You’re working with a affected person who struggles with intense feelings, unstable relationships, and an extended historical past of inauspicious life experiences. You watched that trauma might play a job, however they don’t actually meet the standards for post-traumatic stress dysfunction (PTSD). So, what must you do? Must you nonetheless deal with the trauma or simply focus solely on the ‘character dysfunction’?
People who’re recognized with ‘character dysfunction’ (PD) usually report excessive ranges of disagreeable experiences, akin 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 usually are not often supplied to this inhabitants, partly since PTSD is more likely to be underdiagnosed or masked by the complicated 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). Nevertheless, little is thought about whether or not EMDR may 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 scale back trauma-related signs in folks 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.
Individuals with ‘character dysfunction’ report excessive ranges of antagonistic 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 recognized 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.
Individuals 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 examine included members with and with no 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 members 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 vital variations in demographic or medical traits.
Total, EMDR remedy resulted in larger 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 vital but additionally sustained. In sensible phrases, which means that members who obtained EMDR remedy skilled a lower in trauma-related misery in comparison with those that didn’t obtain energetic therapy.
Amongst members who met PTSD standards at first of this examine, impact sizes have been giant 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 present that some context, a Cohen’s d above 0.8 is conventionally thought of a big impact, so these figures sit properly above that threshold.
Most essential, 65.5% of these within the EMDR group not met standards for PTSD after therapy, and on the follow-up, it elevated to 73.1%. In distinction, fewer members within the waitlist group demonstrated this degree of restoration over the identical time interval.
Apparently, EMDR was additionally efficient for members who didn’t have a proper PTSD analysis. On this group of members, average to giant reductions in PTSD signs have been noticed (d = 0.77 after therapy, rising to d = 1.09 at follow-up), which suggests the EMDR may help deal with trauma-related misery, even when it doesn’t meet the diagnostic thresholds.
The trial additionally explored the varieties of reminiscences focused in remedy. Fairly a number of members labored on experiences, together with emotional abuse and neglect, which don’t at all times meet Criterion A for PTSD. EMDR led to vital symptom decreases throughout several types of antagonistic 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 may help scale back trauma-related signs in folks with a character dysfunction analysis.
Conclusions
The examine suggests that EMDR remedy can scale back PTSD signs in folks 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 function 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 examine has a number of 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 situations. The recruitment from outpatient companies additionally improves the medical relevance of this examine; which means that the findings are more likely to mirror real-world observe. Moreover, together with people with and with no PTSD analysis is a energy, because it addresses a vital hole in literature.
The examine used well-known and dependable instruments, such because the CAPS-5 for PTSD and structured interviews for PD, supporting the validity of the result measures. The follow-up at 3 months confirmed that the therapy results have been maintained over time, which strengthens the examine as properly.
The examine has a number of limitations, which have to be thought of. For instance, a waitlist management was used, fairly than an energetic comparable therapy, so this trial doesn’t inform us whether or not EMDR is simpler than different remedy sorts. Which means that enhancements may mirror non-specific elements like getting consideration from therapists or participant expectations, fairly than the energetic ingredient of EMDR.
Moreover, the examine had greater dropout and lacking final result knowledge within the management group, particularly members with extreme signs. This means potential for bias and overestimation of the effectiveness of EMDR. Due to this fact, the findings ought to be cautiously interpreted.
This examine primarily targeted on PTSD signs, this implies it limits the understanding of the affect of EMDR on different elements of character dysfunction, akin to interpersonal functioning or emotional regulation. Due to this fact, future analysis would profit from additional research that embrace these.
The examine has strengths however essential questions stay.
Implications for observe
This examine has essential implications for the 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 standards for PTSD. The findings of this examine suggest that this may increasingly want some reconsideration.
EMDR can scale back trauma-related signs, even with no full PTSD analysis, difficult the belief that trauma-focused therapies ought to solely be for recognized sufferers, as a result of many individuals with PD present trauma signs linked to antagonistic experiences akin to emotional abuse or neglect. This means that such experiences are nonetheless essential and ought to be addressed in therapy.
For professionals, which means that you will need to assess trauma totally. Signs like emotional dysregulation or interpersonal difficulties may be rooted in unresolved antagonistic experiences. EMDR may doubtlessly be a helpful addition to current remedies for character problems.
This examine makes you consider whether or not previous experiences are persevering with to form current difficulties and in that case, can trauma-focused therapies play a job 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
Main 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 Character Dysfunction: A Randomized Managed Trial. Psychother Psychosom, 94, 453-465.
Different references
Hafkemeijer, L., de Jongh, A., Starrenburg, A., Hoekstra, T., & Slotema, Okay. (2024). EMDR therapy in sufferers with character problems. ought to we worry 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 using a diagnostic instrument. Journal of Character Issues, 38(5), 477–492.
Torres-Giménez, A., Garcia-Gibert, C., Gelabert, E., Mallorquí, A., Segu, X., Roca-Lecumberri, A., Martínez, A., Giménez, Y., & Sureda, B. (2024). Efficacy of EMDR for early intervention after a traumatic occasion: A scientific assessment and meta-analysis. Journal of Psychiatric Analysis, 174, 73–83.
