Mental Health & Commercial Sexual Exploitation

ResearchSex Trafficking
Written By Courtney Furlong

Findings from “Sex Trafficking Vulnerabilities in Context: An analysis of 1,264 case files of adult survivors of commercial sexual exploitation”

Mental health encompasses a variety of conditions that affect thought, mood, and behavior, including anxiety, bipolar disorder, depression, neurodevelopmental disorders, posttraumatic stress disorder (PTSD), and schizophrenia spectrum disorder.1 The National Institute of Mental Health estimates that one in five American adults lives with at least one mental health diagnosis.2 However, survivors of commercial sexual exploitation are disproportionately affected by mental health conditions, even compared to other high-risk populations such as runaways, juvenile offenders, and children in foster care.3 The findings from my recent study highlight significant mental health considerations within this population, like bipolar disorder, neurodevelopmental disorders, and schizophrenia spectrum disorders. An alarming 80% of the survivors of commercial sexual exploitation reported one or more mental health diagnoses, compared to a 20% rate in the general population.2

A diagnosis of bipolar disorder was reported by several survivors, which is characterized by cycling between manic and depressive episodes, sometimes accompanied by psychosis.1 Approximately 4.4% of adults in the United States live with bipolar disorder.4 In a sample of minor victims of CSE, Palines et al. found that the rate of bipolar disorder was 26.6%, significantly higher than in other at-risk groups.2 Out of the 1,264 survivors represented in this study, 38% reported a diagnosis of bipolar disorder.

Neurodevelopmental disorders, including attention deficit hyperactivity disorder (ADHD), autism spectrum disorder, and dyslexia, interfere with academic, occupational, personal, and social functioning.1 The Centers for Disease Control and Prevention (CDC) estimates the rate of ADHD in girls in the United States to be 5.6%.5 Palines et al. discovered a rate of 52.4% for ADHD among minor victims of CSE, significantly higher than in other at-risk groups.2 Autism spectrum disorder affects 1 in 116 girls, but data on its prevalence among commercial sexual exploitation survivors are limited.6 Dyslexia affects 3% to 7% of the U.S. population, but its rate among commercial sexual exploitation survivors is unknown.7

Schizophrenia spectrum disorders involve delusions, disorganized thinking, and hallucinations.1 The National Institute of Mental Health estimates the rate of schizophrenia in the United States to be between 0.25% and 0.64%.8 Palines et al. found a 14% rate of psychosis among minor victims of CSE.2 However, the rate of schizophrenia diagnoses in this study was 13 times the national rate.

The study found that individuals who have been diagnosed with bipolar disorder were 2.51 times more likely to experience cycling (or repeated attempts to exit exploitation), and individuals with a self-reported neurodevelopmental disorder were 1.73 times more likely to experience cycling. Further, individuals with neurodevelopmental disorders (B = -.693, p = .016) or schizophrenia spectrum disorders (B = -.713, p = .005) were about half as likely to be placed into long-term programs compared to those without these disorders (odds = .50 and .49, respectively; R2 = .045, p = .023).

The study underscores the vulnerabilities related to mental health disorders among survivors of commercial sexual exploitation. Practitioners need to be prepared to serve such individuals to improve placement outcomes and disrupt the cycling phenomenon. Training for staff and the use of psychiatric medications in programs are critical steps in supporting these survivors. Partnerships with psychiatric services may also be essential for success.

The findings also call attention to the necessity for more robust, long-term community-based mental health services for commercial sexual exploitation survivors. Individuals with schizophrenia spectrum disorders or neurodevelopmental disorders are particularly vulnerable to abuse, exploitation, and re-exploitation, especially when they do not have a support system (like family). These vulnerabilities will exist across a lifespan. Therefore, increased funding for mental health support as well as training for mental health professionals are critical steps toward decreasing duration of exploitation, disrupting the cycling phenomenon, and ultimately preventing victimization.

References

Furlong, C., & Hinnant, B. (2024). Sex trafficking vulnerabilities in context: An analysis of 1,264 case files of adult survivors of commercial sexual exploitation. PLOS ONE, 19(11), e0311131. https://doi.org/10.1371/journal.pone.0311131

  1. American Psychiatric Association [APA]. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). American Psychiatric Association.

  2. National Institute of Mental Health. (2022d). Mental illness. https://www.nimh.nih.gov/health/statistics/mental-illness#:~:text=Mental%20illnesses%20are%20common%20in,(52.9%20million%20in%202020)

  3. Palines, P. A., Rabbitt, A. L., Pan, A. Y., Nugent, M. L., & Ehrman, W. G. (2020). Comparing mental health disorders among sex trafficked children and three groups of youth at high-risk for trafficking: A dual retrospective cohort and scoping review. Child Abuse & Neglect, 100. https://doi.org/10.1016/j.chiabu.2019.104196

  4. National Institute of Mental Health. (2022b). Bipolar disorder. https://www.nimh.nih.gov/health/statistics/bipolar-disorder#:~:text=Prevalence%20of%20Bipolar%20Disorder%20Among%20Adults,-Based%20on%20diagnostic&text=An%20estimated%204.4%25%20of%20U.S.,some%20time%20in%20their%20lives

  5. Danielson, M. L., Bitsko, R. H., Ghandour, R. M., Holbrook, J. R., Kogan, M. D., & Blumberg, S. J. (2018). Prevalence of parent-reported ADHD diagnosis and associated treatment among US children and adolescents, 2016. Journal of Clinical Child & Adolescent Psychology, 47(2), 199-212. https://doi.org/10.1080/15374416.2017.1417860

  6. Autism Speaks. (2022). Autism statistics and facts. https://www.autismspeaks.org/autism-statistics-asd#:~:text=Autism%20Prevalence,)%2C%20according%20to%202018%20data.&text=Boys%20are%20four%20times%20more,diagnosed%20with%20autism%20than%20girls

  7. Fletcher, J. M., Lyon, G. R., Fuchs, L. S., & Barnes, M.A. (2019). Learning disabilities: From identification to intervention (2nd ed.). Guilford. 

  8. National Institute of Mental Health. (2022e). Schizophrenia. https://www.nimh.nih.gov/health/statistics/schizophrenia#:~:text=Across%20studies%20that%20use%20household,between%200.25%25%20and%200.64%25

Courtney Furlong

Courtney Furlong, MS, MEd, LPC, CRC, is a native of Atlanta, GA and a graduate of Auburn University with a Master of Science in Human Development and Family Science and a Master of Education in Rehabilitation Counseling. A licensed counselor, Furlong has spent over 20 years working with victims of commercial sexual exploitation from ten countries covering Asia, Africa, Europe, and North America. She is currently a PhD Candidate in Human Development and Family Science at Auburn University and serves as the Director of Research for Street Grace. 

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