During socialite Ghislaine Maxwell’s sentencing on sex trafficking charges on June 28, adult survivors spoke out in anguish as they described the long-lasting effects of their years as trafficked teens and young women.

The New York Times said Sarah Ransome fought back tears as she described the suffering doled out by Maxwell and the late Jeffrey Epstein, saying she “became nothing more than a ‘sex toy.’”

Ransome told the court of suicide attempts, alcoholism recovery and relapses, nightmares, anxiety, flashbacks and difficulty maintaining long-term relationships, according to the Insider.

As a psychologist who works individually with victims of trafficking, Northeastern University  criminology professor Carlos Cuevas is familiar with individual symptoms of post-traumatic stress disorder and mental distress. What has been lacking is a large research study of the mental and physical health implications of sex trafficking on adolescent victims, he says.

Cuevas and fellow Northeastern criminology professor Amy Farrell have set out to rectify that situation by surveying 500 adolescent victims of trafficking about their physical and mental health as well as the health services that they use.

“We’re recruiting [participants] from agencies across the country that work with trafficking survivors,” Cuevas says, including agencies in Boston. “We just don’t have much information about the physical health impact of having been a trafficking victim.” 

A 2014 study shows  that sexually traumatized women are more at risk for mental health disorders such as depression and anxiety and for addictions including smoking and alcohol consumption.

Research also indicates a link between child sexual abuse and chronic illness in adulthood.

For years, victims of sexual trafficking have been treated as criminals, even those who were underage, Cuevas says.

Little attention was given to their suffering, in the short or long term.

“Human trafficking, and in this case the issue of sex trafficking of children and adults, has been unrecognized for decades,” Farrell says.

“Passage of federal legislation in 2000 enumerating human trafficking crimes and clarifying that commercial sex with minors is a crime regardless of the evidence of force, fraud or coercion was a critical first step in raising public awareness about the issue,” she says.

Even so, trafficking victims can face a level of criticism and disbelief that can hinder their efforts to get help or healing.

“Traffickers depend on the shame victims will feel,” Farrell says.

“They often tell victims that no one will believe them, that people will blame them and that they have gotten themselves into this one on their own.”

“When victims face public blame, it just affirms all the messages that have kept them coerced for so long,” Farrell says.

Annie Farmer was just 16 when she fell prey to Maxwell and Epstein’s network of abuse that eventually drew in her sister as well.

She spoke in court just before Maxwell was sentenced to 20 years in prison and through her lawyer submitted a lengthy victim witness statement on June 22 that detailed the pernicious effects of her experience.

“One of the most painful and ongoing impacts of Maxwell and Epstein’s abuse was a loss of trust in myself, my perceptions, and my instincts,” she wrote.

“When predators groom and then abuse or exploit children and other vulnerable people, they are, in a sense, training them to distrust  When a boundary is crossed or an expectation violated, you tell yourself, ‘Someone who cares enough about me to do all these nice things surely wouldn’t also be trying to harm me.”’

“This pattern of thinking is insidious, so these seeds of self-doubt took root even as I learned my sister had also been harmed by them, and came to find out years later that many others had been exploited. For years these memories triggered significant self-recrimination, minimization and guilt. I blamed myself for believing these predators actually wanted to help me,” Farmer wrote.

Imbalances in age, power and status can serve as coercive factors in trafficking cases, says Margo K. Lindauer, clinical professor of law at Northeastern and director of the university’s Domestic Violence Institute.

“We have a concept of what a perfect victim is,” Lindauer says. And it does not include poor girls from unstable backgrounds or naive teens thrilled to accept a ride on a private jet.

“We have to expand how we define harm”, she says, to include preying on vulnerable individuals.

“We’re just coming to terms as a society with how prevalent sexual violence, trafficking and domestic violence are a real thing,” Lindauer says.

Boys and young men are trafficked as well as girls and young women, Cuevas says 

“I think it’s important not to make assumptions about the gender of trafficking survivors,” he says.

Young people who identify as lesbian, gay, bisexual, transgender, queer, intersex and asexual may be particularly vulnerable due to lack of family support or other circumstances, Cuevas says.

“Very often victims of trafficking were seen as sex workers and were treated as offenders when in reality they are victims that are being coerced into these behaviors,” he says.

“In reality they are kids who are being repeatedly victimized.” 

They need to be treated as such by law enforcement and in health care settings, Cuevas says.

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