NYU Psi Chi Journal of Psychology Research, Volume II

NYU PSI CHI

JOURNAL OF

PSYCHOLOGY RESEARCH SPRING 2017 VOLUME II

NYU PSI CHI

JOURNAL OF

PSYCHOLOGY RESEARCH SPRING 2017 VOLUME II EDITOR-IN-CHIEF

Joshua Adler

EDITORS

Rachel Shamosh Gabrielle Marczak Robert Leger Alexis Trakhtorchuk Andrea Ng Wen-Xin

PEER REVIEWERS

Angela Page Spears Zoe Siegel Stephanie Leung Rose Liu Ali Bloomgarden Jessica Mandel Elena Marie-Christine Baz

LAYOUT DIRECTOR

Amelia Chu

FACULTY MENTOR

Dr. Andy Hilford

SPECIAL THANKS

NYU Psi Chi Bryan Nelson 2

CONTENTS 4

Letter from the Editor

STAFF ARTICLES 6

Sexual Minority Identity and Self-Esteem: A Bidirectional Approach Joshua G. Adler

CONTRIBUTOR ARTICLES 14

A Painfully Creative Intelligence: Understanding Bipolar I Disorder Zoe Siegel

19

The Psychological, Physical, and Legal Ramifications Faced by Sex Trafficked Girls in the United States Alison Bloomgarden

26

The Relation Between Christian Religiosity and Suicidality in Adolescents Angela Page Spears

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LETTER FROM THE EDITOR This published volume marks the second in the newly founded Psi Chi NYU Journal.

The journal was founded to give students a means to share with their peers, areas of psychological research and practice that they are passionate about and find meaningful.

Keeping true to students’ myriad interests and the extensive experiences they have garnered throughout their undergraduate careers, the topics covered in this journal are similarly diverse. Such topics range from creativity in individuals diagnosed with Bipolar I disorder to the psychological and physical impact of the sexual exploitation of girls in the United States.

I would like to thank Dr. Andy Hilford and past e-board members, particularly Bryan Nelson and Joseph Aryankalayil, for establishing the foundations of this journal. The completion of this volume would not have been made possible without the extensive help from and collaboration between authors, editors, and peer reviewers. Lastly, I give my ineffable gratitude to the current e-board for their continued guidance and support.

Thank you for reading and we hope you enjoy,

Joshua Alder Secretary of NYU Psi Chi Editor-in-Chief of the Journal

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STAFF ARTICLES

ADLER | Sexual Minority Identity and Self-Esteem

Sexual Minority Identity and SelfEsteem: A Bidirectional Approach Joshua G. Adler

How non-heterosexuals are viewed and treated by the public has changed dramatically in America in the past four decades (Herek, 2009; Herek, Gillis, & Cogan, 2015). Lesbian and gay sexualities have been declassified as mental disorders since 1973 (Meyer, 2003). This has been paralleled with change in society’s approach to non-heterosexuality (Herek et al., 2015), represented most notably by the recent U.S. Supreme Court’s decision to overrule state bans on same-sex marriages. Despite this shift, lesbian, gay, and bisexual (LGB) individuals continue to experience stigma and discrimination (Herek et al., 2015). In one study, 55% of LGB participants indicated that they were aware of stigma against sexual minorities and expected to experience discrimination (Herek, 2009). This stigma and discrimination result from sexual minority identity. An identity speaks to the combination of attitudes, views and feelings of the self, especially in relation to a social group or category (Cass, 1984; Rowen & Malcom, 2003).

If a sexual minority so chooses, one will over time become more embedded within sexual minority culture, adopting political and social leanings, and attitudes, that are in line with one’s minority community (Glover, Galliher, & Lamere, 2009; Rowen & Malcom, 2003).

The early stages of sexual minority identity formation, commonly adolescence, can be distinguished by feelings of poor self-acceptance and low self-esteem (Crocker & Major, 1989; Rowen & Malcolm, 2003).

Self-esteem is a domain of psychological well-being and reflects the emotional evaluation of oneself (Doyle & Molix, 2014). Although some have hypothesized the opposite to be true (Katz, Joiner, & Kwon, 2002), there is very little empirical evidence to suggest that sexual minorities exhibit low self-esteem when compared to their heterosexual counterparts (Crocker & Major, 1989; Doyle & Molix, 2014; Meyer, 2003; Pachankis, 2007). Even so, the relation between one’s sexual minority identity and self-esteem is not simple. Much of the research on this topic has investigated the onedirectional relation between sexual minority status and self-esteem. More specifically, research has examined how one’s sexual minority status negatively or positively affects self-esteem. However, this fails to consider the reciprocal role that self-esteem plays in allowing one to embrace or reject LGB identity (Cass, 1984; Cox & Gallois, 1996). The consideration of

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ADLER | Sexual Minority Identity and Self-Esteem

self-esteem’s function within this dynamic offers a bidirectional approach to the two variables. There are numerous moderating factors, such as stigma, group membership and socio-emotional support that provide further details on the relation between sexual minority identity and self-esteem. As such, utilizing both a theoretical and empirical framework, this paper addresses the following questions: How does one’s sexual minority identity impact self-esteem, and how does the need to maintain self-esteem impact the degree to which one embraces that identity?

SOCIETAL AND INTERNALIZED STIGMA It is imperative to consider moderating variables, like sexual stigma, when examining how sexual minority identity and self-esteem impact each other.

Sexual stigma refers to the inherent unfavorable views and inferior status that society applies to any non-heterosexual person (Herek et al., 2015). The stigma that sexual minorities experience can be internalized as part of one’s own value system, a process referred to as self-stigma (Corrigan, Watson, & Barr, 2006; Herek et al., 2015). Self-stigma has three components: the degree to which one agrees with a stereotype, the process of applying to stigma to oneself and the decline of self-esteem within the individual (Corrigan et al., 2006). Studies on stigma of mental illness suggests that one’s agreement with a stereotype will lower one’s self-esteem (Corrigan et al., 2006). In the context of this paper, and as the concept of “self-stigma” makes clear, a person must identify as a sexual minority for stigma to then be relatable to oneself, which in turn lowers self-esteem. This helps explain the relation between stigma and lowered self-esteem within sexual minorities.

High levels of internalized homophobia and perceived repressive environments can be highly stressful for sexual minorities (Herek et al., 2015; Meyer, 2003) and have been found to be positively related to adverse psychological outcomes, like depressive symptoms and low self-esteem (Feinstein, Davila, & Yoneda, 2012; Rowen & Malcolm, 2003). Adolescents who newly self-label as gay show lower self-esteem than gay adults (Crocker & Major, 1989). The newly embraced label brings stigma and discrimination, which then become internalized (Crocker & Major, 1989).

However, the damaging effects first seen tend to dissipate over time, as the individual develops self-protecting mechanisms (Crocker & Major, 1989).

Self-identification may lower self-esteem because of the attached stigma and discrimination directed toward sexual minorities (Herek et al., 2015).

Lowered self-esteem can create psychological distress, further changing the way one feels about one’s sexual minority identity (Herek et al., 2015).

These findings suggest, contrary to earlier hypotheses, that stigma and internalization, rather than sexual orientation, cause lowered self-esteem in sexual minorities (Feinstein et al., 2012; Herek et al., 2015; Rowen & Malcolm, 2003).

Social identity theory stresses the role of self-esteem in developing one’s social identities (Cass, 1984; Cox & Gallois, 1996). According to social identity theory, the maintenance of self-esteem motivates an individual to 7

ADLER | Sexual Minority Identity and Self-Esteem

either turn away or embrace one’s sexual minority identity (Cox & Gallois, 1996). Being able to fully embrace a sexual minority identity is reliant on overcoming internalized heterosexism (Feinstein et al., 2012; Herek & Garnets, 2007; Herek et al., 2015; Rowen & Malcolm, 2003). The failure to overcome internalized heterosexism while continuing to embrace a sexual minority identity is correlated with low self-esteem (Feinstein et al., 2012; Herek et al., 2015). Furthermore, high self-esteem and positive feelings about oneself prevent the internalization of anti-LBG attitudes (Feinstein et al., 2012). Although these elements of self-esteem drive an individual’s ability to engage with a sexual minority identity (Cox & Gallois, 1996), sexual minority status itself can grant membership to a sexual minority community, enabling the individual to utilize strategies to preserve self-esteem.

MEMBERSHIP IN A SEXUAL IDENTITY SOCIAL GROUP The protective factors of belonging to a social group. There is considerable support that group identification is a protective factor for well-being, of which self-esteem is a domain (Doyle & Molix, 2014).

