‘Character problems’ (PDs) are widespread inside psychological well being companies 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 therapy, established remedies can require appreciable time. For instance, therapy for borderline persona dysfunction typically lasts greater than a 12 months (Setkowski et al., 2023). This creates an essential want to think about whether or not shorter interventions may be efficient.
We all know that hostile childhood experiences are strongly related to the event of persona difficulties (Broekhof et al., 2024). Consequently, there may be rising curiosity in whether or not trauma-focused approaches equivalent to Eye Motion Desensitisation and Reprocessing (EMDR) may enhance PD signs by concentrating on distressing reminiscences which 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 adjustments in PD symptom severity, diagnostic remission or emotional regulation (Hafkemeijer et al., 2021).
This paper by Hofman et al. (2025), subsequently, investigated whether or not a short course of EMDR may cut back ‘persona dysfunction’ signs no matter whether or not members had PTSD. Secondary goals had been to look at whether or not EMDR improved persona functioning and emotional regulation and whether or not members continued to satisfy diagnostic standards for a PD following therapy.
Strategies
This was a randomised managed trial involving 159 adults with a identified ‘persona dysfunction’ recruited from two outpatient psychological well being companies within the Netherlands. Contributors had been randomly allotted to both EMDR (79 folks) or a waiting-list management group (80 folks). The EMDR intervention consisted of ten 90-minute classes delivered twice weekly over 5 weeks, concentrating on traumatic or hostile reminiscences related to members’ primary PD signs. The management group obtained no trauma-focused or PD therapy throughout this era. Outcomes had been assessed earlier than therapy, afterwards and at three-month follow-up utilizing measures of PD signs and analysis, persona functioning and difficulties regulating feelings. Assessors had been blind to therapy allocation.
Outcomes
General, the outcomes had been encouraging. Individuals receiving EMDR improved considerably greater than these on the ready record throughout the entire primary areas examined, which included PD signs, persona functioning and emotional regulation.
Following therapy, folks receiving EMDR confirmed a larger 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. Contributors continued to enhance, with variations between the teams turning into considerably bigger by the three-month follow-up. The between-group results had been modest instantly after therapy (Cohen’s d 0.31 to 0.48) and bigger at follow-up (d 0.43 to 0.62).
One notably hanging 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 therapy, 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 identical sample, strengthening confidence that this discovering was not dependent upon one explicit evaluation.
Nonetheless, enchancment was broader than merely whether or not any person retained a analysis. Contributors 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 points of persona difficulties.
Curiously, advantages had been discovered throughout completely different persona dysfunction displays and amongst members with and with out PTSD. This means that any person doesn’t essentially want to satisfy diagnostic standards for PTSD to doubtlessly profit from trauma-focused EMDR.
The therapy additionally appeared comparatively acceptable and protected inside this research. Solely 4 members (5.1%) discontinued EMDR, and the authors reported no hostile occasions. Moreover, 16 members improved sufficiently throughout therapy to be categorized as early completers as a result of they not met PD diagnostic standards.
General, subsequently, ten classes of EMDR delivered over 5 weeks produced significant enhancements which remained evident, and in some areas turned stronger, at three-month follow-up.
Conclusions
- This research offered encouraging proof {that a} temporary 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 members receiving EMDR not met PD diagnostic standards at three-month follow-up.
- Nonetheless, EMDR was in contrast with a ready record relatively than established PD remedies, 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 invaluable element of individualised, integrative PD therapy relatively than assuming that prolonged interventions are at all times mandatory.
Strengths and limitations
There are a number of strengths to the research. It used a randomised managed design, included 159 members from two medical companies and used assessors who had been blind to therapy allocation. A number of outcomes had been thought of, 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 completely different PD displays and members each with and with out PTSD. Retention was comparatively excessive, and therapy 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 record relatively than therapy as ordinary or one other evidence-based remedy. Ready-list comparisons could inflate therapy results as a result of the management group receives little energetic 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 members had avoidant, borderline, obsessive-compulsive or different specified PD, which can restrict how confidently the outcomes might be generalised to different PD displays.
- The authors subsequently acknowledge that longer-term outcomes stay unknown and advocate direct comparisons with established remedies.
Implications for apply
The findings problem the idea that persona difficulties essentially require prolonged therapy earlier than significant change can happen. A comparatively temporary, 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 therapy, adopted by reassessment to ascertain whether or not additional remedy is required. This doesn’t imply EMDR ought to change current remedies; some folks could profit sufficiently from EMDR alone, whereas others may have further help.
As a psychologist working integratively throughout the NHS, I discovered this notably fascinating. The complicated displays we see not often match neatly inside one therapeutic mannequin, so having one other doubtlessly efficient intervention broadens the choices accessible when growing particular person formulations and therapy plans. EMDR may complement, relatively than essentially compete with, approaches equivalent to Dialectical Behaviour Remedy (DBT).
This feels notably related when serious about therapy 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 classes over 5 weeks. This raises an fascinating query about whether or not some folks may profit from a shorter trauma-focused intervention earlier than, alongside, or doubtlessly as a substitute of an extended therapy. Nonetheless, the research didn’t immediately evaluate EMDR with DBT or one other established remedy, so we can not conclude that it’s higher or equal.
One in every of my primary reflections was additionally round what we truly imply by “enchancment”. Decreased PD signs and enhancements in emotional regulation and persona functioning are encouraging, however what does this seem like in somebody’s on a regular basis life? Are their relationships extra steady? Are they managing battle otherwise, participating extra constantly with schooling or employment, or experiencing fewer crises? These outcomes had been past the scope of the research however really feel essential when serious about significant restoration from difficulties which are typically complicated and multifaceted. Extra broadly, it jogged my memory that when evaluating any remedy, symptom discount issues, however so does remaining interested in its wider influence on somebody’s life.
The paper additionally made me rethink assumptions about stability and trauma-focused work. Inside NHS companies, the place emotional dysregulation, self-harm and danger are widespread, there are comprehensible causes for prioritising security and stabilisation. Nonetheless, 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 therapy sequencing could should be individualised relatively than routinely phase-based (Lee et al., 2026). For me, this doesn’t reduce the significance of managing danger or interventions equivalent to DBT. As an alternative, it encourages a barely completely different query: relatively than merely asking whether or not somebody is “steady sufficient” for trauma work, what does this explicit particular person 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 12 months. Though these are very completely different research, each elevate an fascinating query about what occurs after trauma-focused remedy finishes. Hofman et al. (2025) discovered that enhancements had been maintained and, for some outcomes, continued to develop throughout follow-up.
This feels notably related to NHS apply, the place longer-term follow-up after remedy just isn’t at all times attainable. If therapeutic positive aspects can proceed to develop after therapy 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 problems: 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 Problems, 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 Nervousness, 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 Sorts of Adversarial Occasions in Sufferers with a Character Dysfunction? Preliminary Information. Journal of Medical Medication, 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 12 months 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 evaluation 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 practical randomized managed trial of cognitive remedy for submit‐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 handiest and acceptable within the therapy of adults with a (sub)medical borderline persona dysfunction? A scientific evaluation and community meta-analysis. Psychological Medication, 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 therapy versus instant trauma-focused therapy for post-traumatic stress dysfunction as a result of childhood abuse: randomised medical trial. BJPsych Open, 7(6).
Volkert, J., Gablonski, T., & Rabung, S. (2018). Prevalence of persona problems within the normal grownup inhabitants in Western nations: systematic evaluation and meta-analysis. The British Journal of Psychiatry, 213(6), 709–715.
