Abstract
There is a dearth of research on trauma bonding among victims of sex trafficking. This study aims to fill this gap by seeking to understand how service providers working with survivors of sex trafficking conceptualize and observe trauma bonding in their clients. This qualitative study involved interviews with 10 participants. Purposeful sampling was employed among licensed social workers or counselors. Two themes emerged: defining trauma bonding (with four subthemes: embracing intensity, power imbalance, distortion of love, and inescapability) and the development of trauma bonds (with three subthemes: universality, gendered, and grooming). These findings provide much-needed insight into the complexities of trauma bonding.
Main Text
As the field of human trafficking continues desperately working to develop best practices and evidence-based interventions to more effectively serve this population, the insight and experiences of service providers working within these service areas are an invaluable resource to inform and guide research that will be most useful in its application and most beneficial to the practice field. U.S. law defines sex trafficking as a commercial sex act induced by force, fraud, or coercion, however, any instance involving a child under 18 years of age in which something of value is exchanged for any sexual service is considered trafficking, regardless of the presence of force, fraud, or coercion (Trafficking Victims Protection Act, 2000). Given the complex set of needs surrounding this population, social workers are uniquely positioned to play a leading role in effective service provision. Social workers working with survivors of sex trafficking provide a wide array of services, such as advocacy, case management, therapeutic services, and addiction counseling, across a variety of settings including emergency rooms, health clinics, behavioral health facilities, shelters, domestic violence programs, community drop-in centers, residential facilities, and substance use treatment centers. Social workers have been widely identified as key stakeholders in combating sex trafficking for their critical roles in identifying, supporting, and working with survivors (e.g., Amadasun, 2022; Davy, 2015; Hodge, 2014; Schwarz et al., 2016). Notably, in the fight against human trafficking, social workers have been specifically called upon by the U.S. government for their roles in supporting psychological well-being and delivering necessary trauma-specific therapy to trafficking survivors (U.S. Department of State, 2012). Accordingly, in efforts to build the knowledge base and begin bridging the gap between formal research and practice, this paper turns to practitioners working directly with survivors of sex trafficking for further insight into the severely understudied yet pervasive phenomenon of traumatic binding among survivors of sex trafficking.
Modest Estimates of Prevalence
Given the surreptitious and illicit nature of sex trafficking, the field lacks consistent evidence on the incidence and prevalence of sex trafficking in the United States. While current reports likely provide only modest reflections of the actual problem, even such conservative estimates are indicative of the severity of this issue. In 2021, the National Center for Missing and Exploited Children (NCMEC) received over 17,200 reports of possible child sex trafficking in the United States (National Center for Missing and Exploited Children, n.d.). Additionally, given the substantial risk for trafficking among homeless and runaway youth, the NCMEC ventured to estimate that of the 25,000+ runaway youth reported missing to the NCMEC in 2021, one in six were likely victims of sex trafficking (National Center for Missing and Exploited Children, n.d.). In 2020, the United States National Human Trafficking Hotline received reports of 10,583 separate situations of human trafficking, 7,982 of which were related to sex trafficking with 11,467 individuals identified as sex trafficking survivors (Polaris Project, 2021). It is important to note that these numbers are substantially lower than data reported for 2019, however, this is very likely related to social service agency shutdowns and substantial limitations amid the COVID-19 pandemic, leading to less opportunities for outreach and identification, and fewer reports made to the hotline. Thus, these numbers should be understood as reflecting only a percentage of the actual problem. Interestingly, while numbers of all forms of trafficking went down from 2019 to 2020, among reports in which recruitment was specified (n = 4,142), the NHTH reported a 21% increase in the proportion of survivors recruited into trafficking by an intimate partner (from 22% of all survivors in 2019 to 27% in 2020) and a 47% increase in the proportion of survivors recruited by a family member or caregiver (from 21% of all survivors in 2019 to 31% in 2020; Polaris Project, 2021). These dynamics were particularly noteworthy among survivors of sex trafficking. For individuals in which recruiter type (n = 2,448) and relationship to exploiter (n = 2,623) were known, family members/caregivers served as the most common types of recruiters and exploiters, accounting for 41.5% and 38.7%, respectively, followed closely by intimate partners accounting for 39.3% and 38%, respectively (Polaris Project, 2021). In contrast, among those trafficked for labor in which recruitment type was known (n = 1,572), 69% were recruited by an employer, whereas only 15% were recruited by a family member and 5% by an intimate partner. Such findings demonstrate the highly personal nature of sex trafficking, as most survivors are trafficked by someone they know and trust.
Risk Factors
Survivors of sex trafficking often have a prior history of childhood trauma such as physical, emotional, and in particular sexual abuse, rape, neglect, and early exposure to domestic violence (Cole et al., 2016; Countryman-Roswurm & Bolin, 2014; Fedina et al., 2019; Franchino-Olsen, 2021; Greenbaum, 2018; Hickle & Roe-Sepowitz, 2018). These are the most common risk factors for sex trafficking, as such trauma exposure heightens vulnerability. Survivors also often exhibit substance use issues, prior involvement with child protective services, homelessness, have poor mental health or view of self (Franchino-Olsen, 2021), and grew up around friends or family members involved in sex work (Fedina et al., 2019).
Prior trauma history can result in numerous negative effects that make an individual more susceptible to trafficking and exploitative relationships. Exposure to maltreatment early in life often leaves survivors with an internalized normalization of violence and dysfunction, which coupled with the effects of trauma, including poor coping skills, exacerbate vulnerability, making such individuals easier to deceive, control, and exploit (Franchino-Olsen, 2021). Traffickers exploit individual vulnerabilities with the intention of exploitation and recruitment into the sex trade, actively working to break down survivors’ independence, social support, and self-esteem in order to isolate and further control them. Survivors will often misuse substances as a means of coping and traffickers will exploit their addictions by using substances and access to substances as further means of control (Hopper, 2017b). Survivors are often unlikely to seek out help or receive effective services, as they do not recognize themselves as trafficked or their abusers as traffickers (Anderson et al., 2014; Pascual-Leone et al., 2017; Reid, 2010; Reid, 2013). Thus, when survivors do come into contact with various service providers, if they do not self-identify, they are likely to go undetected by providers that lack an accurate understanding of sex trafficking. On the contrary, service providers abreast of the complex and nuanced dynamics of sex trafficking are uniquely positioned to intervene with and provide insight into this often hidden and unidentified population.
