Complex Post Traumatic Stress Disorder

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Complex Post Traumatic Stress Disorder


Complex Post Traumatic Stress Disorder                                                

Background BCCEC

The BCCEW was formed out of two regional meetings of women in and from the sex industry in 2002 and 2003.  Renamed the BC Coalition of Experiential Communities (BCCEC), members include men and women from across the province who have over 30 years combined experience in advocacy, research, service delivery and management, and well over 50 years experience in all facets of the sex industry.  Members have founded, operated or significantly contributed to eight sex worker organizations including the BC Coalition of Experiential Men.  Mandate: The B.C. Coalition of Experiential Communities works to inspire experiential leadership toward the elimination of oppressive systems and forces that create harm within the sex industry. 


It was identified during the BCCEC "Confronting Bad Dates: Research, Collaboration and Action to Reduce Violence against Survival Sex Workers project" that:

  • § provincial victim services were unavailable to collaborate on strategies like the redesign and distribution of a new Bad Date sheet and a 1-800 line for reporting violence;
  • § the Ministry of Public Safety and Solicitor General victim support services were largely unknown and had barriers to accessibility by sex workers;
  • § Sex workers who had past experiences with Victim Services shared that their identification as sex workers limited or eliminated their chances to receive supports; inclusive of counselling and compensation.


These issues led to Victim Services attendance at the Confronting Bad Dates March 2007 multi-stakeholder meeting and later collaboration on victimization issues among sex workers. 


With financial support from the Ministry of Public Safety and Solicitor General, monumental alliances were built and sex workers had access to training from a leading professional psychologist in the area of Post Traumatic Stress. 


Additionally, sex workers and community organization staff members peer reviewed "The 411" a document created by the BCCEC, based on literature developed by the Ministry of Public Safety and Solicitor General.






  1. Members of the BCCEC reviewed and vetted the Ministry of Public Safety and Solicitor General brochures and resources for the purposes of creating an accessible document for sex workers and service providers.  This document incorporates tips on what to do if one becomes a victim of crime and identifies resources, techniques for emotional health, rights information and information on all other relevant topics;


  1. The BCCEC had the privilege of utilizing Victim Services funding to host two Post Traumatic Stress Meetings among sex workers and front line staff July 26th and 27th, 2007.   The July 26th meeting was attended by over 20 front line workers from Vancouver, Richmond and Surrey health and sex work organizations in addition to experiential professional working on the front lines.  The July 27th meeting was intended to be exclusively for experiential professionals and active or former sex workers.  There were around 12 individuals in attendance.  Issues that limited these numbers were the timing of this second meeting. 


  1. During these meetings;



  • Sex workers learned that very little work has been done to research the levels of PTSD experienced by sex industry workers in particular those who work in the dangerous street level environment. Some sex workers had been on the street for more than 30 years and had endured and witnessed unimaginable violence and hardship.


  • Sex workers expressed that this environment was akin to a war zone and that the levels of PTSD affecting us could be compared to those affecting soldiers who have served in a war zone, Vietnam war veteran's or holocaust survivors.


War Zone

1: a zone in which belligerents are waging war; broadly: an area marked by extreme violence

2: a designated area within which rights of neutrals are not respected by a belligerent nation in time of war.


  • Sex workers learned how the children of trauma survivors or the children of holocaust survivors show a distinct set of symptoms and noted that trauma on these levels for this extended period of time will affect generations of people for years to come.


  • Sex Workers acknowledged that the residential schools disaster has had a great impact for first nation's people and first nation's sex workers. The group acknowledged that a strategy specific to first nation's sex workers would be absolutely necessary.


  • Sex workers identified being re traumatized or made to feel unworthy by police, service providers, social workers, nurses and many others when seeking to report violence against them, access support or find assistance.


  • Sex workers now understand addiction as a symptom of or coping mechanism for post traumatic stress and as such mandatory sobriety to access services becomes harmful to those using drugs or alcohol as a coping mechanism. These barriers are seen as one of the greatest contributors to society's failure to address these issues in a way that does not compromise people's safety.


  • Sex workers now understand that the misdiagnosis of our symptoms has lead to wide spread harm through out our community. With symptoms that can be as extreme as hallucinations and strongly resemble the symptoms of schizophrenia, many have been prescribed mind altering drugs that they do not need and in fact harm them.



  • Sex Worker Support Workers expressed frustration at the gaps that currently exist in services ie, mandatory sobriety.


  • Sex Worker Support Workers expressed how lack of sex worker specific programming creates problems for finding safe places for sex workers.


  • Sex Worker Support Workers expressed frustration with sex workers suffering with the symptoms of PTSD and now have a greater understanding of it's causes and effects.


  • Sex Worker Support Workers now have greater understanding of complex PTSD and it's symptoms as it relates to vicarious trauma for the support workers themselves.


  • Sex Worker Support Workers expressed a will to move forward together to design a strategy to raise awareness, capture best practices and fill the gaps that currently exist.




Recommendations and Next Steps


Information provided by the psychologist was in direct conflict with practices and policies of the Ministry of Public Safety and Solicitor General.  For example, PTSD was noted as being cumulative however those who experience violence over long periods of time and who access Victim Services for compensation or counselling must link their trauma to one incident at one particular time.


