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

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

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Executive director of HEAL Trafficking and an emergency physician at Brigham and Women's Hospital in Boston, with appointments at Harvard Medical School, the Harvard T.H. Chan School of Public Health, and the Harvard Humanitarian Initiative, and a researcher, advocate, and speaker in the US and internationally.
Inspirational speaker and author and an expert on trauma resolution and addiction.
Instructor in psychiatry at Harvard Medical School in Boston, and the assistant program director for the MGH/McLean Adult Psychiatry Residency Training Program and the clinical director of McLean Hospital's Psychotic Disorders Division.


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.

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