You’re working with a affected person who struggles with intense feelings, unstable relationships, and an extended historical past of adverse life experiences. You observed that trauma could play a task, however they don’t actually meet the factors for post-traumatic stress dysfunction (PTSD). So, what do you have to do? Do you have to nonetheless deal with the trauma or simply focus solely on the ‘character dysfunction’?
People who’re identified with ‘character dysfunction’ (PD) usually report excessive ranges of disagreeable experiences, similar to emotional abuse, neglect, and different distressing experiences. Analysis means that as much as 73% report abuse and over 80% report neglect (Hafkemeijer et al., 2025). Regardless of this prevalence, trauma-focused therapies aren’t often supplied to this inhabitants, partly since PTSD is more likely to be underdiagnosed or masked by the advanced PD signs (Hofman & Slotema, 2024).
Eye Motion Desensitisation and Reprocessing (EMDR) is an evidence-based remedy for PTSD and well-established (Torres-Gimenez et al., 2024). Nonetheless, little is thought about whether or not EMDR might help people with PD, significantly those that don’t meet the PTSD diagnostic standards, however nonetheless expertise misery linked to previous experiences (Hafkemeijer et al., 2024).
A randomised managed trial by Hafkemeijer et al. (2025) tried to reply the query: Can EDMR cut back trauma-related signs in individuals with ‘character dysfunction’, no matter whether or not they have a proper PTSD analysis? By doing this, it challenges us to rethink how broadly trauma-focused therapies may be utilized in medical observe.
Folks with ‘character dysfunction’ report excessive ranges of opposed life experiences.
Strategies
This trial was a single-blind, multicentre randomised managed trial evaluating Eye Motion Desensitisation and Reprocessing remedy with a waitlist management. Adults identified with PD have been recruited from outpatient psychological well being companies within the Netherlands and randomly allotted to both obtain EMDR or stay on a waitlist.
Members within the EMDR group obtained ten 90-minute classes over a span of 5 weeks, specializing in processing distressing reminiscences linked to present signs. The signs of PTSD and the analysis have been assessed utilizing the Clinician-Administered PTSD Scale (CAPS-5) at baseline, post-treatment, and at a three-month follow-up. Most significantly, the research included individuals with and with out a formal analysis of PTSD, which allowed the researchers to discover whether or not EMDR may be efficient past conventional diagnostic boundaries.
Outcomes
A complete of 159 individuals have been recruited for this trial, with 79 allotted to EMDR and 80 to the waitlist management. Each teams have been in contrast at baseline, with no important variations in demographic or medical traits.
General, EMDR remedy resulted in better reductions in PTSD signs over time in comparison with the waitlist. These enhancements have been demonstrated each instantly after therapy and on the three-month follow-up, which signifies that the advantages weren’t solely important but in addition sustained. In sensible phrases, which means individuals who obtained EMDR remedy skilled a lower in trauma-related misery in comparison with those that didn’t obtain lively therapy.
Amongst individuals who met PTSD standards initially of this research, impact sizes have been massive after therapy (Cohen’s d = 1.26, in comparison with d = 0.28 within the waitlist group), and grew additional at three months (d = 1.5). To provide that some context, a Cohen’s d above 0.8 is conventionally thought-about a big impact, so these figures sit effectively above that threshold.
Most vital, 65.5% of these within the EMDR group now not met standards for PTSD after therapy, and on the follow-up, it elevated to 73.1%. In distinction, fewer individuals within the waitlist group demonstrated this stage of restoration over the identical time interval.
Apparently, EMDR was additionally efficient for individuals who didn’t have a proper PTSD analysis. On this group of individuals, average to massive reductions in PTSD signs have been noticed (d = 0.77 after therapy, rising to d = 1.09 at follow-up), which suggests the EMDR might help tackle trauma-related misery, even when it doesn’t meet the diagnostic thresholds.
The trial additionally explored the sorts of reminiscences focused in remedy. Fairly just a few individuals labored on experiences, together with emotional abuse and neglect, which don’t at all times meet Criterion A for PTSD. EMDR led to important symptom decreases throughout several types of opposed reminiscences, with no clear variations between them. This means that EMDR may be relevant to a spread of distressing life experiences, and never simply historically outlined trauma.
This trial means that EMDR might help cut back trauma-related signs in individuals with a character dysfunction analysis.