Traumatic Bonding Among Survivors of Sex Trafficking
Recent research has begun to call attention to the traumatic bonds that often exist between survivors and their traffickers. Trauma bonds refer to intense attachments between victims and their abusers and occur across a variety of exploitative relationships (Casassa et al., 2021; Hopper, 2017a; Reid et al., 2013). The earliest literature on trauma bonding analyzed such attachments within the context of intimate partner violence (Dutton & Painter, 1981). Dutton and Painter (1981) theorized that these strong attachments were resultant of two specific features characteristic of abusive relationships, power imbalances and intermittent abuse, and that cycles of abuse in which abusers alternate aversive arousal (punishment) with relief (reinforcement) foster traumatic bonding that can be extremely difficult to resolve (Dutton & Painter, 1993). Traumatic bonding and other patterns of abuse essentially stimulate an intense attachment toward the abuser, making relational dynamics between survivors of sex trafficking and their traffickers particularly complex and insidious. Such bonds are commonly characterized by paradoxical complexities of abuse, control, and dependence, coupled with strong feelings of affection for the abuser, such as love, admiration, and gratitude (Raghavan & Doychak, 2015). While various forms of sex trafficking are prevalent within the United States, such bonds may be particularly evident within street-based trafficking, as traffickers involved in street-based commercial sexual exploitation are specifically known to employ harsh and unpredictable punishments and to intentionally foster dependency by creating a false sense of intimacy and attachment within the relationship (Polaris Project, n.d.). Those trafficking multiple survivors often enhance and maintain these attachments by creating a sense of family, using these relational bonds to compel survivors into commercial sex.
The paradoxical nature of trauma bonds has significant implications for survivors of sex trafficking (Casassa et al., 2021): (a) attachment to the perpetrator prevents survivors from leaving abusive situations (Baldwin et al., 2015; Reid et al., 2013); (b) attachments motivate survivors to protect perpetrators from legal consequences (Clawson & Grace, 2007; Nichols, 2016), such protections may extend to moral responsibility, as survivors often blame themselves for the perpetrators’ abusive actions or accept such acts as warranted or even loving, despite the harm that is inflicted; and (c) survivors grow distrustful of outside or institutional systems that can offer help or protection (i.e., social services and police) as they internalize the perpetrator's perceptions of such systems as well as a sense of guilt (Sanchez et al., 2019), making survivors unlikely to utilize such services. Thus, the development of trauma bonds themselves perpetuates physical, emotional, and mental exploitation.
Although the development of trauma bonds is widely acknowledged within the field of sex trafficking, this phenomenon remains severely understudied (Casassa et al., 2021; Raghavan & Doychak, 2015) not only in relation to sex trafficking but across all exploitative relationships (Reid et al., 2013). Established intervention efforts targeting trauma bonding in any population have seemingly yet to be developed, as more research is needed to better understand the complexities of this phenomenon. Aligned with efforts to begin addressing this gap in knowledge, a recent scoping review on trauma bonds among sex trafficking survivors explored how current literature defines trauma bonds regarding this population (Casassa et al., 2021). While an earlier review of the literature noted the dearth of a universally accepted definition or diagnostic criteria for trauma bonding (Reid et al., 2013), Casassa et al. (2021) found descriptions and definitions of trauma bonding to be relatively similar across studies. Of the 15 reviewed studies, 10 provided a definition of trauma bonding (Contreras et al., 2017; Hardy et al., 2013; Hom & Woods, 2013; Hopper, 2017a; Jordan et al., 2013; Lopez & Minassians, 2018; Mehlman-Orozco, 2020; Raghavan & Doychak, 2015; Reid, 2016; Sanchez et al., 2019). Among these studies, trauma bonding was generally defined in terms of power imbalances in favor of the trafficker as well as strong feelings of affection for the trafficker that keep survivors enmeshed in their trafficking situation. Additionally, trauma bonds were characterized by “severe power imbalances, intermittent brutal and kind behaviors, isolation, perceived inability to escape, and internalization of abuser's viewpoints” (Casassa et al., 2021, p. 8). Sanchez et al.'s (2019) study emerged as the only exception to Casassa et al.'s (2021) findings, outlining a theoretical distinction between “trauma bonding” and “trauma-coerced bonding.” The authors based their argument for such distinctions on research that suggests trauma bonding associated with sex trafficking may result in even more complex attachments compared to other forms of victimization (Hopper, 2017a). Sanchez et al. (2019) noted that in instances such as incest (e.g., Adorjan et al., 2012) or Stockholm syndrome (Cantor & Price, 2007), attachments are bidirectional in which perpetrators actually possess affection for the victim, whereas traffickers deliberately cultivate “coercive” unidirectional bonds solely for profit.
In addition to exploring common definitions of trauma bonding, Casassa et al. (2021) also identified four key aspects of trauma bonding that emerged from the literature related to sex trafficking: (a) susceptibility to trauma bonding as strongly related to prior abusive and exploitative experiences, specifically in childhood; (b) survivors’ conviction of their love for their trafficker, which is often maintained even after exiting their trafficking situation; (c) feelings of love fuel survivors’ desire to protect traffickers from prosecution; and (d) traffickers’ exploitation of emotional vulnerabilities and attachment needs such as love, safety, and affection in order to intentionally develop trauma bonds. Notably, Stalans and Finn (2019) found false proclamations of love to be the most prominent recruitment strategy among traffickers, with 34.1% disclosing love as a means to manipulate women into commercial sex.