Individuals tend to be good at maintaining their self-esteem through social comparisons, as evidenced by research on various minority social groups (Cox & Gallois, 1996; Crocker & Major, 1989). A sexual minority identity allows one to belong to the greater LGB community, which can serve as a source for emotional and social support (Crocker & Major, 1989; Herek & Garnets, 2007; Meyer, 2003). Such communities can actively teach skills to manage stressful encounters, invalidate negative stereotypes and reduce internalized stigma (Herek & Garnets, 2007). The community also enables the individual to utilize unconscious coping and protective strategies, like in-group comparisons and casual attributions (Cox & Gallois, 1996; Crocker & Major, 1989). Through attaining a sexual minority social identity, one can make social comparisons and rationalizations of discriminatory behaviors to bolster and maintain one’s self-esteem, refuting the emotional weight of stigma and stereotypes (Cox & Gallois, 1996; Crocker & Major, 1989; Meyer, 2003). However, those who define their sexuality in vague and personal terms, instead of gay or lesbian, may not have the community, and same resources, for coping when facing stigma (Herek & Garnets, 2007). Being members of a social group allows similarly stigmatized sexual minorities to come together for support, a method for improving self-esteem (Meyer, 2003).

These findings give the impression that a rise in self-esteem related to membership in the LGB community is merely a beneficial side effect of such membership. However, social identity theory proposes that sexual minorities join a sexual minority social group for the unconscious purpose of maintaining self-esteem (Cox & Gallois, 1996; Crocker & Major, 1989), through socio-emotional support and coping strategies (Cox & Gallois, 1996; Crocker & Major, 1989; Herek & Garnets, 2007; Meyer, 2003). In considering the bidirectional influence between sexual identity and self-esteem, the literature speaks to the protective nature of group identities in maintaining 8

ADLER | Sexual Minority Identity and Self-Esteem

self-esteem. Even so, there are unique stressors and struggles that arise from belonging to a sexual minority community.

Membership in a devalued group. Membership in a devalued minority group, and the lack of external support stemming from that membership, can contribute to sexual minorities’ at-risk status (Detrie & Lease, 2007).

Belonging to a devalued group has shown to impact emotional well-being and one’s evaluations of oneself, lowering self-esteem, which in turn is associated with depression symptoms (Katz et al., 2002). However, it is crucial to note the extent to which one’s sexual minority identity is at the core of one’s overall identity. According to Cox and Gallois (1996) and social identity theory, those that depend most on a specific social group will have high levels of solidarity with that group. Such a dependence also emphasizes a greater affiliation with the identity that links one to that particular group (Cox & Gallois, 1996). Thus, sexual minorities who depend largely on their sexual minority communities signify a greater affiliation with their sexual minority identity. Because of their stigmatized social group, even the disengagement and disaffiliation from a sexual minority community can be seen as an effort to preserve and maintain one’s self-esteem (Cox & Gallois, 1996).

Those who depend most on their sexual minority group put their selfesteem in greatest danger (Cox & Gallois, 1996; Katz et al., 2002). If the social standing of their group falters, so too will their self-esteem (Cox & Gallois, 1996). Yet, they also have the most to benefit from; when the group’s social standing improves, their self-esteem will rise accordingly (Cox & Gallois, 1996).

As previously stated, most research indicates that sexual minorities’ selfesteem are not automatically at risk (Crocker & Major, 1989; Meyer, 2003; Pachankis, 2007). Regardless, these findings accentuate the ways in which their self-esteem can be harmed due to being highly dependent on a social group that is devalued by society. Although a sexual minority is a member of a devalued group, sexual minorities may conceal their sexual identities from others, unlike members of other devalued groups.

CONCEALABLE IDENTITIES AND THE IMPACT OF SELF-ESTEEM The benefits of a concealable identity. Individuals who are able to conceal aspects of their identity that elicit stigma can limit their exposure to stigma, thereby protecting their self-esteem (Pachankis, 2007). Sexual minorities who most frequently concealed their sexual identity have reported highest self-esteem when in presence of others who were most similar to them, as they are able to more freely express and be themselves (Dolyle & Molix, 2014; Meyer, 2003). When in a comfortable and safe environment, sexual minorities can embrace their sexual identity, allowing their self-esteem to rise. This is further evidence of the relation between embracing a sexual minority identity and an increase in self-esteem. However, choosing to conceal one’s sexual minority identity can also indicate stress around that identity and internalized heterosexism, leading to lowered self-esteem.

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ADLER | Sexual Minority Identity and Self-Esteem

Stressors of concealing one’s identity. Individuals with concealable identities must make a conscious decision to conceal aspects of their identity, a decision typically made out of fear of discovery (Pachankis, 2007). While sometimes done out of safety, a concealed sexual minority identity makes it more difficult to find fellow sexual minorities (Meyer, 2003; Pachankis, 2007). Doing so risks relinquishing the socio-emotional benefits of being members of a sexual minority community (Crocker & Major, 1989; Meyer, 2003; Pachankis, 2007). The concealment of an LGB identity can indicate high levels of internalized stigma and self-stigma, both of which are associated with psychological distress and low self-esteem (Herek & Garnets, 2007; Herek et al., 2015; Pachankis, 2007). There are many factors that contribute to concealing one’s sexual identity and facilitate the comingout process, one being social support.

SOCIAL SUPPORT AS A MODERATOR BETWEEN SEXUAL IDENTITY AND SELF-ESTEEM The homosexual identity formation model states that identity development is achieved when one is fully able to integrate a personal identity with a public identity (Cass, 1984; Cox & Gallois, 1996; Maguen, Floyd, Bakeman, & Armistead, 2002). One’s disclosure of sexual identity is crucial in identity formation because it bridges one’s personal and public identities (Maguen et al., 2002). This is supported by adolescents who have voluntarily disclosed their sexual minority identity to their mothers reporting higher self-esteem than their non-out counterparts (Cohn & Hastings, 2010; Maguen et al., 2002).

However, the direction of that relation is still not entirely clear; does high self-esteem enable these individuals to be comfortable with their sexual minority identity and then fully identify with it (Cohn & Hastings, 2010)? In another study, 90% of adolescent participants indicated they were “out” and placed a high value on social connectedness (Detrie & Lease, 2007).

This suggests that individuals may disclose their LGB sexuality only when they feel comfortable with their sexuality and are ready to join the LGB community (Detrie & Lease, 2007). Family and peer support can facilitate that disclosure process, but there are notable age effects. Perceived family support has been found to be a predictor of psychological wellbeing in adolescents, whereas older participants have relied more on peer support (Detrie & Lease, 2007). High self-esteem has been linked to high psychological well-being within these individuals (Doyle & Molix, 2014), a trend most likely resulting from high levels of perceived family or peer support (Detrie & Lease, 2007; Savin-Williams, 1989).

In a study on gay and lesbian adolescents, not only did positive parental support and relationships correlate with high self-esteem in adolescents, but also led to participants’ greater acceptance of their sexual minority identity (Savin-Williams, 1989). It is most likely that adolescents rely heavily on family for support, rather than peers, because adolescence is 10

ADLER | Sexual Minority Identity and Self-Esteem

characteristically marked by high levels of heterosexism from peers (Glover et al., 2009). Thus, an adolescent’s turning away from peers and toward family for support can be seen as a method to protect one’s self-esteem from the damaging effects of stigma (Crocker & Major, 1989; Glover et al., 2009).

Because of their young age and limiting social environment, adolescents tend to not yet be members of sexual minority social groups like their older counterparts, and therefore cannot turn to their peers for help (Detrie & Lease, 2007). In a myriad ways, past and current research highlights that social support is associated with greater sexual identity acceptance and improved self-esteem.

CONCLUSION This paper discusses the social and personal struggles that lesbian, gay, and bisexual individuals experience and the possible consequences of a sexual minority identity on self-esteem. Through this process, the moderating effects of stigma, group membership and social support in the relation are discussed. The most notable detriment to LGB adolescents’ self-esteem is the stigma they experience (Cox & Gallois, 1996; Crocker & Major, 1989; Doyle & Molix, 2014; Feinstein et al., 2012; Herek & Garnets, 2007; Herek et al., 2015; Katz et al., 2002; Meyer, 2003). Additionally, as many researchers make note, these individuals do not automatically have low self-esteem, despite an inferior and discriminated status in society (Cox & Gallois, 1996; Crocker & Major, 1989; Doyle & Molix, 2014; Rowen & Malcom, 2003). There are many conscious and instinctive strategies that LGB individuals employ to maintain their self-esteem, such as in-group comparisons, which can only be possible with the embracement of their sexual minority status (Crocker & Major, 1989; Meyer, 2003; Pachankis, 2007). Conversely, self-esteem also motivates and drives engagement with one’s sexual minority identity and the larger LGB community (Cass, 1984; Rowen & Malcolm, 2003). Although adolescence is marked by low self-esteem (Rowen & Malcolm, 2003), self-esteem tends to rise as LGB adolescents mature, cultivate protective strategies and become members of LGB communities (Detrie & Molix, 2014; Rowen & Malcolm, 2003).

