A brief course of eye movement desensitisation and reprocessing (EMDR) may help reduce personality-disorder symptoms, according to a randomised controlled trial involving 159 adults in the Netherlands.
The findings suggest that improvements may occur even when a person does not have post-traumatic stress disorder (PTSD). However, the study compared EMDR with a waiting list rather than another active therapy, and participants were followed for only three months.
What the study tested
Psychotherapy is considered the first-line treatment for personality disorders, but established approaches can require substantial time. Treatment for borderline personality disorder, for example, often lasts more than a year.
EMDR is traditionally associated with PTSD. The study by Hofman et al. examined whether a shorter course could improve personality-disorder symptoms, personality functioning and emotional regulation, regardless of whether participants also had PTSD.
The trial included adults with a diagnosed personality disorder who were recruited from two outpatient mental health services in the Netherlands. Participants were randomly assigned either to EMDR or to a waiting-list control group.
- 79 people received EMDR.
- 80 people were placed on the waiting list.
- The EMDR group attended ten 90-minute sessions, delivered twice a week over five weeks.
- Sessions focused on traumatic or adverse memories associated with participants’ main symptoms.
- The waiting-list group did not receive trauma-focused or personality-disorder treatment during the study period.
Assessors did not know which treatment participants had received. Outcomes were measured before treatment, after treatment and at a three-month follow-up.
What changed after EMDR
Compared with people on the waiting list, those receiving EMDR had greater improvements in personality-disorder symptoms, personality functioning and emotional regulation.
Using the clinician-rated SCID-5-PD assessment, about 33% of people in the EMDR group no longer met personality-disorder criteria immediately after treatment, compared with about 8% of the control group. At three months, the figures were 44.1% and 15.8%, respectively. A second measure, the ADP-IV, showed a similar pattern.
The differences between groups were modest immediately after treatment and larger at follow-up. The study reported effect sizes ranging from 0.31 to 0.48 after treatment and from 0.43 to 0.62 at three months.
Benefits were reported across different personality-disorder presentations and among participants both with and without PTSD. Four people in the EMDR group, or 5.1%, discontinued treatment, and the authors reported no adverse events. Sixteen participants improved enough during treatment to be classified as early completers because they no longer met diagnostic criteria.
Why the results need careful interpretation
The trial offers encouraging evidence, but it does not show that EMDR is better than established therapies. The comparison group was on a waiting list rather than receiving treatment as usual, dialectical behaviour therapy or another evidence-based approach.
Waiting-list studies can make treatment effects appear larger because the control group receives little active support. The results may reflect not only EMDR, but also structured therapy, therapist attention or participants’ expectations of improvement.
The study could not be double-blinded, and the follow-up period lasted only three months. It also did not assess wider everyday outcomes such as relationship stability, conflict management, education or employment engagement, crises or quality of life.
Most participants had avoidant, borderline, obsessive-compulsive or other specified personality disorders. This means the findings may not apply in the same way to every personality-disorder presentation.
What this means for care
The findings support considering brief EMDR as a possible component of individualised, integrative care for some people with personality disorders. They do not establish that ten sessions are sufficient for everyone, or that longer interventions are unnecessary.
More research comparing EMDR directly with established treatments, and following people for longer, is needed before its comparative and long-term effectiveness can be determined.
AI tools were used to assist with the preparation of this article.
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