Study Purpose
This study aims to build on prior research to more fully develop a cohesive understanding of trauma bonding as it occurs among sex trafficking survivors. This study specifically seeks to understand how service providers working with survivors of sex trafficking conceptualize and observe trauma bonding in their clients. Social workers and counselors work daily with trafficking survivors to help them heal from their trauma, and as such, have a unique vantage point from which to observe this phenomenon. The research questions guiding this study are: (a) How do service providers observe, witness, and perceive the phenomenon of trauma bonding among the survivors of sex trafficking to whom they are working with and providing services to? (b) How do they describe the indicators of a trauma bond?
Method
Design
This cross-sectional qualitative study was descriptive and exploratory in nature. This paper utilizes aspects of a grounded theory approach. Grounded theory is a systematic methodology introduced by Glaser and Strauss (1967) in which hypotheses and theories are constructed through data collection and analysis. In utilizing aspects of grounded theory, the study aims to give voice to service providers without preconceived notions, allowing the perspective of the paper to truly focus on and reflect the valuable information shared by service providers. Aligned with a grounded theory approach, data collection for this research used an iterative interviewing process (Padgett, 2008). Additionally, grounded theory aspects of memo writing to document data collection and analytic decisions, inductive coding techniques, and weaving theoretical ideas and concepts into the emergent findings were used throughout this study's data collection and analysis phases (Padgett, 2008).
Sampling
The inclusion criteria for this research included social workers or counselors licensed within the state of residence, currently working in positions that involved direct practice with survivors of sex trafficking. All the interviews for this research were conducted by the first author, who has over four years of practice experience with survivors of sex trafficking. The first author purposively selected agencies that offer services to sex trafficking survivors in a specific Midwestern city. The first author identified publicly available email addresses of service providers from the internet and sent emails to potential participants with information about the study and informed consent procedures. A total of 16 emails were sent, and 12 service providers expressed a desire to participate in the study, of which 10 service providers were interviewed for this research. The first author scheduled a meeting with potential participants at a location of the participant's choosing for privacy and convenience. At this meeting, the first author explained informed consent procedures and obtained written consent, and participants were then enrolled in the study. This study was determined Exempt from IRB review by the first author's university review board.
Data Collection
Four of the interviews were conducted in person, and the other six were conducted via zoom due to COVID concerns. The interviews ranged from approximately 45–60 min. All the interviews were conducted in English and were audio-recorded using an audio recording device. No compensation was offered to the service providers for participating in this study. After the 10 interviews were completed, it became apparent that no new information was emerging from the interviews and saturation was reached, thus the recruitment process was stopped. The authors assigned pseudonyms for participants that were used across all study materials, and participants were not asked to provide any identifiable data. All the interviews were completed between March and December 2020.
An open-ended semi-structured interview guide was used to collect data. The questions focused on service providers’ understanding and definition of trauma bonding and their experience identifying such bonds among sex trafficking survivors. Some of the questions were as follows: What do you think leads to or creates a trauma bond? Are there risk or protective factors? How can you tell when a survivor of sex trafficking has experienced trauma bonding? How does the presence of a trauma bond affect a sex trafficking survivor?
Strategies for rigor included journal writing during data collection, peer debriefing, and analyses for reflexivity throughout data collection and analysis. The first author's own prior practice experience with sex trafficking survivors helped to facilitate trusting conversations with service providers serving as the participants of this research. The first author took active efforts to acknowledge and bracket her feelings and engage in journal writing and peer debriefing to address reflexivity during the data collection phase. Additionally, each author of this paper has graduate degrees in social work and experience working directly with sex trafficking survivors or studying topics relevant to the discipline. Biases and knowledge gaps were identified and noted throughout data analysis in ongoing zoom and phone conversations. Collectively, these strategies helped build rigor in this qualitative study.
Data Analysis
For the purpose of analysis, each interview was transcribed verbatim. The audio recordings were deleted after transcription to protect participants’ confidentiality, and the transcriptions were labeled with pseudonyms instead of participant names or any other identifying information. Initially, the first author listened to the recordings and made notes about her earliest impressions of the data. Next, using a grounded theory approach, she completed the first cycle coding of the transcripts with in vivo, process, and initial codes (Saldaña, 2014). One hundred and four codes were created during the first cycle. These codes along with the transcripts were shared with the second and third authors, who provided feedback and discussed them with the first author. After this, the first author completed a second cycle of coding using focused, axial, and theoretical coding (Saldaña, 2014). After this second cycle, there were 67 codes. Once again these codes and the transcripts were shared with the second and third authors, and the authors together discussed the codes and began to develop themes which portray the relationships between codes emerging from the data. ATLAS.ti was used for all coding and data analysis. Throughout all coding and data analysis, the authors used constant comparative analysis to examine contrasts across the different participants, situations, and contexts (Padgett, 2008). Additionally, memos were used to record analytic and conceptual notes, the basis for definitional statements for codes, and to assist in reflexivity on the authors’ part throughout the research process (Padgett, 2008).
Results
Participants
All 10 participants identified as non-Hispanic white or European American cisgender women. Participants’ ages ranged from the mid-20s to early 50s, with the average age range being 31–35. All 10 participants held master's degrees in either social work or counseling. Participants’ length of time working in the social work or counseling field ranged from three to 15 years, with an average of 10 years, and the length of time working specifically with survivors of sex trafficking ranged from two to 15 years, with an average of seven years.
Trauma Bonding
Two main themes emerged from the data: defining trauma bonding and the development of trauma bonds. Defining trauma bonding had four subthemes, and the development of trauma bonds had three (see Figure 1).
Themes and Subthemes.
