Human Trafficking, Mental Illness, and Addiction: Avoiding Diagnostic Overshadowing

AMA J Ethics. 2017 Jan 1;19(1):23-34. doi: 10.1001/journalofethics.2017.19.1.ecas3-1701.


This article reviews an emergency department-based clinical vignette of a trafficked patient with co-occurring pregnancy-related, mental health, and substance use disorder issues. The authors, including a survivor of human trafficking, draw on their backgrounds in addiction care, human trafficking, emergency medicine, and psychiatry to review the literature on relevant general health and mental health consequences of trafficking and propose an approach to the clinical complexities this case presents. In their discussion, the authors explicate the deleterious role of implicit bias and diagnostic overshadowing in trafficked patients with co-occurring addiction and mental illness. Finally, the authors propose a trauma-informed, multidisciplinary response to potentially trafficked patients.

Publication types

  • Case Reports

MeSH terms

  • Crime Victims / psychology*
  • Delivery of Health Care
  • Emergency Medicine
  • Emergency Service, Hospital
  • Ethics, Medical*
  • Female
  • Human Trafficking / psychology*
  • Humans
  • Mental Disorders / complications
  • Mental Disorders / diagnosis*
  • Physicians / ethics*
  • Pregnancy
  • Pregnancy Complications / psychology
  • Psychiatry / ethics*
  • Substance-Related Disorders / complications
  • Substance-Related Disorders / diagnosis