Risky Business: Working with Compulsive and Self-endangering Behaviors in Trauma Survivors 

Survivors of trauma and early attachment disturbance are at elevated risk of a variety compulsive and self-endangering behaviors, ranging from suicidality and self-injury to substance abuse, indiscriminant sexual activities, binge eating, and problematic gambling. Many of these difficulties are seen as evidence of a personality disorder, behavioral addiction, or impulse control disorder. However, emerging research suggests that these types of risky behavior are more accurately understood as coping responses to triggered childhood memories and inadequate emotional regulation capacities.

Calling on his upcoming book Risky Behavior: Treating Trauma, Attachment Disturbance, and Self-Endangerment (Guilford), John Briere presents an integrated approach to self-endangering behavior, the compensatory avoidance model. This treatment system includes a range of interventions that directly target the trauma-dysregulation dynamic, including safety/stabilization, trigger management, emotional regulation training, mindfulness and “emotion surfing,” implicit and explicit memory processing, and harm reduction.

Approaches to three risky behaviors will be presented in detail: self-injury, risky sexual behavior, and bingeing and purging. Attendees will be provided with worksheets and assessment instruments that organize the treatment process.