationship and outside of it warrants specific exploration. We conclude with suggested future directions for researchers to begin the systematic and empirical study of this traumatic outcome.

Reconceptualizing Frameworks Of Trauma Bonding As

Trauma-coerced attachment

The first theoretical step researchers should consider is to reframe trauma-coerced attachment as a traumatic response to a terrifying chronic stressor rather than as a dysfunctional attachment that reflects masochism, weakness, or social vulnerability in the victim. Such a framework is not new and undergirds the conceptualization of complex PTSD (Herman, 1992b). However, the nature of a prolonged terrifying interpersonal trauma has not been well specified in trafficked contexts. Accordingly, we suggest that using the concept of coercive control—drawn from the intimate partner violence literature—may be helpful in defining the prolonged traumatic experiences that trafficked women often have.

Coercive controlling behaviors have been well documented in intimate partner relationships (Stark, 2007). In using coercion, the abuser attempts to entrap the victim by systematically stripping her of her decision-making ability, forcing her to believe in his omnipotence, and isolating her from any validation of the abuse (Johnson, 1995; Johnson, 2006; Stark, 2007). The relationship between a sex-trafficking victim and her abuser mirrors the power imbalances and abusive control dynamics within an intimate partnership (Herman, 1992a). This may be particularly true when the trafficker is also romantically involved with the victim, a point we take up below.

Common tactics used within coercive control are: microregulation, surveillance, threats, intimidation, humiliation, and isolation. These tactics are applied continuously and often permeate multiple domains of the victim’s life, which can include but are not limited to: finances, children, dress, employment, family, and friends (Dutton & Goodman, 2005; Johnson, 1995; Lehmann, Simmons, & Pillai, 2010). Although this control framework is informed by the intimate partner violence literature, the potential dual or hybrid role of the relationships in the sex-trafficking context (both lover and trafficker, developed below) offer new avenues of control dynamics to consider (e.g., the increased legitimacy of the financial aspect or the use of other sex-trafficked women to humiliate and create competition).

The coercive control framework can also help shed light on the confusion concerning the apparent absence of physical violence in many trafficked relationships suggesting that the relationship between the trafficker and the victim may not be so bad after all. However, successful coercive control creates an environment of fear, dread, and obedience even in the absence of physical violence (Beck & Raghavan, 2010; Dutton & Goodman, 2005; Romero, 1985; Stark, 2007). The invisibility of the power imbalance may, in part, be responsible for the flummoxed reaction law enforcement and the public have when confronting sex-trafficked victims. If there is no physical abuse, or if it is infrequent, then why is commercial sex coerced? Addressing the invisibility issue, researchers who study coercion have long argued that abuse is not a simple addition of the frequency and severity of physical abuse and that such a concrete framework has failed to capture the true power imbalances in an abusive relationship (Raghavan, Swan, Snow, & Mazure, 2005; Stark, 2006; Stark, 2007). Rather, it is that traumatic entrapment is created by a complex interaction of exploited power imbalances, physical and sexual abuse, humiliation, dehumanization, as well as vague and unpredictable threats, which are clearly specified within coercive controlling behaviors.

Similar to any prolonged interpersonal trauma, including torture and abduction, the traumatic outcomes of coercive control include symptoms that resemble classic post-traumatic stress disorder such as intrusive memories of abuse, hyperarousal, and flashbacks (Zoellner et al., 2013). In addition, the prolonged coercion also results in a set of symptoms that distort the victim’s view of herself and her relationship to the abuser (Dutton & Painter, 1993; Herman, 1992a; Herman, 1992b). It is this self-relational component which is key to understanding trauma-coerced attachment. Over time, these coercive tactics create an environment of psychological captivity for the victim marked by powerlessness and uncertainty, but also love and idolization (Cantor & Price, 2007; Herman, 1992a; Herman, 1992b).

Viewing these contradictory feelings as a predictable traumatic response, Cantor and Price (2007) propose that these positive feelings the victim experiences are a direct result of: “(i) perceived threat to one’s physical or psychological survival at the hands of an abuser(s); (ii) perceived small kindnesses from the abuser to the victim; (iii) isolation from perspectives other than those of the abuser; and (iv) the inescapability of the situation” and are used as a coping and defense mechanism to trauma (p. 379). To this end, at the risk of adding more terminology to a confusing field, we have adopted the term trauma-coerced attachment and/or trauma-coerced bonds rather than trauma bonding. The latter suggests that the woman is in some way responsible for her bond to the abuser, whereas the former helps to adequately portray the attachment as a product of the abuser’s deliberate tactics.

