By Madelyn Dorn, LMSW
Impact Manager & Mental Health Professional
Wellspring Living
June is Post-Traumatic Stress Disorder (PTSD) Awareness Month, and for those of us who work with trauma, we know and understand what PTSD is all too well. However, Complex PTSD (C-PTSD) is an emerging construct that offers a more nuanced perspective when understanding the needs of survivors of sex trafficking and commercial sexual exploitation. C-PTSD develops in response to prolonged trauma involving coercion, abuse, exploitation, or situations where a person feels trapped or unable to escape, such as trafficking. While survivors of sex trafficking often experience many PTSD symptoms, their traumatic experiences are often prolonged, relationally based, and ongoing, often starting in early childhood.
Understanding C-PTSD
C-PTSD includes many symptoms associated with PTSD, such as flashbacks, hyper vigilance, avoidance, emotional distress, shame, and disconnection from others. In addition to PTSD symptoms, survivors often experience ongoing difficulties with emotional regulation, self-worth, trust, relationships, and feeling safe or connected to others. Survivors may struggle with chronic shame, emotional numbness, people-pleasing, and persistent beliefs that they are damaged, powerless, or unworthy of care. Rather than signs of weakness, these responses are often adaptive survival strategies developed in response to ongoing trauma and exploitation. Remember, diagnoses are simply clusters of symptoms — not the essence of someone’s identity.
Survivor’s Experiences
Survivors of sex trafficking endure profound harm in relationships through physical, emotional, and psychological abuse. For many survivors, this harm begins long before exploitation through earlier experiences of abuse, instability, or unhealthy relationships. These experiences can alter perceptions of safety, love, and care, increasing vulnerability to further coercion and exploitation. As a result, advocates, mentors, treatment providers, and other safe adults have an opportunity to model healthy relationships and create spaces where healing can occur and skills can be learned to mitigate future exploitation.
Healing and Relationships
Since C-PTSD is developed in harmful relationships, survivors’ healing must happen in safe, supportive relationships. This means that safe adults must also remain aware of their own triggers, beliefs, and relational patterns so they do not unintentionally recreate harm. These relationships must be honest, consistent, nonjudgemental, and provide unconditional care so that survivors can feel what healthy relationships are like. Relational healing is the core work for many survivors, and we, as safe, healthy adults, have a key role to play in building safety and trust, coregulating, reducing shame, and increasing worthiness and self-advocacy skills. Let’s break these down.
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Felt- Safety & Trust: Facilitating felt-safety and building trust take time, patience, and the ability to remain consistent as survivors navigate a novel environment. Healing is not linear, and many of the C-PTSD symptoms may be highly present when first exiting the life. It’s the safe adult’s responsibility to remain calm, warm, present, consistent, reliable, and accountable to the survivor’s needs. The early stages of relational healing can be the hardest, and remaining kind, having consistent boundaries, and aiming to learn the survivor’s unique needs – and then meeting those needs – are critical.
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Coregulation: When trust and safety are established between two people, we can help each other regulate our emotions, come back from intense dissociation, and feel safe again after intense triggers or setbacks. Coregulation is biological and physiological – it’s a foundational human need. We need to be in connection with others to learn how to regulate ourselves. Once we know how to regulate with others, we may be able to regulate on our own.
- Shame-reduction: When survivors’ stories land in safe, nonjudgemental spaces and they are free to show up as their unhealed, somewhat-messy, vulnerable selves, the intense shame that developed as a result of traumatic relationships may go down. This means witnessing, listening to, and being non-judgemental with the stories and presentations of survivors before, during, and after healing is critical for reducing shame.
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Worthiness: As shame lessens and survivors feel connected to safe, positive adults, we get the opportunity to reflect survivors’ worthiness to them. We know that C-PTSD leaves survivors feeling unworthy. Still, over time, repeated experiences of being seen, believed, supported, and treated with dignity can begin to challenge the shame and negative beliefs trauma often creates about oneself – leading to an increased sense of worthiness and belonging.
- Self-Advocacy and Rebalanced Power: When survivors begin to feel worthy, have reduced shame, and know they are valued, we can support the practice of self-advocacy and negotiating power in relationships. As safe, trusted adults, we get to hold a container for survivors to practice asking for what they want, setting boundaries, and learning what is and isn’t okay for them. As these skills are built in a safe container, they may choose to practice these skills at work, in future romantic relationships, and in other spaces beyond the healing environment. This is the crux of the healing work.
Post-Traumatic Growth
All of these positive experiences lead to Post-Traumatic Growth in survivors, a positive psychological change resulting from a highly challenging life situation. Growth may include greater appreciation for life, improved relationships, increased personal strength, recognition of new possibilities, or spiritual change. Healing is a worthwhile venture that can sustain newness, possibilities, and profound insight, but it takes safe people who have the time, put in the effort, and stay present with survivors.
