‘Character issues’ (PDs) are widespread inside psychological well being providers and might considerably have an effect on people, their households and wider society (Volkert et al., 2018). Though psychotherapy is taken into account the first-line remedy, established therapies can require appreciable time. For instance, remedy for borderline persona dysfunction usually lasts greater than a yr (Setkowski et al., 2023). This creates an essential want to think about whether or not shorter interventions is also efficient.
We all know that hostile childhood experiences are strongly related to the event of persona difficulties (Broekhof et al., 2024). Consequently, there’s rising curiosity in whether or not trauma-focused approaches corresponding to Eye Motion Desensitisation and Reprocessing (EMDR) may enhance PD signs by focusing on distressing recollections that will contribute to present difficulties (Hafkemeijer et al., 2021). Importantly, EMDR is historically related to post-traumatic stress dysfunction (PTSD), however rising analysis means that it might additionally profit folks with PD who don’t meet standards for PTSD. Earlier analysis discovered enhancements following EMDR, however had not examined modifications in PD symptom severity, diagnostic remission or emotional regulation (Hafkemeijer et al., 2021).
This paper by Hofman et al. (2025), due to this fact, investigated whether or not a quick course of EMDR may cut back ‘persona dysfunction’ signs no matter whether or not individuals had PTSD. Secondary goals have been to look at whether or not EMDR improved persona functioning and emotional regulation and whether or not individuals continued to satisfy diagnostic standards for a PD following remedy.
Strategies
This was a randomised managed trial involving 159 adults with a recognized ‘persona dysfunction’ recruited from two outpatient psychological well being providers within the Netherlands. Individuals have been randomly allotted to both EMDR (79 folks) or a waiting-list management group (80 folks). The EMDR intervention consisted of ten 90-minute periods delivered twice weekly over 5 weeks, focusing on traumatic or hostile recollections related to individuals’ fundamental PD signs. The management group obtained no trauma-focused or PD remedy throughout this era. Outcomes have been assessed earlier than remedy, afterwards and at three-month follow-up utilizing measures of PD signs and analysis, persona functioning and difficulties regulating feelings. Assessors have been blind to remedy allocation.
Outcomes
General, the outcomes have been encouraging. Folks receiving EMDR improved considerably greater than these on the ready checklist throughout all the fundamental areas examined, which included PD signs, persona functioning and emotional regulation.
Following remedy, folks receiving EMDR confirmed a higher discount within the quantity and severity of ‘persona dysfunction’ signs than those that had not obtained EMDR. Importantly, these enhancements didn’t disappear instantly after remedy ended. Individuals continued to enhance, with variations between the teams changing into considerably bigger by the three-month follow-up. The between-group results have been modest instantly after remedy (Cohen’s d 0.31 to 0.48) and bigger at follow-up (d 0.43 to 0.62).
One significantly placing discovering involved diagnostic remission. Utilizing the clinician-rated SCID-5-PD evaluation, roughly 33% of the EMDR group not met standards for a ‘persona dysfunction’ instantly after remedy, in contrast with roughly 8% of the management group. At three-month follow-up, this elevated to 44.1% of the EMDR group, in contrast with 15.8% of controls. A separate PD measure, the ADP-IV, produced an analogous sample, strengthening confidence that this discovering was not dependent upon one explicit evaluation.
Nevertheless, enchancment was broader than merely whether or not someone retained a analysis. Individuals receiving EMDR additionally demonstrated improved persona functioning and fewer difficulties with emotional regulation. That is essential as a result of difficulties in how somebody experiences themselves, pertains to others and manages feelings are central elements of persona difficulties.
Curiously, advantages have been discovered throughout totally different persona dysfunction shows and amongst individuals with and with out PTSD. This implies that someone doesn’t essentially want to satisfy diagnostic standards for PTSD to doubtlessly profit from trauma-focused EMDR.
The remedy additionally appeared comparatively acceptable and protected inside this research. Solely 4 individuals (5.1%) discontinued EMDR, and the authors reported no hostile occasions. Moreover, 16 individuals improved sufficiently throughout remedy to be labeled as early completers as a result of they not met PD diagnostic standards.
General, due to this fact, ten periods of EMDR delivered over 5 weeks produced significant enhancements which remained evident, and in some areas grew to become stronger, at three-month follow-up.
Conclusions
- This research offered encouraging proof {that a} transient course of EMDR could cut back ‘persona dysfunction’ signs and enhance persona functioning and emotional regulation, even when PTSD just isn’t current.
- Virtually half of individuals receiving EMDR not met PD diagnostic standards at three-month follow-up.
- Nevertheless, EMDR was in contrast with a ready checklist relatively than established PD therapies, and follow-up was solely three months, which means its comparative and longer-term effectiveness stays unsure.