Defining trauma bonding
Yearning for intensity
One of the most defining features of trauma bonding discussed by participants was the intensity that characterizes the relationship dynamic. As Robin explained, “It's like intensity must equate to truth.” Robin elaborated on the consequences of this assumption when describing the attitude she has witnessed among survivors she has worked with: “I feel most intensely towards these other women or these dudes, so therefore the truth must be that I’m supposed to be with them or we’re meant to be together.” This desire for intensity is often met through sex, as Robin explained: Sex is essentially the ultimate form of intimacy and the ultimate bond, so—’cause they’re probably craving, like, “I need to feel alive,” and the only way they felt alive with all the adrenaline going through them is life or death situations or high intensity, extreme unhealthy sex, so they’re like, “Well, I’ll just create it so I can feel alive again.”
Participants explained that this craving for intensity stems in part from repeated experiences of abusive relationships. Brenda put it this way: “When clients have had these really tumultuous relationships, the highs are really romantic and sexy and the lows are abusive and detrimental, a normal so-to-speak or healthy relationship feels really boring.” Ashlyn echoed this sentiment when she remarked that often for survivors, “what's healthy then feels weird and uncomfortable and unsafe and unstable.” Dorothy theorized that some of this is due to brain chemistry: The brain gets used to these really intense relationships and the rush of chemicals that come with it, even though it might not always be pleasant, but it is very intense. If that's what you’ve known in a relationship is that intensity, then it becomes very difficult to have a normal relationship because the good, much less intense loving feelings don’t feel as intense, so it doesn’t feel as real.
Experiencing abuse in childhood specifically was a common thread discussed among participants, particularly in relation to the normalization of intensity as an adult. Robin explained: It's human nature to think intensity means truth because even with a parent, if one parent yelled at you every day that you’re worthless, the intensity of how negative that would feel, like one of two people that brought you in the world is verbalizing this to you over and over, it— they will absorb that as truth. I will feel worthless. Even if you had seventy five people also telling you every day that you’re a good person, the intensity, usually people latch onto that as truth.
Darla shared a similar observation, noting “In their development, they become more familiar with power dynamics with almost abuse in relationships being quote unquote normal, so that being kind of a normal thing.” Catherine discussed this as well: I think it all goes back to peoples’ childhoods…. Their environment was really chaotic so chaotic seems normal to them and that's not like a red flag to stay away from a chaotic person…. Any kind of childhood abuse, sexual abuse, or emotional or physical abuse because you know it teaches them at an early age it's okay to be mistreated or they’ll go above and beyond to try to maintain you know the connection with someone even if it's unhealthy or unsafe.
Both Robin and Dorothy specifically mentioned witnessing domestic violence in childhood as a primary risk factor for developing trauma bonds as an adult. Robin explained: “They’re hearing the words ‘I love you’ verbalized in conjunction with the actual attacks.”
Power imbalance
The power imbalance between the two parties, in this case with the survivor of sex trafficking having less power than the perpetrator, is another defining feature of a trauma bond. Darla called it: A complex relationship where there's intermittent reinforcement of affection, of love, of gifts, of things that really strengthen an emotional bond and make it difficult for the person on the—because there's a power dynamic there. The person that's in the lower end of things that makes it more difficult to leave the relationship. Because they're getting, again, that intermittent reinforcement of love, affection, things like that, it makes it more difficult to leave.
Participants explained that this power imbalance is created in part by a cycle of abuse that alternates positive and negative interactions. Ashlyn described: The cycle of abuse, there is a reward piece in that, and that feels good. That also brings about feel-good chemicals in the brain that are just very confusing when that's followed with more abuse and the fact that it's a cycle.
The “positive” interactions are often the perpetrator meeting the needs the survivor has, or perhaps rewarding them in some way. This may occur in the form of providing drugs, as suggested by Catherine: It can [be] the person who gives them their drugs because you know when you’re addicted, it feels like the person that's giving you drugs is taking care of you because you’re withdrawing and it feels bad and then they do something to make you feel better, even if that thing is getting you high which then keeps you in the situation or that you have to pay back that money by turning tricks.
In other instances, it could be lavishing the survivor with affection or gifts, as Darla described: “Physical or emotional affection, gifts, jewelry, clothing, et cetera…. Those things, the gifts, the rewards really deepen that emotional bond that's there.” Experiencing affection or generosity at the hands of a perpetrator bonds the survivor to them, making it difficult for survivors to leave. Lynne echoed the feelings she has heard survivors repeatedly express: Even though this is unsafe, sometimes it's also providing me what I need. Sometimes he's nice, sometimes he's loving, but then sometimes he's not and sometimes he beats me, but when he's nice, he's nice. He's good. He's loving. He's romantic. That's like he loves me hard and then he abuses me hard.
Relatedly, Catherine suggested that for many survivors, their relationship with the perpetrator might be the only “caring” relationship they have: People think this person cares about me because they you know have provided these things for me when I’ve needed it or they’ve had my back, or like they’ve killed someone else who was trying to kill me, it's such intense things sometimes and so, but even the daily needs of clothes, and food, and drugs, and those things send mixed messages and so it's hard to just say this person doesn’t care about me because sometimes it seems like they do, and I think that prevents people from just you know cutting ties, and sometimes it feels like the only family they have or the only relationships they have so that's a lot to give up.
This power imbalance is also perpetuated through intentionally cultivated competition between survivors, as Vicky described: We hear a lot about a dope boy setting up competition between his group of women, and sometimes he's not romantically involved with those women, but whoever can bring in the most money gets some kind of perk. Maybe she doesn't have to go out as often or as long, or maybe she gets to stay in the house and use more as opposed to being kicked out. I think it happens both ways.