In order to recognize PTSD among sex workers and provide them with the counselling and support they require, more research needs to be done to define the disorder among sex workers.  With empirical evidence, advocacy initiatives influence policies that currently exclude our most vulnerable members from the services they desperately need;


A series of focus groups/work shops which engage all stakeholders will work to identify gaps, increase awareness of complex PTSD, increase understanding of factors contributing to PTSD amongst sex workers, and create a strategy which can be embraced by the systems responsible for caring for sex workers that ensures the problems of the past are addressed and eliminated.

susan davis susan davis's picture


How to work within abstinence based funding environments                        





With all of the information emerging about the symptoms of PTSD, addiction as a coping mechanism and the dangers associated with interrupting people's coping mechanisms, it's difficult to find ways to ensure no harm within abstinence based funding environments. "Get clean" or off of drugs to receive support policies are compounding emotional harm for trauma survivors and are in direct conflict with the recommended treatment for such injuries. If you interrupt a person's coping mechanisms before they are ready to deal with their injuries, their emotional stability becomes at risk, their symptoms could escalate and at the very least their recovery will be seriously impeded.


 Some programs have found a way to by pass abstinence based approaches by including treatment of "relapse". Instead of cutting off support because a person has relapsed into addiction and "used", the reasons for the relapse are examined and addressed. New coping strategies and alternatives to self harm can be implemented/ suggested and over time these will help to limit exposure to emotionally triggering environments preventing or at least lessening future relapses.


So, yes "get clean" but with attention to relapse. This way funding for addictions treatment becomes available and still respects the symptoms of trauma survivors. I have included a tool for trauma survivors to map triggers and begin to self monitor in the handout's at the front as well as a sheet detailing some alternatives to self harm you may find effective when providing support.



Physical contact- should be a last resort- touching/man handling the victim's of violent crimes can further traumatize them. Members shared how being grabbed or restrained triggered them and contributed to their lack of trust in the systems designed to protect them. The explosive rage and extreme passion of trauma survivors when triggered can be difficult. Monitor their safety but maintain your distance. Restraining a trauma survivor during an episode can prolong the event and make their recovery from it longer and more difficult. Only in the most extreme cases should physical restraint be employed.


Over prescribing feeds addiction and under prescribing forces people to seek other ways to supplement prescriptions. Both situations are difficult and could result in harm to a trauma survivor. Too much and we are enabling, too little and people will take risks (like work in the dangerous street trade) to fill their needs. Try to remember this and see each individual case for what it is then with potential outcomes I mind asses what treatment/ prescription to employ


There is a tendency to blame the victim in these situations. A person who has been abused repeatedly is sometimes mistaken as someone who has a "weak character." Because of their chronic victimization, in the past, survivors have been misdiagnosed by mental health providers as having borderline, dependent, or masochistic personality disorder. When survivors are faulted for the symptoms they experience as a result of victimization, they are being unjustly blamed.


Awareness is key here. Make yourselves familiar with symptoms and treatment. When a person understands their symptoms better, they can become less fearful of them and better able to manage them. By recognizing the effects of PTSD and knowing more about its symptoms, a person is better able to make decisions regarding treatment.


Researchers hope that a new diagnosis of complex PTSD will prevent clinicians, the public, and those who suffer from trauma from mistakenly blaming survivors for their symptoms and misdiagnosising the survivors of trauma.



Triggers are things that cause physical, mental or emotional changes within a trauma survivor such as certain smell, sound, place, or person. Generally symptoms and feelings become more intense and survivors may avoid thinking and talking about trauma-related topics because the feelings associated with the trauma are often overwhelming. They may use alcohol and substance abuse as a way to avoid and numb feelings and thoughts related to the trauma. Survivors may also engage in self-mutilation and other forms of self-harm.


When the intensity of these feelings has passed identify any particular smells, touch, place, and/or sound that may have set off the intense feelings and reminders of the crime. Getting a sense of triggers can help a survivor avoid situations where they may encounter them. Then ask, what do you say to yourself?  A survivor's understanding of their reactions to triggers can empower them to change those reactions, see themselves differently or to understand why those feelings emerge.


Coping Mechanisms in PTSD

Coping mechanisms can also be described as Survival Strategies. These strategies have been utilized by survivors in the past, or they are using them at present to help numb the pain of the abuse. They are also used to control feelings, which may threaten to overwhelm survivors. Survivors may have experienced or are presently experiencing problems associated with drugs, alcohol, food/eating, and/or self-injury.

  • Recent studies have shown a relationship between the frequency of drug use and a history of abuse.
  • A similar relationship has been noted with the development of alcoholism and the impact of abuse.
  • Eating Disorders are common to female survivors. They may develop anorexia nervosa or bulimia. For a survivor, compulsive control of food intake can be a way of exerting control over her body, control that was denied when she was being abused.
  • Some survivors injure themselves, hurting their bodies by burning, slashing or cutting. The reasons for this behavior vary. It can be a way of relieving unbearable anxiety, triggered by memories of the abuse. It can also develop as a way of dealing with and confronting strong, painful emotions, "using new pain to hide old pain". 

Social Isolation and withdrawal is also common.  Survivors report feeling uncomfortable and unsafe around others.  They also report feeling uncomfortable talking about themselves and their experiences