Thus, further research should aim to develop extensive interventions to ease adolescents’ sexual identity formation, pulling mainly from the beneficial moderators discussed in this paper, such as social support and group membership. Such interventions should manage heterosexism in adolescents’ most common settings, such as school. Additionally, programs should educate LGB adolescents on managing stigma, work to incorporate families to provide additional crucial support, and bring young sexual minorities together to establish supportive communities.

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ADLER | Sexual Minority Identity and Self-Esteem

REFERENCES Cass, V. C. (1984). Homosexual identity formation: Testing a theoretical model. Journal of Sex Research, 20(2), 143-167.

Cohn, T. J., & Hastings, S. L. (2010). Resilience among rural lesbian youth. Journal of Lesbian Studies, 14(1), 71-79.

Corrigan, P. W., Watson, A. C., & Barr, L. (2006). The self-stigma of mental illness: Implications for selfesteem and self-efficacy. Journal of Social and Clinical Psychology, 25(8), 875-884 Cox, S., & Gallois, C. (1996). Gay and lesbian identity development: A social identity perspective. Journal of Homosexuality, 30(4), 1-30.

Crocker, J., & Major, B. (1989). Social stigma and self-esteem: The self-protective properties of stigma.

Psychological Review, 96(4), 608-630.

Detrie, P. M., & Lease, S. H. (2007). The relation of social support, connectedness, and collective self-esteem to the psychological well-being of lesbian, gay, and bisexual youth. Journal of Homosexuality, 53(4), 173-199.

Doyle, D. M., & Molix, L. (2014). Perceived discrimination and well-being in gay men: The protective role of behavioural identification. Psychology & Sexuality, 5(2), 117-130.

Feinstein, B. A., Davila, J., & Yoneda, A. (2012). Self-concept and self-stigma in lesbians and gay men. Psychology & Sexuality, 3(2), 161-177.

Glover, J. A., Galliher, R. V., & Lamere, T. G. (2009). Identity development and exploration among sexual minority adolescents: Examination of a multidimensional model. Journal of Homosexuality, 56(1), 77-101.

Herek, G. M. (2009). Sexual stigma and sexual prejudice in the United States: A conceptual framework. In Contemporary perspectives on lesbian, gay, and bisexual identities (pp. 65-111). Springer New York.

Herek, G. M., & Garnets, L. D. (2007). Sexual orientation and mental health. Annual Review of Clinical Psychology, 3, 353-375 Herek, G. M., Gillis, J. R., & Cogan, J. C. (2015). Internalized stigma among sexual minority adults: Insights from a social psychological perspective. Stigma and Health, 1(S), 18-34.

Katz, J., Joiner Jr, T. E., & Kwon, P. (2002). Membership in a devalued social group and emotional wellbeing: Developing a model of personal self-esteem, collective self-esteem, and group socialization.

Sex Roles, 47(9-10), 419-431.

Maguen, S., Floyd, F. J., Bakeman, R., & Armistead, L. (2002). Developmental milestones and disclosure of sexual orientation among gay, lesbian, and bisexual youths. Journal of Applied Developmental Psychology, 23(2), 219-233.

Meyer, I. H. (2003). Prejudice, social stress, and mental health in lesbian, gay, and bisexual populations: conceptual issues and research evidence. Psychological Bulletin, 129(5), 674-697.

Pachankis, J. E. (2007). The psychological implications of concealing a stigma: a cognitive-affectivebehavioral model. Psychological Bulletin, 133(2), 328-345.

Rowen, C. J., & Malcolm, J. P. (2003). Correlates of internalized homophobia and homosexual identity formation in a sample of gay men. Journal of Homosexuality, 43(2), 77-92.

Savin-Williams, R. C. (1989). Coming out to parents and self-esteem among gay and lesbian youths.

Journal of Homosexuality, 18(1-2), 1-35.

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CONTRIBUTOR ARTICLES

SIEGEL | Bipolar I and Creativity

A Painfully Creative Intelligence: Understanding Bipolar I Disorder Zoe Siegel It is not simply coincidence that our literary and artistic giants have consistently dealt with the diagnosis of Bipolar I disorder (Jamison, 1993).

“Historically, many of our literary and artistic masterminds (e.g., Hemingway, Fitzgerald, Woolf, and Plath) could have been diagnosed with Bipolar I disorder” (Jamison, 1993; Johnson, Tharp, & Holmes, 2015). Bipolar I is a set of manic symptoms of fluctuating severity, specifically defined by an occurrence of mania, with or without a simultaneous episode of depression, referred to as a mixed episode” (Murray & Johnson, 2010). An episode of mania is defined as a discrete period of abnormally and tirelessly prominent, irritable mood (Jamison, 1993). According to the CDC (2013), to highlight the magnitude of the issue, the prevalence rate of Bipolar disorder is 4.4% in the United States, which is among the highest in the world. However, because Bipolar I can coexist in extremely high functioning individuals, it is important to fully understand both the potential positive influences, such as fame and success, as well as the suffering it can cause (Jamison, 1993).

Because those diagnosed with Bipolar I note that the link between creativity and their mood disorder is important, this topic has continually attracted researchers and has captured the public’s fascination (Taylor, Fletcher, & Lobban, 2015). This literature review will explore the following question: What is the relation between Bipolar I and creativity?

CREATIVITY Heightened creativity is one of the many encouraging aspects often associated with Bipolar I (Jamison, 1993). For the purpose of this review, creativity is defined as behaviors or feelings that are simultaneously innovative, unique, adaptive, and constructive (Feist, 1998; Murray & Johnson, 2010). Research suggests those with Bipolar I score remarkably higher in creativity than those without Bipolar I (Richards et al., 1988). Therefore, researchers have further investigated if there are genetic links associated with a predisposition to creativity for those with Bipolar I (Richards et al., 1988). It was suggested that the link with creativity is significantly higher for those with affective disorders such as Bipolar I than without.

The mechanisms guiding creativity in Bipolar I are widely disputed; however, genetic vulnerability (i.e., how genes change) and positive affect (i.e., the extent to which an individual experience positive moods) seem to be consistently recognized as means for creativity (Johnson et al., 2015).

Genetic vulnerability refers to how the genes change in relation to the mental 14

SIEGEL | Bipolar I and Creativity

illness over time and what role that has on the severity of Bipolar I (Johnson et al., 2015). Through measuring the mechanisms that nurture the creativity in Bipolar I, research suggests that the factors typically associated with creativity are fame and recognition, improvement in specific activities, like creating works of writing or art, and divergent thinking, which is the ability to design a creative solution to various problems (Johnson et al., 2012; Johnson et al., 2016). To further elaborate, when a creative accomplishment is achieved, outcomes such as fame and support naturally encourage and reinforce the creative process. The creative process involves a combination of various elements such as different temperaments and speed of thought (Galvez, Thommi, & Ghaemi, 2011). These facets cultivate a productive space to be creative and in turn benefit from that creative space. A variety of factors in creativity link to Bipolar I through various personality and environmental traits (Galvez, Thommi, & Ghaemi, 2011).

MANIC PHASE AND CREATIVITY It is widely believed both through research and perceptions that “mania” is the fundamental source of creative power and intellect in individuals with Bipolar I (Johnson et al., 2012). The manic phase has been studied repeatedly by scholars and researchers because of its strong effects on the lifestyles and functioning of individuals. Research indicates that the highest level of creativity takes place during the manic phase. For instance, Ludwig (1992) found that 8.2% of artists had a history of mania, compared to 2.8% of non-artists. This research suggests that mania was most prevalent among persons who excelled in the study of English and the arts (i.e., those who exhibit high creativity and are most successful with a creative burst) (Jamison 1993; Johnson et al., 2012). Equally important, the possibility of mania and having mania are related to an individual’s self-ratings of their creativity (Johnson et al., 2012). These self-ratings refer to positive feelings towards one’s own creativity through the Adjective Checklist Creative Personality Scale (Johnson et al., 2012). Because some personality factors encourage new experiences and extraversion, it may be that the tremendous transitions of moods incite creative bursts (Taylor et al., 2015).

There are a few consistent themes throughout research on this topic.