The intentional alternation of positive and negative interactions was emphasized by many participants as a key feature of trauma bonding. Brenda expressed, “If someone causes your turmoil and they rescue you from the turmoil, that is kind of a standout feature of a trauma bond.” Kristie described a similar outlook: The goal of the perpetrator is to instill in their victim not only fear of death but gratitude for being allowed to live. And so I also think of a trauma bond as something that's been like uniquely, it's a play, like it's a play by a perpetrator or a trafficker in this case of I am going to provide the thing for you that you need, like while also inflicting harm and so there's this weird mix of fear and gratitude.
Distortion of love
The third theme that emerged regarding a definition of trauma bonding is a distortion of love. As has been alluded to in the previous two themes, participants reiterated at length the emotional attachment and affection survivors often feel toward their perpetrators, and their belief that such feelings are reciprocated. Participants specifically noted that survivors tend to have a distorted understanding of what love is, and a skewed perspective on their relationship with their traffickers or other perpetrators. Robin explained that many survivors cannot distinguish between a bond and love, and this contributes to the distortion: They always confuse that ‘cause I think they’re always like, “But I love him,” and I’m like, “Well, you probably don’t love him. You’re probably just bonded to him.” They usually get this look of like, “Oh, my God.” I’m like, “It's not necessarily the same thing.”
Catherine discussed why this may occur: Sometimes it's our brains way of coping with traumatic things happening, that we try to see it in a positive light, because that's easier to cope with, like easier to swallow, than acknowledging that this person is harming me, this person is intentionally doing these things to me.
Lynne put it simply when she said, “Yeah, it's a hard thing to come out of because they truly, truly believe that the abuser loves them and cares for them.” Vicky described this distortion as: The really intense feeling of this person is the only one who knows me and always being lured back to that. Nobody else can fill that hole like he could, so it makes it hard, really hard, to get clean, stay clean, stay out of the life, not go back to it, not just start looking for him again. People who have been clean decades say they still have loving feelings for that person even though in their head they know it was trauma bonding. They know they were trafficked. They still love him.
Sometimes this skewed perspective is revealed through the way in which survivors talk about their perpetrators, or their affect when discussing traumatic experiences. Robin provided an example of this: I think of the last girl I worked with a lot ’cause her—the guys she was trauma bound to… she’ll be like, “He is the worst. He tied me to this and almost killed me one time,” and I don’t even think they realize that they’re smiling. I’ll be like, “Do you notice that you’re smiling right now and that you have a glow about you? That is a problem,” ’cause I’m just like, “This person was trying to kill you, and you are losing sight of that.”
In many cases, this distorted view of love involves the trafficker. Robin explained that for many survivors, the purchaser of sex (often called the john or trick) is viewed as the real evil, and the trafficker is seen as a rescuer or savior from that evil: But the pimps I’ve noticed… I think that they get caught up with this sense of savior, this bonding savior thing where they’re like, “Even though you brought me into this situation, I saw the truly evil person as the trick. The trick was either not giving me money or choking me or doing something and you either intervened or you took me away from that situation.” They lose sight of, “You brought me here. You facilitated all this.” I just call it psychological survival… It's like when you’re truly in life-threatening situations or when these women are in concentration camp-like experiences, it's human instinct to want to latch on to the most positive thoughts. If they’re like, “I can’t cope with anything,” they just want to focus on, “You took me away from this situation,” so being like, “You got me out of that hotel room.” Even though the guy brutalized them in there, if it's like, “You’re taking me away from this rapist,” then they will develop this positive bond of like, “You were like a savior to me.”
However, in other cases, this distortion of love might apply to the john as well, and a trauma bond can also be formed with those individuals. Catherine explained: I think that some people probably have it with their johns too. Especially if the john didn’t like actively mistreat them, you know like if like a john rapes someone they don’t usually form a trauma bond with the john, but if that john paid them well, took them out to eat, gave them lots of stuff, a lot of times people are going to view that as like a positive safe person who cares about me and takes cares of me. And they’re neglecting the fact that this person took advantage of you and like enabled your addiction and all these other things by giving you money or asking you to do things that you didn’t personally want to do.
Inescapability of the bond
The inescapability of traumatic bonding was the final feature discussed by participants. This refers to the permanence and strength of the bond, and survivors’ sense that it is impossible to break the bond. Robin said a trauma bond is “a permanent seal. It is an absolutely permanent seal.” To illustrate this inescapability, Kristie shared about a specific survivor who has been free of trafficking and substance abuse for over 10 years, but who still experiences some aspects of a bond with her trafficker: I also think about people like [survivor's name], you know, who have now 10 and a half years, you know, out of the life, and still acknowledge that there are these moments that she finds herself wondering how her trafficker is doing. Now I don’t think today she’d say she's in love with her trafficker or that she's thinking about her trafficker every day. The reality is for her, even ten and a half years later, there are just moments, and I think, that, so when you ask that question, I think about someone like her and I think it's not even just that initial painful period of like grieving all these things you’re giving up, it's also the fact that maybe for a long time in your life this person's going to come into your mind, you know, and so having like the distress tolerance skills to just sort of like notice that but not be taken by that, you know?
Participants discussed survivor behaviors that make escaping the bond incredibly difficult. These include maintaining communication with the perpetrator, protecting them, and leaving treatment to be with them, as Ashlyn explained: If there's any current communication with people, they're not getting out of it if there's still any ongoing interaction… They're supporting them some way. There's dishonesty from the client's part about who even is this person. No, it's my uncle or my cousin. There's a lot of protection of the other person to still have them in their life without us helping professionals know… People have left treatment to go back to traffickers, which is, I think, so sad and awful.
This can also affect trauma treatment, as survivors might be resistant to sharing negative experiences involving the perpetrator they are bonded to. Kristie discussed this: “There's this desire to protect the perpetrator, a desire to almost like hold onto those memories, or hold onto to whatever was maybe perceived good in that scenario.” Brenda also shared that this persistent bond can contribute to survivors relapsing while in recovery: “Every relapse that I’ve ever sort of dug into when someone's come back leads to a relationship.”