In sum, we suggest that trauma-coerced a have been less well documented ttachment is a traumatic disorder which results from chronic interpersonal trauma. The interpersonal trauma is most efficiently captured by the concept of coercive control, which has been well studied in intimate partner violence contexts. By reframing it thus and extending it to sex-trafficking contexts, this traumatic outcome and its presentation in and consequences for victims lends itself to systematic and comprehensive empirical study.

Complex Relationships In Sex-Trafficking Contexts—The Role Of Traffickers And Other Women

Sex-trafficking victims often are romantically involved with their traffickers and in some cases, have children with them. At the same time, they engage in commercial sex with numerous partners in the context of coercion and a seriously impaired degree of agency (Giobbe, 1993; Matthews, 2015; Monto, 2004). As a consequence, in addition to experiencing the abusive tactics present in intimate relationships (e.g., threats, intimidation, isolation, etc.), they are also subject to additional tactics such as, pressure to pay off large debts, threats concerning citizenship status, and terrorization about exposing their work to family and friends (Matthews, 2015).

This hybrid relationship leads to a particular complication, which involves the distinct difference between the way the victim views her abuser (i.e., a lover) and the way the criminal justice system sees him (i.e., a criminal). From the perspective of the victim, her abuser is a romantic companion—one to whom she is emotionally loyal and in some cases, one with whom she has children. In certain relationships, the romantic component is coercively introduced to facilitate control. This hybrid relationship is not always apparent because the massive power imbalance that undergirds it is carefully concealed by the abuser (Herman, 1992b). The obstacles the victim faces are then compounded with not only those she faces as a coerced sex worker, but also those she faces as an intimate partner in an abusive relationship (e.g., legal ties, fear of loneliness, economic dependence, loyalty, and social support; Anderson & Saunders, 2003; Iverson et al., 2013; Raghavan et al., 2005). When examining the relationship of trafficked women to their trafficker, clinicians and researchers should strive to define the relationship first and foremost from the victim’s point of view, rather than a legal one. Such a viewpoint will provide better insight to her behaviors and coerced bonds.

A second area of relationships, which is crucial to consider are those of the trafficked women to other women who work beside her (if her working context involves multiple women). These peer relationships mirror those of trafficker to victim and are marked by competition, abuse, and exploitation, on the one hand, but also often constitute the only social support group women have. The competition may take form of newer younger women and new favorites threaten to the victim’s position and whom the trafficker may actively offer as threatening. The older favorite may be asked to take an active role in “breaking” in the new woman, disciplining her, and humiliating her when she brings in less money or does not meet the expected earnings. This can lead to personal criminal charges reflecting violence and abuse (JohnTV, 2014). The result of this tangled net of power imbalance—powerful trafficker and fluctuating power among trafficked victims—has not been seriously considered within the trauma framework.

How might these more vertical power relationships compound the trafficked victim’s psychological entrapment and trauma-coerced bond to the trafficker? First, the presence of an unreliable yet desperately needed social group undermines further the possibility of stable human attachment. Thus, the traumatic-coerced attachment may grow more powerfully because all other relationships are marked by mistrust and betrayal. Two, when asked to exploit, abuse, and punish other women, trafficked victims are being asked to violate their own moral stance to an extreme (Herman, 1992a). This betrayal of values is considered key to trauma-coerced bonds. That is, these victims are not only experiencing personal abuse, but also inflicting abuse in the sacrifice of others. This creates a complete violation of moral standards marked by a final surrender of will, autonomy, and the self—it often leads to shame, self-hatred, and ultimately, identification with the abuser as a means of coping and protection from their ‘wrong doing’ (Herman, 1992a; Cantor & Price, 2007).

The phenomenon of trauma-coerced attachment needs to be explored and understood specifically within this context of complex hierarchical and vertical relationships, rather than a single dominant relationship. The hybrid relationships (i.e., both that of a coerced and exploited working relationship and an intimate partnership) and complex peer dynamics (i.e., only form of social support, yet marked by competition and abuse) create convoluted interpersonal interactions and have negative consequences of the victim’s selfhood and eventual trauma-coerced bond. Again, adopting the coercive control framework to understand these hybrid relationships within the sex-trafficking context can provide a means of systematic and deliberate empirical study.

