Clinical approaches to autogenic PTSD

Externalising behaviours such as homicide, violent and sexual offending, and internalising behaviours such as Non-Suicidal Self-Injury (NSSI) and suicide attempts, can result in post-traumatic-stress responses in the individual engaging in these behaviours. Described using the neutral term autogenic PTSD, evidence demonstrates that autogenic sources of PTSD symptomatology are relevantly common, can reach diagnostic thresholds, persist in the absence of treatment and significantly elevate the risk of future re-offending. As such this phenomenon is of critical relevance to practitioners working in forensic settings. However, these experiences are largely unrecognised, poorly understood and overlooked in our considerations for trauma-informed approaches to care and the provision of specialist trauma pathways. Developing policies, service frameworks as well as assessment and treatment pathways inclusive of autogenic experiences is critical to ensure a holistic approach to psychological trauma. This chapter outlines key debates relating to language and diagnostic considerations, offers guidance in the development of trauma pathways in forensic settings, explores ethical and practice dilemmas and outlines potential therapeutic approaches, integrating core trauma.