- General, the research helps contemplating EMDR as one other doubtlessly precious part of individualised, integrative PD remedy relatively than assuming that prolonged interventions are at all times needed.
Strengths and limitations
There are a number of strengths to the research. It used a randomised managed design, included 159 individuals from two medical providers and used assessors who have been blind to remedy allocation. A number of outcomes have been thought-about, together with each self-report and clinician-rated PD measures alongside measures of persona functioning and emotional regulation. One other energy was the inclusion of individuals with totally different PD shows and individuals each with and with out PTSD. Retention was comparatively excessive, and remedy dropout was low. The authors spotlight the broad vary of PDs, excessive retention and use of each dimensional and categorical measures as strengths that improve confidence within the findings.
There are, nevertheless, essential limitations:
- Most importantly, EMDR was in contrast with a ready checklist relatively than remedy as normal or one other evidence-based remedy. Ready-list comparisons could inflate remedy results as a result of the management group receives little lively intervention. This makes it tough to find out how a lot enchancment was particularly attributable to EMDR relatively than receiving structured remedy, therapist consideration or anticipating to enhance.
- The research couldn’t be double-blinded, and three months can be a comparatively quick follow-up interval when investigating difficulties historically understood as enduring.
- Most individuals had avoidant, borderline, obsessive-compulsive or different specified PD, which can restrict how confidently the outcomes could be generalised to different PD shows.
- The authors due to this fact acknowledge that longer-term outcomes stay unknown and suggest direct comparisons with established therapies.
Implications for observe
The findings problem the belief that persona difficulties essentially require prolonged remedy earlier than significant change can happen. A comparatively transient, five-week EMDR intervention produced reductions in ‘persona dysfunction’ (PD) signs, alongside enhancements in persona functioning and emotional regulation. The authors counsel that EMDR may doubtlessly be provided earlier in remedy, adopted by reassessment to determine whether or not additional remedy is required. This doesn’t imply EMDR ought to substitute present therapies; some folks could profit sufficiently from EMDR alone, whereas others might have further assist.
As a psychologist working integratively throughout the NHS, I discovered this significantly attention-grabbing. The complicated shows we see hardly ever match neatly inside one therapeutic mannequin, so having one other doubtlessly efficient intervention broadens the choices accessible when growing particular person formulations and remedy plans. EMDR may complement, relatively than essentially compete with, approaches corresponding to Dialectical Behaviour Remedy (DBT).
This feels significantly related when eager about remedy size and NHS ready lists. Complete DBT has a powerful proof base however is comparatively prolonged and resource-intensive, whereas the EMDR intervention on this research concerned solely ten periods over 5 weeks. This raises an attention-grabbing query about whether or not some folks would possibly profit from a shorter trauma-focused intervention earlier than, alongside, or doubtlessly as a substitute of an extended remedy. Nevertheless, the research didn’t instantly examine EMDR with DBT or one other established remedy, so we can not conclude that it’s higher or equal.
Considered one of my fundamental reflections was additionally round what we really imply by “enchancment”. Decreased PD signs and enhancements in emotional regulation and persona functioning are encouraging, however what does this appear to be in somebody’s on a regular basis life? Are their relationships extra steady? Are they managing battle in another way, partaking extra constantly with schooling or employment, or experiencing fewer crises? These outcomes have been past the scope of the research however really feel essential when eager about significant restoration from difficulties which might be usually complicated and multifaceted. Extra broadly, it jogged my memory that when evaluating any remedy, symptom discount issues, however so does remaining interested by its wider affect on somebody’s life.
The paper additionally made me rethink assumptions about stability and trauma-focused work. Inside NHS providers, the place emotional dysregulation, self-harm and threat are widespread, there are comprehensible causes for prioritising security and stabilisation. Nevertheless, proof more and more questions whether or not everybody requires a separate interval of stabilisation earlier than trauma processing (De Jongh et al., 2016; Van Vliet et al., 2021), with newer analysis suggesting that remedy sequencing could should be individualised relatively than routinely phase-based (Lee et al., 2026). For me, this doesn’t reduce the significance of managing threat or interventions corresponding to DBT. As an alternative, it encourages a barely totally different query: relatively than merely asking whether or not somebody is “steady sufficient” for trauma work, what does this explicit individual want, what’s sustaining their difficulties, and which intervention, or mixture of interventions, makes most sense now?