Role of Sex

A third area of inquiry is sex. Ironically, the psychological role of having sex with paying clients has been neglected in the study of trafficking other than determining what is considered coerced and if there is violence involved. However, the role of sex in commercial sex is much more complex. First, those entering commercial sex often have extensive histories of sexual abuse and trauma (Matthews, 2015; Monto, 2004). They frequently enter into their coerced working and intimate relationships with a poor knowledge of healthy sexuality (Matthews, 2015). Often they begin commercial sex from places of desperation (e.g., economic desolation or immigration status) or fear and coercion (e.g., threatened violence from a partner or pimp). The subsequent level of “consent” these women exert over their sexual agency is seriously impaired—at best, and completely coerced—at worst (Matthews, 2015; Monto, 2004).

Women with sexual abuse histories can and do use sex to feel powerful (Marcus et al., 2014). The very fact that men are willing to pay for their bodies creates a momentary empowerment. However, such empowerment can result in dangerous overreliance on the body and obscuring the original need to compulsively fend off feelings of shame and degradation. Thus, at the first level, “consent” to have sex may not actually reflect the qualitative experience of the actual sex act. Under such conditions (conscious willingness but unconscious dread or fear or use of sex to repel powerlessness) and the repeated and consistent violation of personal bodily autonomy, regardless of “voluntary consent” can lead to a host of negative outcomes. These include the routine use of dissociation to tolerate sex with paying clients, drugs to induce the dissociation or to reintegrate the mind and body, and a cycle of shame and self-hatred punctuated by empowerment (Herman, 1992a). All of these outcomes likely enforce, maintain, and or strengthen trauma-coerced bonds, or contribute to such distress that the bonds cannot be severed. As such, the role of sex—separate from a moral stance associated with selling sex—should be explored in more depth.

In furthering understanding trauma-enforced attachment, researchers should return to understanding that the study of sex in trafficking contexts has been done with an implicit mind-body divide. Did she say yes? In that case, the body cannot be hurt. Was she hit or raped? No? In that case, the mind was not injured. These are false dichotomies. This Cartesian rupture between mind and body hinders our understanding of the human experience, particularly within the complex context of sex trafficking. We recommend that instead of these concrete benchmarks that obscure the interconnection between body experience and emotional functioning, researchers should begin with the assumption that the body is not separate from the mind. The concept of embodiment has gained popularity as a key paradigm within interdisciplinary research in psychology, psychiatry, and neuroscience (Fuchs & Schlimme, 2009). Within the embodiment paradigm, origins of cognitive and emotive processes are understood as embedded within an individual’s sensory-motor experience (Corazon, 2011; Fuchs & Schlimme, 2009; Johnson, 2008). The flow of human experience and emotion is rooted in the body’s engagement with, and experience of, the people, places, and activities of everyday life—the human experience cannot be separated from how the body feels in its environment (Fuchs & Schlimme, 2009).

Further, the body is evolutionarily designed to be an instrument of mutual reciprocated communication and desire, to provide intimacy whether briefly in passionate temporary encounters, or more continuously as is the case of more committed relationships. If we agree with this evolutionary premise, how do we as living organisms tolerate repeated, regular, unreciprocated, imbalanced sexual contact divorced from the experience of people, place, and activity? Would such an imbalance create traumatic outcomes related to violation of autonomy? How are these outcomes mitigated by consent or non consent? Are some women able to protect themselves from dissociation because they do not feel violated? Are these women in the majority or minority? How is consent mitigated by histories of abuse and the resulting power imbalance?

Asking these questions while embracing an embodiment paradigm will allow for deeper exploration of the victims’ subjective experience in addition to the relationships with their environment. Through such an exploration, we may discover that victims of sex trafficking experience what Fuchs & Schlimme (2009) term “disturbances of embodiment” that affect sense of self, body image, and body awareness after prolonged abuse. To attempt to live with the abuse, victims of sex trafficking may disintegrate mind and body, thus experiencing “disembodiment,” or detachment from self and body. Because the lived body unites the mind and brain (Fuchs & Schlimme, 2009), this can have negative effects on cognition, emotion, and social interaction, which may shed light on the formation and consequences of trauma-coerced bonding.