These themes can direct the conversation of the connection between Bipolar I and creativity that have emerged when examining the influence of mania on creativity in individuals with and without Bipolar I (Johnson et al., 2015). One main theme to highlight is the notion that creativity is central to some individuals with Bipolar I (Johnson et al., 2015). More specifically, over half of the individuals interviewed suggested that this aspect of their personality dictates their livelihood and serves as a core aspect of their identity (Johnson et al., 2015). Another outcome of creativity is its importance in reducing stigma and refining treatment. If the central role of creativity within individuals with Bipolar I were to be incorporated in treatment, there would be less stigma by healthcare providers and an improvement in the lifestyle of individuals with Bipolar I (Johnson et al., 15

SIEGEL | Bipolar I and Creativity

2015). Instead of perceiving creativity as hindering the individual, it should to be used in a strengths-based approach to benefit these individuals and improve potential treatment outcomes.

THE EFFECTS OF CREATIVITY Creativity is one of the many constructive aspects of Bipolar I, along with resilience, spirituality, realism and empathy (Galvez et al., 2011). In understanding the beneficial aspects of Bipolar I, there is potential to increase knowledge for improving treatment and outcomes of the diagnosis (Galvez et al., 2011). To demonstrate, many believe there to be positive attributes to the negative emotions associated with Bipolar’s depressive occurrences. Because individuals often idealize depressive moods by believing they increase creativity, these stints are frequently detrimental (Galvez et al., 2011). Others perceive additional positive aspects of Bipolar I to be spirituality, empathy, realism, and resilience (Galvez et al., 2011).

However, it is impossible to remove the hardships and struggles that are inherent in these perceived positive aspects of Bipolar I (Andreasen, 2008).

It is necessary to look at the many complexities of Bipolar I because the diagnosis tends to be romanticized. Bipolar has been characterized by intuition and imagination—two strengths of those with Bipolar I which were also greatly valued in creative settings during the Enlightenment period (Murray & Johnson, 2010). In particular, what separates Bipolar from other disorders is that a number of those diagnosed with Bipolar I produce works of art and inevitably draw attention to their story, which is consequently glamorized (Lehrer, 2010; Murray & Johnson, 2010).

SUICIDALITY While many diagnosed with Bipolar I are indeed creative, they also suffer greatly. Although Van Gogh produced roughly 300 great works during his severe stints of mania and depression, he suffered terribly, leading him to end his life early (Andreasen, 2008). Because many of those holding creative professions have Schizophrenia or Bipolar I, it is crucial to explore the link between suicidality and the disorder (Kyaga et al., 2013).

Findings indicate that 25-60% of individuals diagnosed with Bipolar I will attempt suicide during their lifespan and roughly 4-19% of attempts will be successful (Novick, Swartz, & Frank, 2010). Many individuals with Bipolar I commit suicide because of their suffering (Kyaga et al., 2013). Oftentimes when excess creativity and energy cannot be funneled into productivity, individuals are driven to suicidal tendencies (Taylor et al., 2015). One study suggests that those with creative occupations, specifically authors, have higher chances of committing suicide (Kyaga et al., 2013). In sum, suicide remains a concerning factor in the larger understanding of Bipolar. And while those with Bipolar I may benefit from a boost of creativity, they may also be at higher risk to commit suicide.

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SIEGEL | Bipolar I and Creativity

CONCLUSION Exploring the greater phenomenological relationship between Bipolar I and creativity can lead to improvements in treatment and a better understanding of these individuals. Recognizing the complexities of such a severe mental illness can collectively help fight the associated stigma of Bipolar I and better understand the role creativity plays in an effort to enhance the lives of those diagnosed with the disorder. The connection between Bipolar disorder and creativity has interested the public and academic world for some time, but more research is required to investigate this complex relation. Through more research and exposure, public awareness of the disorder can be improved and therapeutic techniques can be further developed (Johnson et al., 2012). Some limitations in current research include only focusing on male populations, failing to differentiate between Bipolar I and depression, and the inevitable challenges of studying creativity, such as measuring an abstract topic and basing creativity off produced works of art (Andreasen, 2008; Kyaga et al., 2013). While this review does examine the relation between mania and suicidality, further research must focus on personality characteristics of Bipolar I and their influence on treatment outcomes (Jamison, 1993). Developing a deeper understanding of this connection will enhance the treatment of Bipolar I and reduce risks of the illness.

REFERENCES Andreasen, N. C. (2008). The relationship between creativity and mood disorders. Dialogues in Clinical Neuroscience, 10(2), 251- 255.

Burden of Mental Illness. (2013, October 04). Retrieved December 14, 2016, from https://www.cdc.gov/ mentalhealth/basics/burden.htm Feist, G. J. (1998). A meta-analysis of personality in scientific and artistic creativity. Personality and Social Psychology Review, 2(4), 290-309.

Galvez, J. F., Thommi, S., & Ghaemi, S. N. (2011). Positive aspects of mental illness: A review in bipolar disorder. Journal of Affective Disorders, 128(3), 185-190.

Hemingway, E. (1986). The Garden of Eden. C. Scribner’s. New York, New York.

Jamison, K. R. (1993). Touched With Fire. Simon and Schuster. New York, New York.

Johnson, S. L., Murray, G., Fredrickson, B., Youngstrom, E. A., Hinshaw, S., Bass, J. M., ... & Salloum, I. (2012). Creativity and bipolar disorder: Touched by fire or burning with questions? Clinical Psychology Review, 32(1), 1-12.

Johnson, S. L., Moezpoor, M., Murray, G., Hole, R., Barnes, S. J., & Michalak, E. E. (2015). Creativity and bipolar disorder igniting a dialogue. Qualitative Health Research.

Johnson, S. L., Tharp, J. A., & Holmes, M. K. (2015). Understanding creativity in bipolar I disorder.

Psychology of Aesthetics, Creativity, and the Arts, 9(3), 319-327.

Kyaga, S., Landén, M., Boman, M., Hultman, C. M., Långström, N., & Lichtenstein, P. (2013). Mental illness, suicide and creativity: 40-year prospective total population study. Journal of Psychiatric Research, 47(1), 83-90.

Lehrer, J. (2010). Depression’s Upside. Retrieved October 02, 2016, from http://www.nytimes. com/2010/02/28/magazine/28depression-t.html Ludwig, A. M. (1995). The Price of Greatness: Resolving the Creativity and Madness Controversy. New York: Guilford Press.

Murray, G., & Johnson, S. L. (2010). The clinical significance of creativity in bipolar disorder. Clinical Psychology Review, 30(6), 721-732.

Novick, D. M., Swartz, H. A., & Frank, E. (2010). Suicide attempts in bipolar I and bipolar II disorder: A review and meta‐analysis of the evidence. Bipolar Disorders, 12(1), 1-9.

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SIEGEL | Bipolar I and Creativity Richards, R., Kinney, D. K., Lunde, I., Benet, M., & Merzel, A. P. (1988). Creativity in manic-depressives, cyclothymes, their normal relatives, and control subjects. Journal of Abnormal Psychology, 97(3), 281-288.

Soeiro-de-Souza, M. G., Dias, V. V., Bio, D. S., Post, R. M., & Moreno, R. A. (2011). Creativity and executive function across manic, mixed and depressive episodes in bipolar I disorder. Journal of Affective Disorders, 135(1), 292-297.

Taylor, K., Fletcher, I., & Lobban, F. (2015). Exploring the links between the phenomenology of creativity and bipolar disorder. Journal of Affective Disorders, 174, 658-664.

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BLOOMGARDEN | The Sex Trafficking of Girls in the United States

The Psychological, Physical, and Legal Ramifications Faced by Sex Trafficked Girls in the United States Alison Bloomgarden The fastest growing form of criminal activity in the world is sex trafficking, with victims primarily being women and children (Goździak & MacDonnell, 2007). Sex trafficking is defined as “the recruitment, harboring, transportation, provision, or obtaining of a person for the purpose of a commercial sex act” (Law, 2000, p. 8). Globally, the number of children sold for sexual services is as high as 10 million (Willis & Levy, 2002). The United States alone is home to the third largest population of sex trafficked youth in the world, encompassing approximately 300,000 children (Dillon, 2008; Estes & Weiner, 2001; Willis & Levy, 2002), who are often forced to have sex with five to ten clients a day (Willis & Levy, 2002). The average age of girls sold for sex in the U.S. is between 12 and 14. However, out of fear that sexually experienced girls are more likely to spread sexually transmitted infections, demand for younger girls who have not had sexual encounters is increasing (Estes & Weiner, 2001; Reid & Jones, 2011).