Lastly, I used to be struck by the discovering that enchancment didn’t essentially cease when EMDR ended. This jogged my memory of the DECRYPT trial of cognitive remedy for PTSD in kids and adolescents carried out by Meiser‐Stedman et al. (2025), which I beforehand mentioned in one other Psychological Elf weblog earlier this yr. Though these are very totally different research, each increase an attention-grabbing query about what occurs after trauma-focused remedy finishes. Hofman et al. (2025) discovered that enhancements have been maintained and, for some outcomes, continued to develop throughout follow-up.
This feels significantly related to NHS observe, the place longer-term follow-up after remedy just isn’t at all times attainable. If therapeutic features can proceed to develop after remedy ends, measuring outcomes primarily at discharge could solely inform a part of the story. Maybe follow-up doesn’t must imply extra remedy, however may contain checking in a number of months later and contemplating not solely symptom scores, however relationships, functioning, emotional wellbeing and high quality of life. If change can proceed past the remedy room, maybe our analysis of remedy wants to increase past it too.
Assertion of pursuits
Lisa Lloyd is a medical psychologist. She has no conflicts of curiosity to declare.
Editor
Edited by Dr Dafni Katsampa.
Hyperlinks
Main paper
Simon Hofman, Laurian Hafkemeijer, Advert de Jongh, Cristina Slotema (2025). Eye motion desensitization and reprocessing remedy in individuals with persona issues: A randomized medical trial. JAMA Community Open, 8(9), e2533421.
Different references
Broekhof, R., Nordahl, H. M., Eikenæs, I. U., & Selvik, S. G. (2024). Adversarial childhood experiences are related to persona Dysfunction: A Potential, longitudinal research. Journal of Character Issues, 38(1), 19–33.
De Jongh, A., Resick, P. A., Zoellner, L. A., Van Minnen, A., Lee, C. W., Monson, C. M., Foa, E. B., Wheeler, Ok., Broeke, E. T., Feeny, N., Rauch, S. A., Chard, Ok. M., Mueser, Ok. T., Sloan, D. M., Van Der Gaag, M., Rothbaum, B. O., Neuner, F., De Roos, C., Hehenkamp, L. M., . . . Bicanic, I. A. (2016). CRITICAL ANALYSIS OF THE CURRENT TREATMENT GUIDELINES FOR COMPLEX PTSD IN ADULTS. Despair and Anxiousness, 33(5), 359–369.
Hafkemeijer, L., Starrenburg, A., Van Der Palen, J., Slotema, Ok., & De Jongh, A. (2021). Does EMDR Remedy Have an Impact on Recollections of Emotional Abuse, Neglect and Different Forms of Adversarial Occasions in Sufferers with a Character Dysfunction? Preliminary Information. Journal of Medical Drugs, 10(19), 4333.
Hafkemeijer, L., Slotema, Ok., De Haard, N., & De Jongh, A. (2023). Case report: Transient, intensive EMDR remedy for borderline persona dysfunction: outcomes of two case research with one yr follow-up. Frontiers in Psychiatry, 14, 1283145.
Lee, Y., Park, S., & Cho, Y.-E. (2026). Part-based versus non-phase-based psychological interventions for complicated PTSD: a scientific overview and meta-analysis. European Journal of Psychotraumatology, 17(1).
Meiser‐Stedman, R., Allen, L., Ashford, P. A., Beeson, E., Byford, S., Danese, A., Farr, A., Finn, J., Goodall, B., Grainger, L., Hammond, M., Harmston, R., Humphrey, A., King, D., Lofthouse, Ok., Mahoney‐Davies, G., Miles, S., Moore, J., Morant, N., … Smith, P. (2025). A realistic randomized managed trial of cognitive remedy for publish‐traumatic stress dysfunction in kids and adolescents uncovered to a number of traumatic stressors: the DECRYPT trial. World Psychiatry, 24(3), 422–434.
Setkowski, Ok., Palantza, C., Van Ballegooijen, W., Gilissen, R., Oud, M., Cristea, I. A., Noma, H., Furukawa, T. A., Arntz, A., Van Balkom, A. J. L. M., & Cuijpers, P. (2023). Which psychotherapy is best and acceptable within the remedy of adults with a (sub)medical borderline persona dysfunction? A scientific overview and community meta-analysis. Psychological Drugs, 53(8), 3261–3280.
Van Vliet, N. I., Huntjens, R. J. C., Van Dijk, M. Ok., Bachrach, N., Meewisse, M., & De Jongh, A. (2021). Part-based remedy versus quick trauma-focused remedy for post-traumatic stress dysfunction attributable to childhood abuse: randomised medical trial. BJPsych Open, 7(6).
Volkert, J., Gablonski, T., & Rabung, S. (2018). Prevalence of persona issues within the normal grownup inhabitants in Western nations: systematic overview and meta-analysis. The British Journal of Psychiatry, 213(6), 709–715.
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