Exploring each of these questions will aid us in understanding not only a more diverse range of traumatic outcomes, but how these traumatic disorders can affect those involved in the sex-trafficking context specifically. Thus, the complex, yet crucial role of sex both out of and within the relationship warrants further inquiry. As researchers begin to examine trauma-induced attachment within the sex-trafficking context, the role of sex should be explored systematically as well.

Non-Binary Victimhood

In the past, ‘victimhood’ has wrongfully been conceptualized through a binary identification—true victim versus not a victim at all. Because many victims of sex trafficking are vulnerable and coerced but not immediately physically abused, they are defined as “voluntary” or “consenting,” and thus subject to criminal charges and deportation, among other consequences (Matthews, 2015). However, the reality for victims of sex trafficking is much more complex. They are subject to extensive physical and emotional abuse and a host of sexual, physical, and emotional issues. In turn, many of them utilize unhealthy coping mechanisms (e.g. drug use) to offset these negative experiences (Zimmerman et al., 2006). They also face a host of traumatic outcomes, including: dissociation, somatization, changes in affect and identity, and emotional dysregulation (Herman, 1992a; Herman, 1992b; Matthews, 2015).

Accordingly, the conceptualization of “victimhood” should involve more complex considerations than a binary identification system can offer. Further, understanding victim status as affected by not only physical abuse or “captivity,” but also by exploited power imbalances can enrich researchers’ and clinicians’ understanding of victim experiences. By repeated exploitation of her subordinate position (in concert with his other abusive behaviors), the abuser makes himself the most powerful person in her life—both physically and emotionally. Over time, her psychology reflects this power differential leaving her uncertain, lost, fearful, and entrapped (Herman, 1992a).

Future Directions

In conclusion, we suggest reframing the conceptualization of trauma bonding to one that reflects a trauma-coerced attachment or bond. Adopting the framework of coercive control can be helpful in fostering our understanding of the pathways to the complex outcome of these traumatic experiences and lends its inquiry to systematic study. We also proposed that the hybrid and complex relationships of victims of sex trafficking warrant individual attention due to the additional burdens they place on these victims. Finally, we suggested that the role of sex within relationships and the working context be examined using an embodied united mind-body framework, rather than a Cartesian split as is currently favored.

Researchers and clinicians are beginning to make strides toward this dynamic understanding of traumatic outcomes. The DSM-5 has expanded its PTSD diagnosis (Friedman, 2015; Zoellner et al., 2013) and is beginning to recognize the importance of broken and abusive relationships as a function of trauma. Specifically, symptomology of self-blame, pervasive negative mood, and shame are offered in the new PTSD criteria and a rich range of traumatic outcomes (e.g., attachment, love, idolization) is central to complex PTSD, and will be listed in the ICD-11 (Friedman, 2015). However, clinical considerations of traumatic experiences still fail to specify the full range of traumatic outcomes (e.g., attachment, love, idolization). In order to fully understand the range of possible outcomes to chronic and repeated abuse or trauma, the current gaps in the literature need systematic and empirical exploration.

Systematic inquiry into trauma-coerced attachment is not an easy undertaking, despite the prevalence of domestic and international victims. Many of the outcomes for victims are abstract and difficult to conceptualize and measure (e.g., cognitive shift and diminished sense of self). Further, this population is difficult to access when they are currently in the lifestyle and are usually interviewed several years after exiting. Empirical inquiry post-relationship may yield to missing pieces of information or details about traumatic experiences and outcomes. Therefore, researchers must explore these outcomes and develop systematic and cohesive forms of measurement in order to offer a comprehensive understanding of their role within trauma-induced attachment and their presentation in victims who experience them.

Future directions for research in this area should aim to reintroduce and clarify the concept of trauma-coerced attachment within the trauma literature. Further aims should include comparing the presentation of these attachments in victims of sex trafficking to other forms of victimization (e.g., intimate partners, childhood sexual abuse, etc.) in order to more clearly grasp what commonalities these relationships share and also how they differ. More specifically, little is known about the process of forming the attachment or bond—is the process rigid or does it fluctuate? Further, why do some women bond and others do not? What level of awareness do the victims have over their cognitive shift? How does the dual role of intimate partners and coerced working relationships and the nature of sex work, which involves the body, affect the presentation of the trauma-coerced attachment and the experiences had by the sex-trafficking victim? Lastly, prevention and intervention strategies should be explored so that researchers, clinicians, and the criminal justice system are better equipped to successfully meet the needs of these victims.

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