Although current literature and legal terminology use “prostitution” and “sex trafficking” interchangeably (Willis & Levy, 2002), this paper will refrain from using the term “prostitution” because its definition suggests consenting to engage in sexual acts for payment. However, according to the United Nations Convention on the Rights of the Child, because the female youth discussed in this paper are under the age of 18, they are considered children, and therefore are not of legal status to consent to engage in sexual acts (Panko & George, 2012; Willis & Levy, 2002). Thus, referring to “sex trafficking” as “prostitution” supports the pervasive false narrative that underage girls choose to participate in sexual activities in exchange for money.

There are multiple pathways through which underage girls become involved with sex trafficking in the United States, including being brought to the U.S. from another country to be sold for sex, gang trafficking, and pimp trafficking (Clayton et al., 2013; Rieger, 2007). A “pimp” is an individual who exploits, sells, and physically, sexually, and emotionally abuses others for economic purposes (Clayton et al., 2013). Of the large population of sex trafficked girls in the United States, about 50 percent of them are trafficked by pimps (Estes & Weiner, 2002). As a result, this paper will primarily focus on the ramifications of sex trafficking female minors through pimp trafficking. This paper will refrain from using the term “pimp” because, in 19

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slang, it has a positive, alluring connotation (Clayton et al., 2013). The term “trafficker” will be used instead.

THE PROCESS OF BECOMING SEX TRAFFICKED To understand how so many young girls are sex trafficked, an understanding of how girls are introduced to the industry is necessary. Pimps can be strangers, family members, friends, or significant others (Clayton, Krugman, & Simon, 2013; Kortla, 2010). Their victims are often neglected or abused — girls who have run away from an abusive home or system, or have been homeless, in foster care, or in juvenile detention, and, as a result, are particularly vulnerable to exploitation (Albanese, 2007; Clayton et al., 2013; FACJJ, 2007). Societal norms of female oppression also perpetuate the likelihood of girls being trapped in sexual bargains, as girls are taught to be insecure about their sexual performance and inexperience, and to rely on men to take the initiative (Hanna, 2002; Riegler, 2007). In this vein, traffickers’ entrapment tactics, otherwise known as grooming, begin by assuming the role of the girl’s boyfriend (Kotrla, 2010). To gain her loyalty and trust, he will often provide her with consistent attention (like feelings of love and protection), a sense of belonging, and will also buy her gifts (Kotrla, 2010).

He will do this while also making her feel a sense of indebtedness (Raphael, Reichert, & Powers, 2010). Furthermore, because society has taught her that females are subordinate to males, she will likely comply (Riegler, 2007).

Ultimately, traffickers become controlling and coercive, using violence to maintain fear and, thus, servitude (Gragg, Petta, Bernstein, Eisen, & Quinn, 2007; Lloyd, 2012). The manipulative nature of the industry is just one of a multitude of reasons that sex trafficking young children qualifies as an organized form of child sexual abuse (Clayton et al., 2013).

Despite the prevalence of sex trafficking, and in light of its exploitive nature, there is a limited understanding and scant information depicting the experiences of sex trafficked children, particularly within the U.S (Cecchet & Thoburn, 2014). To highlight the severity of this crime and the long-term harm these girls experience, this paper will explore the question: What are the psychological, physical, and legal ramifications faced by female youth who are sex trafficked in the United States?

LEGAL RAMIFICATIONS Though the United States Government criminalizes juvenile sex trafficking, it was only recently that more attention has turned toward its detrimental impacts. In 2000, The Victims of Trafficking and Violence Protection Act (VTVPA) was passed, rendering commercial sex trafficking illegal if the victim is coerced to participate in sexual acts without providing consent, or if the victim is under the age of 18 (Raphael et al., 2010).

Federally, because of the VTVPA, trafficked girls are considered victims who need humanitarian legal protection from exploitative adults (Law, 2000). However, state and local laws (except in some parts of Nevada) still 20

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tend to conflate prostitution — which is historically seen as both a choice and a crime — with sex trafficking (Raphael et al., 2010). In line with this interpretation, law enforcement often labels victims of sex trafficking as criminals who willingly participate in the illegal practice of sexual acts in exchange for payment (Albanese, 2007; Clawson & Goldblatt Grace, 2007; Raphael et al., 2010; Reid & Jones, 2011).

Ultimately, while the federal statute recognizes minors as sexually trafficked victims rather than criminals, girls continue to be prosecuted for prostitution offenses (Raphael et al., 2010; Reid & Jones, 2011). Some police officers assert that they arrest trafficked youth to ensure their safety, as they assume incarceration facilities are safer than the girls’ current environment (Halter, 2010). Regardless of whether legal officials at the state and local level are trying to protect girls or not, they often label those girls as criminals (Halter, 2010). Similarly, studies have shown that girls may also see themselves as criminals, rather than victims (Clawson & Goldblatt Grace, 2007). However, at federal level girls are now being recognized as victims instead of criminals. Even so, it is difficult for change to be enforced when many state and local law enforcement officials continue to support the criminalization of minors by arresting them (Clawson & Goldblatt Grace, 2007).

Further, the burden of legal ramifications for being involved in sex trafficking disproportionately affects the victim compared to the actual trafficker (Raphael et al., 2010). Girls who are sex trafficked are criminalized and prosecuted much more frequently than their traffickers, regardless of whether the state and local laws are in compliance with federal statutes (Raphael et al., 2010; Reid & Jones, 2011). While young girls are frequently arrested and tried, their traffickers are not prosecuted through either state or federal laws (Raphael et al., 2010). For instance, the New York Division of Criminal Justice Services (as cited in International Women’s Human Rights Clinic) reported that almost 3,000 individuals were arrested for prostitution in New York State, while less than 40 traffickers were prosecuted. These statistics emphasize how police make arrests to stop acts of prostitution as opposed to arresting those who control the prostitution industry.

PSYCHOLOGICAL RAMIFICATIONS Sex trafficking has various profound effects on the mental health of young girls. Psychological consequences include, but are not limited to, extreme anxiety and fear, memory loss, eating disorders, attention-deficit/ hyperactivity disorder, somatization problems, post-traumatic stress disorder, depression, suicide, decreasing self-concept, personality disorders, trauma bonds, and dissociative disorders (Clawson & Goldblatt Grace, 2007; Greenbaum, 2014). Trauma bonds and dissociative disorders are especially prevalent for victims of abuse, like sex trafficking (Greenbaum, 2014). For the sake of space, only these two psychological outcomes will be discussed.

Sex trafficked youth often suffer from traumatic bonding, “a form of coercive control in which the perpetrator instills in the victim fear as well as 21

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gratitude for being allowed to live” (Clawson & Goldblatt Grace, 2007; U.S. Department of Health and Human Services). As previously mentioned, the controlling pimp-victim relationship often begins with what seems to be a loving, romantic relationship (Kotrla, 2010). In the face of danger brought on by her abuser, a young girl may feel an elevated need for attachment and comfort; with no one else around, she may feel driven by loyalty to turn to her abuser for support (Clawson & Goldblatt Grace, 2007; Van der Kolk, 1989). Trauma bonds complicate a very explicitly toxic relationship between the girl and her pimp. In response to his continuous abuse, her attachment to him further develops. Because of her bond, she is less likely to see his actions as wrong or feel the desire to escape (Clawson & Goldblatt Grace, 2007).

Dissociative disorders are also common among sexually victimized youth, as they develop when one is subjected to prolonged periods of abuse and “brainwashing” (APA, 2000, p. 242). While enduring consistent abuse, victims often begin to break from reality or dissociate. Dissociation manifests as a mental separation from one’s own body (Sinason, 2002), and often results in disruption in memory and identity (Kluft, 1996). More specifically, brainwashing is particularly effective in the sex trafficking recruiting process as victims are exposed to an organized method of being “romanced—then isolated, manipulated, violated, and degraded by a trafficker” (Kaplan & Sadock, 1998, p. 863). When a girl is brainwashed, she is vulnerable to having thoughts and behaviors she otherwise would not agree with because she has dissociated from her preexisting opinions (Reid & Jones, 2011). Brainwashing is used to instill loyalty and, like trauma bonds, keeps the girl from seeing herself as a victim of abuse, which may otherwise encourage her to escape.

PHYSICAL RAMIFICATIONS Victims of sex trafficking demonstrate a variety of physical ramifications.