Conclusions
The research suggests that EMDR remedy can cut back PTSD signs in individuals with character problems. Apparently, these results have been noticed each in people with a proper PTSD analysis and in these with out, highlighting the potential worth of trauma-focused remedy past conventional diagnostic boundaries.
The researchers concluded that EMDR may be efficient in focusing on a variety of distressing reminiscences, together with these that don’t often meet the PTSD standards, and will play a significant position in bettering outcomes for this inhabitants.
This analysis means that EMDR may be efficient in focusing on a variety of distressing reminiscences, together with in those that that don’t meet PTSD standards.
Strengths and limitations
This research has just a few notable strengths. Firstly, the use of a randomised managed trial design strengthens the findings, because it reduces the chance of choice bias and permits for clear comparisons between EMDR and the management circumstances. The recruitment from outpatient companies additionally improves the medical relevance of this research; which means the findings are more likely to replicate real-world observe. Moreover, together with people with and with out a PTSD analysis is a power, because it addresses an important hole in literature.
The research used well-known and dependable instruments, such because the CAPS-5 for PTSD and structured interviews for PD, supporting the validity of the end result measures. The follow-up at 3 months confirmed that the therapy results have been maintained over time, which strengthens the research as effectively.
The research has a number of limitations, which should be thought-about. For instance, a waitlist management was used, moderately than an lively comparable therapy, so this trial doesn’t inform us whether or not EMDR is simpler than different remedy sorts. Because of this enhancements may replicate non-specific elements like getting consideration from therapists or participant expectations, moderately than the lively ingredient of EMDR.
Moreover, the research had greater dropout and lacking consequence information within the management group, particularly individuals with extreme signs. This suggests potential for bias and overestimation of the effectiveness of EMDR. Due to this fact, the findings needs to be cautiously interpreted.
This research primarily centered on PTSD signs, this implies it limits the understanding of the affect of EMDR on different elements of character dysfunction, similar to interpersonal functioning or emotional regulation. Due to this fact, future analysis would profit from additional research that embody these.
The research has strengths however vital questions stay.
Implications for observe
This research has vital implications for a way we’d take into consideration trauma in people with ‘character dysfunction’. Within the medical world, trauma is usually included within the affected person’s historical past, however not at all times focused in therapy, particularly if the affected person doesn’t meet the factors for PTSD. The findings of this research indicate that this may occasionally want some reconsideration.
EMDR can cut back trauma-related signs, even with out a full PTSD analysis, difficult the belief that trauma-focused therapies ought to solely be for identified sufferers, as a result of many individuals with PD present trauma signs linked to opposed experiences similar to emotional abuse or neglect. This means that such experiences are nonetheless vital and needs to be addressed in therapy.
For professionals, which means it is very important assess trauma completely. Signs like emotional dysregulation or interpersonal difficulties may be rooted in unresolved opposed experiences. EMDR may doubtlessly be a helpful addition to current remedies for character problems.
This research makes you concentrate on whether or not previous experiences are persevering with to form current difficulties and in that case, can trauma-focused therapies play a task in therapy.
Assertion of pursuits
Vivien Ciftci has no conflicts to declare. AI instruments have been used to help with proofreading and structuring.
Edited by
Edited by Simon Bradstreet.
Hyperlinks
Major paper
Hafkemeijer, L., Hofman, S., de Jongh, A., et al. (2025). The Effectiveness of Eye Motion Desensitization and Reprocessing Remedy on Submit-Traumatic Stress Dysfunction Signs and Diagnostic Standing in Sufferers with a Persona Dysfunction: A Randomized Managed Trial. Psychother Psychosom, 94, 453-465.
Different references
Hafkemeijer, L., de Jongh, A., Starrenburg, A., Hoekstra, T., & Slotema, Ok. (2024). EMDR therapy in sufferers with character problems. ought to we concern symptom exacerbation? European Journal of Psychotraumatology, 15(1).
Hofman, S., & Slotema, C. W. (2024). Underdiagnosis of posttraumatic stress dysfunction amongst outpatients with character problems in medical observe regardless of the usage of a diagnostic instrument. Journal of Persona Problems, 38(5), 477–492.
Torres-Giménez, A., Garcia-Gibert, C., Gelabert, E., MallorquÃ, A., Segu, X., Roca-Lecumberri, A., MartÃnez, A., Giménez, Y., & Sureda, B. (2024). Efficacy of EMDR for early intervention after a traumatic occasion: A scientific evaluation and meta-analysis. Journal of Psychiatric Analysis, 174, 73–83.
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