This study assessed the characteristics that place adolescent girls at greatest risk for sex trafficking involvement. It was hypothesized that girls with a greater history of risk behaviors, unstable home environments, child maltreatment, and increased psychiatric complexity would be more likely to be involved in domestic minor sex trafficking (DMST). Retrospective chart review of two cohorts of adolescent girls, one with known DMST history, and an age-matched cohort without DMST history, was conducted. Patients came from a Child Abuse clinic and primary care clinic within a single large urban children's hospital in the Northeast United States. Multivariate clustering analysis identified two groups of patients within the sample, one sharing "low risk" traits, and one with "high risk" traits. A variable for "psychiatric complexity" and its relationship to DMST risk was assessed. Hypothesis tests of mediation were conducted. 44 DMST patients and 181 Primary Care patients were included in the final sample, who were then grouped into two clusters based on conceptualized "risk" characteristics. Hypothesis testing supported evidence that patients in the "high risk" group tended toward higher psychiatric complexity (p = .0016) and greater likelihood of DMST involvement (p = .0328). Patients with increased psychiatric complexity also tended towards DMST involvement, regardless of "risk" cluster (p < .0001). This study demonstrates the relationship between social characteristics, psychiatric problems, and DMST involvement. We demonstrated that adolescents with increased psychiatric complexity tend towards greater risk of DMST. These findings demonstrate the important relationship between psychiatric complexity and sexual victimization.