There is a strong correlation between the sex trafficking of minors and violence, resulting in a multitude of physical injuries and reproductive health problems that remain over an extended period of time (Estes & Weiner, 2002). Pimps beat, rape, and starve the girls they traffic to assert their power, administer control over the girls, and remove agency from the girls (Estes & Weiner, 2002). Through beatings and rapes, these girls often experience physical injuries, such as, but not limited to, broken bones or teeth, asphyxiation, gunshot or stab wounds, brain injuries, and burns; additionally, wounds often go untreated, resulting in infection or loss of function in the area (Clawson & Goldblatt Grace, 2007; Greenbaum, 2014).

Furthermore, starvation and dehydration can lead to malnutrition, which weakens the body. This in turn increases the likelihood of broken bones and impairs the body’s ability to repair wounds (Greenbaum, 2014).

Sexual abuse by traffickers may lead to pregnancy, forced abortions, genital contusions, hemorrhage, urethral injury, and cervical dysplasia or

22

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cancer (Cecchet & Thoburn, 2014; Greenbaum, 2014). It can also increase exposure to HIV and sexually transmitted infections (Cecchet & Thoburn, 2014; Greenbaum, 2014). Constant sexual abuse can lead to reproductive health complications, including fertility issues, especially after forced abortions (Clawson & Goldblatt Grace, 2007), in which a girl is beaten to induce a miscarriage (Willis & Levy, 2002). As previously mentioned, girls are increasingly being sold for sex at younger ages, well before puberty (Estes & Weiner, 2001). Continuous rape and sexual abuse, particularly of undeveloped girls, may increase the likelihood of injuries.

DIFFICULTIES IN OUR UNDERSTANDING Despite the prevalence of sex trafficking, there is limited understanding and scant information of the experiences of sex trafficked children, particularly within the U.S. (Cecchet & Thoburn, 2014). There are many reasons for this lack of understanding and underreporting. First, sex trafficking in the U.S. is most prevalent in neglected populations, such as racial and ethnic minorities (Clayton et al., 2013). Because these populations are not prioritized, there is less focus on them; as a result, minimal changes have been made.

Second, it is often difficult to contact or identify current or previously sex trafficked minors (Greenbaum, 2014). For example, if the minor goes to see a medical professional, she may not disclose the true cause of her physical or psychological wounds out of fear that her trafficker will punish her for revealing her entrapment (Greenbaum, 2014). Another reason she may not reveal the cause of her physical or psychological wounds is that she does not see herself as a victim (Greenbaum, 2014). Additionally, most providers do not receive proper training to screen at-risk youth, making it challenging to identify such girls (Greenbaum, 2014). From the perspective of victims and survivors, trafficked minors are often arrested as criminals, rather than seen as victims, so they may fear disclosing their trafficked past (Clayton et al., 2013). As a result, girls may not disclose their status, which would contribute to the unreliable estimates of the extent to which female youth are sex trafficked in the United States (Stransky & Finkelhor, 2008).

Another reason for this lack of understanding is the biased media representation of sex trafficking. While awareness of sex trafficking has increased over the last decade, it is often focused internationally, instead of within the U.S. (Hughes, 2007). American media frequently represents the sex trade in developing countries as commonplace, distracting the U.S. public from the high rates of the sex trafficking of minors within their own country (Clayton et al., 2013). In fact, more citizens of the United States are sex trafficked than immigrants (Hughes, 2007). Due to the lack of attention placed on the sex trafficking industry in the United States, there are no reliable estimates to understand this problem (Stransky & Finkelhor, 2008).

CONCLUSION The impact of sex trafficking young girls in the U.S. is devastating, with 23

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severely negative legal, psychological, and physical outcomes that are both immediate and long-term. Legally, the federal government has recently begun to recognize the prevalence and magnitude of sex trafficking within the U.S. However, state and local officials continue to arrest and prosecute these girls instead of the individuals who traffic and abuse them.

Psychologically, trafficked girls can suffer from comorbid mental health issues, particularly trauma bonds and dissociative disorders. Physically, girls face bodily injuries and reproductive health problems due to the physical and sexual abuse they endure.

More comprehensive efforts to prevent the sex trafficking of minors are needed that target legal and medical practices, and public awareness.

Efforts can include reforming the criminal justice and child protection systems. For minors who are sex trafficked, many legal adjustments can be made to stop these girls from being arrested as criminals. The Federal Advisory Committee on Juvenile Justice (2007) has suggested that the President and Congress should amend The Juvenile Justice and Delinquency Prevention Act of 1974 to assert that states must see child prostitution as a crime. This would ensure that these girls are not treated as willing criminals, but rather are victims who are exploited, abused, and in need of services (FACJJ, 2007).

Another area of focus should be the education of medical professionals on identifying at-risk youth. When an exploited girl visits a medical provider, she does not usually self-identify as a victim of sex trafficking (Greenbaum, 2014). Medical practitioners must be educated through a trauma-informed approach to identify the signs of sex trafficking and at-risk youth (Clawson, Salomon, & Grace, 2007). Such an approach would entail a sensitive response to the girl, as well as an understanding that manifestations of trauma display themselves in various and subtle ways for victims of abuse (Clawson et al., 2007). Also, in response to the psychological consequences of being trafficked, there is an increased vulnerability for sexual revictimization (Finkelhor & Browne, 1985). As such, different girls require different levels of care to ensure they are stable and not revictimized (Clawson & Goldblatt Grace, 2007).

Additionally, citizens must be educated about the prevalence and devastating impacts of sex trafficking so that it is no longer an “overlooked, misunderstood, and unaddressed domestic problem� (Clawson & Goldblatt Grace, 2007; Clayton et al., 2013, p. 19). It is important for the American public to be more aware of the realities of sex trafficking in the U.S. The media needs to start reporting on the exploitation of minors in America, rather than portraying it solely as a problem of developing countries, particularly Southeast Asia (Clayton et al., 2013).

Nevertheless, there are limitations to this research. The current literature discussing the sex trafficking of minors in the U.S. emphasizes a significant amount of underreporting of participants in the data (Estes & Weiner, 2001).

The limited existing statistics represent the entire population of commercially sexually exploited youth, and are not specific to just sex trafficking and other 24

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sexual demands of minors. The commercial sexual exploitation of children (CSEC) comprises a wide range of sexual acts demanded of children and adolescents, predominantly for economic gain (Estes & Weiner, 2001). Some examples are exploiting a minor through sex trafficking, pornography, sex tourism, bride trade and marriage, and/or performance in sexual venues, primarily as a stripper (Clayton et al., 2013). Future studies need to focus on reporting the most accurate statistics possible to express the magnitude of children affected by sex trafficking and other sexually exploitive acts.

Further, the literature does not look at particularly vulnerable populations—LGBTQ youth, justice-system involved youth, and racial and ethnic minority populations—and their specific risk factors and needs (Clayton et al., 2013). As the populations often affected by sex trafficking are marginalized and disenfranchised, researchers must pay particular attention to these communities to collect highly accurate data (Estes & Weiner, 2001).

The sex trafficking of female youth in the United States is a human rights issue. In the words of UNICEF (1995), sex trafficking is “one of the gravest infringements of rights that children can endure.” This paper outlines the psychological, physical, and legal ramifications faced by sex trafficked female youth in the United States to demonstrate the severity of this issue and to hopefully encourage people to fight for the rights of exploited children.

REFERENCES Albanese, J. (2007). Commercial sexual exploitation of children: What do we know and what do we do about it. National Institute of Justice Report. Retrieved November 4, 2016, from https://www.ncjrs. gov/pdffiles1/nij/215733.pdf.

American Psychiatric Association. (2000). Diagnostic and statistical manual of mental disorders (4th ed., rev.). Washington, DC: Author.

Cecchet, S. J., & Thoburn, J. (2014). The psychological experience of child and adolescent sex trafficking in the United States: Trauma and resilience in survivors. Psychological Trauma: Theory, Research, Practice, and Policy, 6(5), 482-493.

Clawson, H. J., & Goldblatt Grace, L. Finding a path to recovery: Residential facilities for minor victims of domestic sex trafficking. UNL Digital Commons, 2007. Accessed 11/4/16 from http://digitalcommons. unl.edu/humtraffdata/10/ Clawson, H. J., Salomon, A., & Grace, L. G. (2007). Treating the hidden wounds: Trauma treatment and mental health recovery for victims of human trafficking. Washington, DC: Department of Health and Human Services, Office of the Assistant Secretary for Planning and Evaluation.

Clayton, E. W., Krugman, R. D., & Simon, P. (Eds.). (2013). Confronting Commercial Sexual Exploitation and Sex Trafficking of Minors in the United States. National Academies Press.

Dillon, S. A. (2008). What human rights law obscures: Global sex trafficking and the demand for children.

UCLA Women’s Law Journal, 17, 121-186.