Ashlyn shared that when a trauma bond is present, survivors will often miss perpetrators long after being separated from them: There's elements of well, I miss them. They really did love me. They'll second guess it later on too or have dreams, either good ones or bad ones, with this person popping up… people feel pretty messed up about the missing them part because they know that this abuse was so wrong and bad and painful, but part of me still wants them.
This inescapability is also observed in the conflicted feelings survivors experience toward their perpetrators. Kristie spoke to this when she said: You’ve got someone who, they might even also recognize, like that their life might improve, if they were able to get some separation, from this person, but the addiction, if you will, or the pull, is so strong… attachment and I want to be rid of you, the ambivalence of it, right, like I want to be able to get rid of you and I’m so in love with you, or I want to get rid of you but I’m so attached to you.
Finally, some participants suggested that it is impossible to sever a trauma bond. Robin suggested this, and put forth that a trauma bond will persist even if a survivor is able to escape from the effects: “I don’t think it's possible to break trauma bonds, but what is possible is what you said: disconnecting from those people and not acting on it.”
Development of trauma bonds
Universality
The first theme that emerged regarding how trauma bonds are developed is the universality of the experience. Participants explained that anyone can develop a trauma bond if they experience certain circumstances, and “your status doesn't affect whether or not you can have a trauma bond with someone” (as Ashlyn put it). To illustrate this, several participants gave hypothetical examples. Robin described: I’ll be like, “Okay. We’re sittin’ here in this McDonald's right now, but if a gunman came in here and had us all at gunpoint for 30 min, you and I could walk away from each other. We would never see each other again, but if I saw you 10 years from now, you and I would lock eye contact and we would be like, ‘Oh, my God. I was there and you were there. I get it.’ We would be trauma bonded because we went through an experience that we thought we were gonna die together and that wasn’t necessarily violent, but a decade could go by and I wouldn’t see you and I would still—you and I would still be bonded.
Similarly, Catherine shared: So I usually kind of say you know a trauma bond is when you go through a traumatic experience with someone, like if you and I went in the car together you know and we left here and we got in a car accident, like we would have a bond together because no one else experienced it and only the other person can completely understand what happened. So you feel very understood by that person, you feel close to them.
Kristie said: Even like, I can just think of for me, if I experience something that I experience as traumatic in my life today, the people that I reach out to or that I lean on in that season of my life, there's something forged there that is cherished forever, you know? And they could be awesome people, they could be shitty people, but like, there is something about shared trauma that I think builds just builds some intimacy.
The defining element is experiencing trauma with another person. As Robin shared: Everybody becomes trauma bonded to anybody that they experienced life or death with… it's just human nature to become bonded to the people that you have experienced trauma with… [a trauma bond is] the invisible and unexplainable glue that seals you to the people that were present during your life-threatening experience.
Participants did indicate that the length of trauma exposure can impact the development of a trauma bond, with a more prolonged time period being more likely to foster a trauma bond. Ashlyn explained: I would say if there's more—more so in cases of prolonged relationship or prolonged abuse or prolonged exposure. I have seen that less likely with my clients for single-incident things. Like I was kidnapped, and this all happened, but it was a few days, and then I managed to escape. I don't see the same thing there. I think a prolonged time period is indicative.
Likewise, Kristie expounded: Whereas I think the trafficking survivors we worked with, no, obviously, some of them are exploited more rapidly like in that force concept, but when you have fraud or coercion, particularly fraud, I think that's, that builds upon the idea of like building trust and building a relationship and so I think there's something slower about it.
According to participants, this all means that trauma bonds can either be good or bad, as Robin explained: Trauma bonding is either a great thing or it's really destructive because I’ll feel low key trauma bonded to a lot of the guys that I work with or girls ’cause we’re in these pretty chaotic situations. None of ’em I would say would be life-threatening, so it's not like a real trauma bond, but the people that have good real trauma bonds are people that are in military, in war together, that have each other's backs and whatnot. I usually say trauma bonding is either beautiful or awful…That's either gonna be good or bad. It's good for firefighters, and it's really bad for women who the men that have hurt them are the only people that they feel like can understand or accept them.
Given these factors and the nature of sex trafficking, participants unsurprisingly affirmed that almost all of the survivors they personally worked with had trauma bonds, and in many cases more than one. Catherine shared: “Yeah I’ve never dealt with someone who didn’t have trauma bonds. Yeah and I think it's usually with multiple people. And some are more you know significant than others, stronger than others.” Similarly, Robin said, “There's so much trauma bonding everywhere, between the pimp, all the johns, the people that are loyal to the pimp that will hurt the girls around their dates.”
Almost every single participant spoke to the role of brain chemistry in the development of trauma bonds, which further undergirds the universality, because as Ashlyn said, “No one has control over their brain chemicals.” Kristie discussed the involuntary nature of the neurochemistry in bonding: One thing I’d be curious to learn more about is … what is happening in the brain? During a trauma bond and like sort of the neuro chemistry of it all? Because I’ve heard for example you know that the body releases like hormones, and you know even like natural sort of like opiates like in the body to protect itself, heal itself, in moments of trauma, which to me, I mean, so then you, then you imagine in those scenarios that you’re creating, you’re actually, your body is sort of creating, you brain, body, whatever, seems to be like creating a bond with someone who's harming you, which you’re not consenting to that happening it just happens.
Naomi shared similar thoughts regarding the body's protective response: “If we’ve been hurt, some of the hormones that get released to make that experience less painful also cause us to feel warm feelings, and there can be a neurobiological response.” Oxytocin specifically was mentioned by participants as playing a role in the development of trauma bonds. Brenda explained: It [oxytocin] reduces pain, creates a little bit of fuzziness about a memory, and it creates bonding to a perpetrator. Usually that in the context of childbirth, because people love their babies who cause all this pain. The same thing happens when we’re abused by another person, and I think that helps to kind of explain at least a little bit of the physical piece.
