It is well established that being a victim of violent crime can be a highly traumatic experience. However, evidence is emerging from research and clinical practice that those who commit violent or sexual offences can also become traumatised as a result of their own criminal behaviour. This chapter draws from across the literature to explore the prevalence and nature of offence-related trauma. It also attempts to identify characteristics of offending behaviour which may heighten the risk for an offender to develop post-traumatic stress disorder (PTSD) relating to their criminal behaviour. Several detailed clinical case studies are presented which illustrate the importance of these offence characteristics, and which also highlight the complexity in treating offence-related trauma. These case studies demonstrate the survival response that some offenders use in response to previous and offence-related trauma and give an insight into the challenges faced in offering psychological treatment, particularly when there is pre-existing trauma or experiences of prior victimisation. Drawing the evidence from research and clinical practice together, the chapter concludes with a detailed clinical framework for working with offence-related trauma and provides some key questions for consideration when offering assessment and therapeutic intervention in these cases.