Estes, R. J., & Weiner, N. A. (2001). The Commercial Sexual Exploitation of Children in the US, Canada and Mexico. University of Pennsylvania, School of Social Work, Center for the Study of Youth Policy.

Federal Advisory Committee on Juvenile Justice. (2007). Federal advisory committee on juvenile justice annual report 2007. Retrieved November 4, 2016, from http://www.facjj.org/ annualreports/2007FACJJReport508.pdf.

Finkelhor, D., & Browne, A. (1985). The traumatic impact of child sexual abuse: A conceptualization.

American Journal of Orthopsychiatry, 55, 530–541.

Goździmak, E., & MacDonnell, M. (2007). Closing the gaps: The need to improve identification and services to child victims of trafficking. Human Organization, 66(2), 171-184.

Gragg, F., Petta, I., Bernstein, H., Eisen, K., & Quinn, L. (2007). New York prevalence study of commercially sexually exploited children. Rensselaer, NY: New York State Office of Children and Family Services.

Greenbaum, V. J. (2014). Commercial sexual exploitation and sex trafficking of children in the United

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Halter, S. (2010). Factors that influence police conceptualizations of girls involved in prostitution in six US cities: Child sexual exploitation victims or delinquents? Child Maltreatment, 15(2), 152-160.

Hanna, C. (2002). Somebody’s daughter: The domestic trafficking of girls for the commercial sex industry and the power of love. William and Mary Journal of Women and Law, 9, 1–29.

Hughes, D. (2007). Enslaved in the USA. National Review, 30.

International Women’s Human Rights Clinic (n.d.). Clearing the slate: Seeking effective remedies for criminalized trafficking victims (Rep.). New York, NY: CUNY School of Law. Kaplan, H. I., & Sadock, B. J. (1998). Synopsis of psychiatry: Behavioral science/clinical psychiatry (8th ed.). Baltimore, MA: Lippincott Williams & Wilkins Co. Kotrla, K. (2010). Domestic minor sex trafficking in the United States. Social Work, 55(2), 181-187.

Kluft, R. P. (1996). Dissociative identity disorder. In Handbook of dissociation: Theoretical, empirical, and clinical perspectives, (pp. 337-366). United States: Science & Business Media.

Law, P. (2000). Victims of trafficking and violence protection act of 2000. Public Law, 106, 386.

Lloyd, R. (2012). Girls like us: Fighting for a world where girls are not for sale: A memoir. Harper Perennial.

N.Y. Division of Criminal Justice Services. N.Y. Division Of Criminal Justice Services, Computerized Criminal History Oracle File. Retrieved from http://www.law.cuny.edu/academics/clinics/iwhr/ publications/Clearing-the-Slate.pdf.

Panko, T. R., & George, B. P. (2012). Child sex tourism: Exploring the issues. Criminal Justice Studies, 25(1), 67-81.

Raphael, J., Reichert, J. A., & Powers, M. (2010). Pimp control and violence: Domestic sex trafficking of Chicago women and girls. Women & Criminal Justice, 20, 89-104.

Reid, J. A., & Jones, S. (2011). Exploited vulnerability: Legal and psychological perspectives on child sex trafficking victims. Victims and Offenders, 6(2), 207-231.

Riegler, A. (2007). Missing the mark: Why the Trafficking Victims Protection Act fails to protect sex trafficking victims in the United States. Harvard Journal of Law & Gender, 30(1), 231-256.

Sinason, V. (2002). Attachment, trauma and multiplicity: Working with dissociative identity disorder.

Psychology Press.

Stransky, M., & Finkelhor, D. (2008). How many juveniles are involved in prostitution in the US. Durham, NH: Crimes Against Children Research Center, University of New Hampshire.

UNICEF. (1995). The progress of nations. Child rights—the ultimate abuse. New York: UNICEF. Retrieved April 9, 2017, from https://www.unicef.org/pon95/chil0015.html.

U.S. Department of Health and Human Services. (n.d.). Fact sheet on sex trafficking. Retrieved December 17, 2016, from http://www.acf.hhs.gov/trafficking/about/fact_sex.html Van der Kolk, B. A. (1989). The compulsion to repeat the trauma: Re-enactment, revictimization, and masochism. Psychiatric Clinics of North America, 12(2), 389–411.

Willis, B. M., & Levy, B. S. (2002). Child prostitution: global health burden, research needs, and interventions. The Lancet, 359(9315), 1417-1422.

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SPEARS | Religiosity and Suicidality

The Relation Between Christian Religiosity and Suicidality in Adolescents Angela Page Spears In 2015, research suggested that Christianity was the most widely practiced religion in the United States with around 70.6% of the population practicing the faith (Pew Research Forum, 2015). Despite popular adherence to Christianity, psychologists rarely use faith-based treatments over evidencebased approaches (Gorsuch, 1988). Psychologists define religions as social entities that are distinguished by specific beliefs or practices (Abu-Raiya & Pargament, 2015). Research also suggests that the way people engage in religion impacts their mental health (Abu-Raiya & Pargament, 2015; Hoffman & Marsiglia, 2014; Kay & Francis, 2006). In fact, increased religiosity, (i.e., the importance of religion) (Longo, Walls, & Wisneski, 2013), may relate to the likelihood of suicidality, including suicidal ideations (i.e., thoughts about killing oneself) and committing suicide (Norko, Freeman, Hunter, Lewis, & Viswanathan, 2017). However, according to Christian religious doctrines and beliefs, suicide automatically assigns one to eternal damnation (Abu-Raiya & Pargament, 2015). Therefore, it is important for clinicians to understand their client’s religious beliefs when treating patients whom are suicidal to better asses motivations and the probability of committing suicide. Additionally, it is crucial to further examine faith-based treatments as an important factor in treatment of suicidality (Goldston et al., 2008).

When working with adolescent populations, it is especially critical to examine faith-based treatment methods because adolescence is a salient time when individuals independently engage with their faith and evaluate their religion, such as how it will be incorporated into their lives (Fowler & Dell, 2006). Adolescence is also a vital time in mental health development; the Center for Disease Control (CDC) reports suicide as the second leading cause of death amongst adolescents (Goldston et al., 2008). While some research suggests that elements of religiosity, such as a relationship with God, church attendance, or belief in religious doctrine, can help protect adolescents against suicidality (Eskin, 2004; Martin, Kirkcaldy & Siefen, 2003; Miller & Thoesen, 2003), other research proposes that religion can increase suicidal ideation (Goldston et al., 2008; Rasic, Kisely & Langille, 2011). Specifically, there are some aspects of an adolescent’s identity that may moderate the relation between religiosity and suicidality. For example, identifying as gay may conflict with a Christian’s belief system (Longo et al., 2013). Therefore, with a significant number of the population practicing the Christian faith, this paper will explore the following research question, how does Christian religiosity affect suicidality among adolescents?

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SOCIAL CONNECTIONS Having a sense of community and belonging is a significant protective factor against committing suicide for adolescent populations (Eskin, 2004; Goldston et al., 2008; Hoffman & Marsiglia, 2014; Kay & Francis, 2006).

Researchers posit that adolescents in religious groups have more social connections, like friends at church, bible study groups, musical worship teams, and are therefore less likely to commit suicide because they do not feel as alone (Eskin, 2004; Goldston et al., 2008; Hoffman & Marsiglia, 2014).

Feeling less alone is critical, as these connections may make an adolescent feel less inclined to commit suicide (Eskin, 2004). Social psychologists explain that social connections are a strong protective factor against suicide because belonging is a fundamental human need (Aronson, 2012). However, research suggests that one’s sense of belonging to a religious group is related to the degree to which one is actively involved in their religious community.

Specifically, more involvement in a religious community is related to greater feelings of belonging (Eskin, 2014; Hoffman & Marsiglia, 2014). Therefore, the role of religion in creating a sense of community, such as church, can fulfill this need, especially if one is active within the community (Fiala, Bjorck, & Gorsuch, 2002; Hoffman & Marsiglia, 2014).

While belonging to a community does decrease suicidality among adolescents (Eskin, 2004), research indicates the decreased suicide rate amongst those in religious groups is distinct from other communities a young person may belong (Kay & Francis, 2006; Rasic et al., 2011). According to existing research, non-religious communities, such as clubs or sports teams, have not been found to have the same influence as religious groups in decreasing suicidal ideation (Kay & Francis, 2006). In other words, unique elements about the church community may be therapeutic when compared to secular groups (Kay & Francis, 2006). While researchers are still exploring gaps in the literature regarding the specifics of this therapeutic nature, some posit that religious groups may be more helpful due to religious communities’ direct addressing of suffering, such as feelings of suicide (Fiala et al., 2002). In fact, religious communities may provide more global healing (i.e., healing that focuses on the mind and spirit) and support for adolescents than other secular groups provide (Eskin, 2004; Fiala et al., 2002; Kay & Francis, 2006; Rasic et al., 2011).