Interestingly, despite the universality of the development of trauma bonds, participants shared that they believe there is still a strong stigma against survivors who display symptoms of trauma bonding. Kristie shared, “I definitely don’t have a shock about it, I think some folks if they don’t, if they’re not educated about trauma bonding, might listen to a client who has a trauma bond, and view them as like a little bit crazy.” Correspondingly, Ashlyn said, “I think too, the general public doesn't understand, and then people get blamed for things like not leaving [the perpetrator].”
Gendered bonds
Despite the universality of the development of trauma bonds described above, participants also spoke to the gendered nature of trauma bonding; specifically, women seem more likely to develop trauma bonds than men. Participants discussed that this seems to be in part due to cultural messaging women face, paired with normal human desires that “people want to be wanted by someone else and want to be loved,” as explained by Ashlyn. Vicky spoke to this: I also think in our culture where women are really taught you have to have a man to be—if you don't have a man you're not complete. Your life doesn't have a lot of worth. What gives you value is having a man wanna be with you. I think that's part of it, the cultural messages, that makes it—yeah … I think so much is in the culture … it's so ingrained that this is the purpose of your life is to be with someone and be in love and get those feelings back. It's just relationship, relationship, multiple, multiple, multiple with whomever gives them the time of day.
Kristie shared a similar idea: It definitely feels like just even from gender, like gender normative ideas that women are sort of trained to be taken care of, thanks Disney (laughs). I mean you know though, it's like, it's just like truly what we’re taught, whether we grew up on the streets or whether we had a great upbringing, so in some ways yeah I do think that's actually a vulnerability … Yeah no I definitely think being a woman is a liability in this case.
Furthermore, in addition to cultural conditioning, prior abuse also likely contributes to the gendered nature of trauma bonding. As previously suggested, childhood abuse is a risk factor for developing trauma bonds as an adult. Catherine explained: Obviously any kind of childhood abuse, sexual abuse, or emotional or physical abuse because you know it teaches them at an early age it's okay to be mistreated or they’ll go above and beyond to try to maintain you know the connection with someone even if it's unhealthy or unsafe.
Vicky agreed: “Yeah, and a risk factor, the early childhood sexual abuse is probably the biggest one.” Since girls experience childhood sexual abuse at a higher rate than boys, this helps explain participants’ theory that women have a greater predisposition to developing trauma bonds than men.
Grooming
The final theme related to the development of trauma bonds is grooming. This theme captures participants’ notion that perpetrators, specifically traffickers, intentionally seek to cultivate a trauma bond with survivors as a tactic to manipulate and exploit them. Under this paradigm, the trauma bond is not something that just emerges by accident, but rather a goal of many traffickers. Ashlyn surmised that perpetrators look for ways to meet survivors’ needs and gain power over them: There's force or other things that the abuser is doing that create this dynamic. Maybe if I'm meeting some of your needs, if you live with me, or I hold all the financial power or what have you. I think there's things the abuser does that also create real needs or things that can lead to this.
Correspondingly, Darla explained: Again, if we're looking at those gifts or rewards to woo them into a relationship, it can be a pretty easy way to get a woman stuck in that cycle—I shouldn't say just woman—get a person stuck in that cycle.
For many perpetrators in trafficking situations, drugs are the perfect tool for coercion. Darla elaborated on this: “Traffickers, they're smart. They know. Drugs can be used either to initially get a woman into a trafficking situation, or they may find a woman who is already addicted.”
Participants discussed how many traffickers are experts at this “brainwashing mind game,” and often they are “preying on vulnerabilities and real needs that often exist,” as Ashlyn explained. Dorothy commented: “Abusers know to look out for people who are vulnerable to being trafficked or are looking for someone to love them and can use that to manipulate them.” Similarly, Kristie described traffickers as skilled at building relationships with vulnerable individuals, saying “Then you just need somebody who can exploit that, you know? And [who] has some skill, quite frankly, at you know, like, making themselves look trustworthy right, and earning that trust, and then exploiting that trust.”
Discussion
The goal of this study was to examine how service providers working with survivors of sex trafficking conceptualize and observe trauma bonding in their clients. Two main themes emerged from the data: how service providers define trauma bonding, and how they theorize trauma bonds develop in survivors of sex trafficking. How service providers define trauma bonding can be broken up into four subthemes: yearning for intensity, power imbalance, distortion of love, and inescapability of the bond. How service providers believe trauma bonds develop can likewise be divided into three subthemes: universality, gendered bonds, and grooming. These findings support and build upon the existing literature in several important ways.
First, when discussing survivors’ yearning for intensity and distortion of love in trauma-bonded relationships, participants often referenced prior abuse, particularly in childhood, as an explanation for these phenomena. Participants’ comments align with previous literature establishing exposure to maltreatment in childhood as a risk factor for not only trafficking but a survivors’ normalization of abusive behavior, thus making them susceptible to developing trauma bonds (Casassa et al., 2021; Franchino-Olsen, 2021). Second, participants spoke at length about the power imbalance between a perpetrator (often the trafficker) and a victim (the survivor of trafficking). This power imbalance has been discussed in other research on sex trafficking and trauma bonds and has been tied to the intermittent display of positive and negative attention (Casassa et al., 2021). In this study, participants elaborated on this and explained how the use of gifts and competition further solidifies the power differential in trafficking situations.
Third, previous literature has elaborated on the fact that many survivors of sex trafficking experience difficulty leaving their traffickers or holding them legally accountable, in part due to feelings of loyalty or affection (Baldwin et al., 2015; Clawson & Grace, 2007; Nichols, 2016; Reid et al., 2013). Participants’ remarks expanded on this as they spoke to the power of trauma bonds, and how survivors often miss their traffickers years after exiting their trafficking situation. Participants also commented on how in therapy, survivors will often refuse to address trauma related to their perpetrators, due to the bond that they have or a desire to protect a certain narrative of what occurred. Fourth, participants considered the grooming behaviors of a trafficker or perpetrator a key element in the development of trauma bonds. This supports Casassa et al.'s (2021) findings regarding traffickers intentionally developing trauma bonds with trafficking survivors by preying on emotional vulnerabilities and attachment needs.
