“Hey, Zeeema! You're going to see me today?” shouted a 15-year-old girl sitting on a dented metal picnic table outside the mental health trailer. A skilled solicitor, Ruby had been sentenced to probation camp for six months for prostitution. Her previous eight arrests, beginning at age 13, had ended in early release from L.A. County jail. Instructed by her pimp to lie about her age if arrested, she feigned adulthood and used the overcrowded conditions to her advantage. If her minor status had been revealed, she faced a much longer sentence to probation camp and her pimp lost at least $500 a day.

Running away from her mother at age 13, Ruby quickly drifted into a world of daily crack cocaine and inhalant use and was regularly drugged at night by her pimp “for sleep.” By age 15 she had been a victim of severe choking and multiple beatings and had attempted to hang herself from the bars of her pimp's exercise equipment. She was not pregnant on intake to the camp, but she tested positive for two sexually transmitted diseases. Although her story is common, it is not frequently told.

In this issue, a study of the mental health of female adult film performers by Grudzen and colleagues provides a rare glimpse into the traumatic childhoods of female porn actors and the trajectory of exposure to forced sex and domestic violence they experience as adults. Compared with a statewide sample of California women, the female porn actors were more likely to have had childhood histories of foster care, to have received welfare, to have had forced sex, and to have been younger at first sexual intercourse. With a few exceptions, most of these risk factors were not independent predictors of self-reported mental health and depressive symptoms. Nevertheless, rates of depressive symptoms were 1.5 to 2.5 times higher among the female adult film performers than among those in the statewide sample. More than half wanted mental health care, but less than half had received it. Ironically, the Internet, a medium that exploits them, was also creatively used to recruit the female porn actors into the study and confidentially gather the data to tell their story.

At Ruby's last mental health visit, our session ended with a hug. “Don't let them hurt you like that again,” I said as we embraced. “I hope to never see you again in here, Zeeema, but I'll see you on the outs!” she said with pride. As she turned away, we both realized the naïveté of these words.