In addition to feelings of belonging and global healing for adolescents, religious involvement with the church is also related to involvement in a larger social network (Fiala et al., 2002). This protective factor against suicidality grants adolescents more resources for help, particularly when they attend church meetings or activities (Fiala et al., 2002; Hoffman & Marsiglia, 2014).

Additionally, the religious setting may encourage those who are suffering to reach out for help from someone in their church community, whether that be a peer or member of the clergy (Fiala et al., 2002; Goldston et al., 2008; Kay & Francis, 2006). For example, church leaders, such as church counselors or priests, can give at-risk adolescents formal support such as mental health counseling (Fiala et al., 2002). Also, the church community 28

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may normalize these feelings and make it easier for adolescents to come forward with their struggling when the community preaches that all people suffer (Kay & Francis, 2006). Some research suggests that being exposed to the Christian belief that suffering is a part of life mentally prepares adolescents to face suffering, which may in turn decrease their suicidality (Ting & Watson, 2007).

It is important to note, however, that while participation in religious services is often related to lower suicidality (Eskin, 2004), adolescents must actively choose to participate in the religion so that they may benefit from these positive effects. More specifically, if adolescents are forced to go to religious services, instead of independently pursuing involvement with the religion, they may feel less connected to both the community and beliefs of the religion (Martin et al., 2003). Furthermore, if an adolescent’s mental health diagnosis, such as depression, contributes to their suicidality, they may have decreased interest in activities they usually enjoy, such as going to church, and have less motivation to pray to religious figures (Hoffman & Marsiglia, 2014; Rasic et al., 2011). In cases such as this, an adolescent’s religiosity may have either no effect or an increased effect on their suicidality (Hoffman & Marsiglia, 2014).

PERSONAL IDENTITIES AND BELIEFS Beliefs. The religious community’s aversion to suicide may also serve as a factor related to lower suicidality in adolescents (Hoffman & Marsiglia, 2014). Durkheim (1951), theorized that the internalization of norms against suicide in Catholic and Protestant sects of Christianity has made suicide socially unacceptable and unimaginable (Hoffman & Marsiglia, 2014).

Research has substantiated Durkheim’s claims, finding that commitment to any religion that sternly believes suicide is socially and religiously unacceptable decreases suicidality in its members (Greening & Stoppelbein, 2002; Stack, 1983). For example, if a religion preaches that suicidality is a sin, it is no longer an acceptable option for an adolescent to use as an escape from the pain they are feeling. As a result, the adolescent is taught to find another method to escape from their pain (Eskin, 2004). Therefore, an adolescent’s personal conviction to follow the rules, laws, or norms of their religion can be a protective factor against suicidality (Durkheim, 1951).

Specifically, adolescents may not act on their impulse, despite experiencing high suicidal ideation, if they feel morally and religiously obligated to not commit suicide (Eskin, 2004; Stack, 1983; Stack, 2000).

At the same time, it is important to note that if an adolescent is not very observant of their Christian faith, this will not be as strong of a protective factor (Martin et al., 2003). Furthermore, even if this type of private faith is related to greater moral objections to suicide, an individual’s attitudes do not always align with their actions. Thus, conviction alone cannot protect a young person from committing suicide. An adolescent may believe that suicide is wrong, but still choose to commit it in response to their psychological pain (Hoffman & Marsiglia, 2014; Rieger, Peter & Roberts, 29

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2015).

Identity. Other aspects of identity can further moderate the relation between suicide ideation and religion. Likelihood of suicide may increase if an adolescent feels that an aspect of their identity is persecuted by their religious community (Longo et al., 2013). Specifically, the lesbian, gay, and bisexual (LGB) community is one group that is often ostracized by the Christian faith; many churches preach that having sexual relations with someone of the same sex is a sin (Goldston et al., 2008; Longo et al., 2013). Religious LGB adolescents may have poor psychological wellbeing because they may internalize the church’s negative attitudes toward the LGB community or experience homonegative prejudice (Brewster et al., 2016; Sowe et al., 2014). Homonegative prejudice, general negative attitudes about LGB persons, can increase suicidal ideation in LGB adolescents (Brewster et al., 2016). Subsequently, LGB adolescents who identify as religious are more likely to be exposed to homonegative experiences due to the church’s critical attitudes towards them (Sowe et al., 2014). Research indicates that the conflict between identifying with a religious community that condemns LGB groups, while also identifying as LGB, can lead to higher rates of depression and shame among LGB individuals. Feelings of depression and shame may then increase suicidality (Kralovec, Fartacek, Fartacek, & Plöderl, 2014). While certain sects and churches differ in their tolerance and acceptance of LGB adolescents (Brewster, Velez, Foster, Esposito, & Robinson, 2016; Longo et al., 2013; Sowe, Brown, & Taylor, 2014), identifying as LGB has shown to moderate the relation between religiosity and suicidality in adolescents (Goldston et al., 2008; Longo et al., 2013).

In addition to the possible acceptance of the LGB population, the intensity with which churches speak out against the LGB community is a critical factor when related to the likelihood of suicidality. While many Christian faiths preach against homosexuality, churches that preach that the LGB community will spend eternity in Hell may adversely affect its LGB members more than a church that does not regularly discuss the issue of homosexuality in such a negative light (Brewster et al., 2016). Even so, some research suggests that any social support provided by religious groups is often still protective against suicidality amongst LGB youth in the church (Brewster et al., 2016; Kralovec et al., 2014); however, LGB adolescents experience less shame and suicidality if they feel accepted by their church (Longo et al., 2013; Sowe et al., 2014).

COPING MECHANISMS Many adolescents also use their faith communities and religious beliefs to inform their coping mechanisms and responses to stress, which in turn decrease their suicidality (Carver, Scheier, & Weintraub, 1989). Due to effective coping strategies, religious adolescents may have low stress and in turn feel better about their own lives, reducing suicidality (Abu-Raiya & Pargament, 2015; Rieger et al., 2015). Religion often gives meaning to times of stress and suffering. People often turn to religion when they feel their 30

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stress is something that must be endured or is greater than they can handle (Abu-Raiya & Pargament, 2015; Carver et al., 1989). The Christian belief that God will fix stressors beyond an individual’s control is important because it gives adolescents hope for recovery when distressed (Goldston et al., 2008).

However, this is only an effective coping mechanism if the adolescent believes that God is responsive to prayer (Stack, 1983). In fact, adolescents may feel hopeless and experience increased risk for suicide if they feel their continued pain is due to unanswered prayers (Stack, 1983). Furthermore, adolescents may also experience higher rates of suicidality if they believe that God has heard their prayers, but they continue to suffer because they deserve their pain (Goldston et al., 2008). This is known as fatalism, which is defined in research about religiosity as, “the acceptance of one’s situation and suffering,” (Goldston et al., 2008, p. 23). Due to fatalism, adolescents may be more likely to commit suicide if they believe their suffered is deserved, they are inherently bad, or will never feel better (Goldston et al., 2008).

CONCLUSION Research surrounding suicidality and religiosity suggests it is critical to understand an adolescent’s beliefs during treatment because aspects of identity, like religious involvement, may impact their risk of suicide.

Furthermore, although research on suicidality and religiosity has been done across many different cultures (Eskin et al., 2004; Hoffman & Marsiglia, 2014; Kay & Francis, 2006), unaccounted aspects of these cultures these can profoundly affect adolescents’ understanding of religion and suicide. For example, if an adolescent is from an individualistic society, the adolescent is less likely to seek help and immediately turn to suicide (Stack, 1985). Also, many studies have employed a self-report measure to assess suicidality (Eskin, 2004; Hoffman & Marsiglia, 2014; Rieger et al., 2015). Social desirability bias may have influenced research findings due to the sensitive and personal topics covered. Because suicide is a personal and stigmatized subject, some adolescents may not want to disclose that they have had suicidal ideations, particularly if their religious communities preach against suicidality.

Therefore, to better understand how individuals are impacted by their religious beliefs, further research needs to address these concerns, as well as how different religions approach suicide. In relation to practice, findings that suggest increased religiosity is often related to lower rates of suicidality in adolescents should encourage clinicians to incorporate more faith-based interventions in their treatment of religious clients. Finally, due to complex nature of this relation, clinicians should be trained to better understand the conflicting roles of clients’ identities and the relationships to their communities before employing faith-based treatments.

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