In addition to supporting the existing literature, these findings also shed new light on the occurrence of trauma bonds. Specifically, participants described trauma bonding as a universal phenomenon that can occur among any individuals who experience life-or-death situations together. Instead of a malady only plaguing those with prior abuse, for example, participants explained trauma bonds as normal—adaptive even—responses to trauma. This holds significance for reducing the stigma facing survivors who return to abusive situations or protect their perpetrators from prosecution and highlights the need for future research to explore the brain chemistry underlying the development of trauma bonds (which participants theorized about). Increased understanding surrounding the mechanisms of trauma bonding will allow for more effective ways to help survivors sever trauma bonds formed with unhealthy and unsafe individuals. Additionally, the notion that trauma bonding can have a gendered component and women may be more susceptible to developing trauma bonds than men is a new insight and one that holds implication for further study.
This study's findings pose important questions for future research. Particularly, conducting similar studies with survivors themselves will provide important insight into how survivors make sense of their own experiences and offers the best chance at developing an accurate, comprehensive understanding of trauma bonding. True grounded theory research must be done to develop an adequate theory of trauma bonding among survivors of sex trafficking. Additionally, given the homogeneity of this sample, it will be important in future studies to examine how diversity affects the development of trauma bonds or their expression. Do different cultures have unique perspectives on how trauma bonds are perceived? This information would also inform the development of interventions that are able to be tailored to the background of the client. Relatedly, similar studies with practitioners and survivors from populations such as intimate partner violence and incest would further elucidate the similarities and differences in trauma bonding among sex trafficking cases and other populations. Perhaps most importantly, intervention studies are needed to provide an evidence base for modalities that counselors and social workers can utilize when working with sex trafficking survivors who have experienced trauma bonding. An evidence-based strategy for psychoeducation concerning trauma bonding also needs to be developed for clinician use with clients who are survivors of trafficking. It is especially important that such psychoeducation is designed in such a way that precludes clinician blame of the client, which is unfortunately present all too often (Leedom et al., 2019).
In addition to influencing future research, these findings also hold significance for current practice with survivors of sex trafficking. For practitioners working directly with survivors, the themes that emerged from this study's data contain numerous insights that can shape their practice. First, the understanding that for many clients who are survivors of sex trafficking, intensity equates to truth, can help practitioners be prepared for instances in which clients view healthy relationships as boring, or where they normalize or accept violence and abuse as typical behavior. Instead of pathologizing these tendencies as abhorrent or unhealthy, practitioners can instead understand why their clients have this yearning for intensity and be better equipped to meet them where they are in the change process. Second, understanding how the intermittent nature of abuse (alteration of positive/rewarding and negative/abusive behavior) contributes to the power imbalance between a survivor and her trafficker, can inform practitioners in how they approach and discuss the trafficker with their clients. If a practitioner comes on too strongly and only denounces the abusive behavior of the trafficker, they risk alienating their client and thus might lose the opportunity to address the trauma bond in any impactful way. This is an especially important consideration, as many survivors are already hesitant to talk about the perpetrator in therapy, whether to protect the individual or their own narrative of what occurred. On the contrary, if a practitioner is able to validate the positive or rewarding behaviors the trafficker engaged in and how at times, their client felt cared for by the trafficker, the practitioner will have a greater likelihood of engaging the client about that relationship and getting to a point where the trauma bond can be discussed openly, all the while building trust and rapport, as opposed to alienating the client.
Third, understanding the distortion of love that many survivors experience due to their trauma bonds can inform practitioners in their work with clients, as they provide psychoeducation to help clients distinguish between love and bonding (namely, trauma bonds). Fourth, understanding the sense of inescapability many survivors feel regarding their trauma bond can help practitioners establish realistic goals for their clients. If the goal is not to “break” the trauma bond, but instead, get to a place where one can feel the pull of the attachment without acting on it, then practice will significantly differ from a setting where the goal is to sever the bond completely. Finally, the emphasis from respondents on the universality of trauma bonding can help practitioners counter stigma, both in themselves and in larger society, against individuals who return to abusive situations or protect their traffickers. Practitioners have an important role to play in normalizing trauma bonds as a response to trauma and abuse.
Furthermore, an increased understanding of trauma bonding among sex trafficking survivors gained from this study can also inform legislators, who draft laws regarding the prosecution of traffickers or protection of victims, and law enforcement officials, who often respond to trafficking situations. Increased awareness of how trauma bonds present and the ways in which they may influence a survivor's actions and behaviors will help legislative and criminal justice entities to better recognize, respond to, and protect trafficking survivors. Additionally, the current Diagnostic Statistical Manual does not include diagnostic criteria or other information concerning trauma bonding, and the findings from this study are essential to build the understanding needed to move toward this sort of development.
The strengths of this study lie in the rigorous qualitative methods used to reduce researcher bias and reactivity, including maintaining a journal, detailed audit trail, and peer debriefing throughout data collection and analysis. Regarding limitations, the study respondents did not represent diverse racial, ethnic, and gender identities. Even though the respondents provided a range of services to trafficking survivors in the Midwestern city, the sample's lack of diversity may have resulted in a biased response. Additionally, the self-selection of respondents into the study may have resulted in bias based on the subset of the service providers who felt comfortable participating. Further, due to the onset of the COVID-19 pandemic, most respondents had to be reached for interviews via zoom. Potential zoom fatigue or lack of technological know-how could have further dissuaded likely respondents from reaching out to the researchers.
Footnotes
Declaration of Conflicting Interests
The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.
Funding
The author(s) received no financial support for the research, authorship, and/or publication of this article.
