EMDR Shows Promising Results for Personality Disorders

A woman in her early forties has undergone numerous treatments. She experiences mood swings, feels quickly rejected, and her relationships fall apart. Conflicts escalate at work as well. The diagnosis: borderline personality disorder. She doesn't expect to qualify for EMDR therapy (Eye Movement Desensitization and Reprocessing therapy). "Isn't that for war traumas?" she asks, surprised. Yet she decides to give it a try. After a few sessions, she notices her emotions becoming less intense. "I can live instead of just survive."

Research on EMDR Therapy in People Without PTSD

Laurian Hafkemeijer regularly treats people with EMDR therapy and wondered whether this form of treatment also works for people with a personality disorder without a PTSD diagnosis. A personality disorder often arises from a combination of predisposition, stressful circumstances, and significant life events. Many people do not meet the PTSD criteria, for example, because they have developed survival strategies that make symptoms less visible. They may also have primarily experienced emotional neglect, rejection, or emotional abuse. According to Hafkemeijer, it's not just about the given diagnosis; these types of experiences can still evoke a lot of emotional charge and influence how someone thinks, feels, and reacts. Her research found EMDR to be effective for various types of memories, including those related to neglect or emotional abuse.

Beyond PTSD

EMDR therapy helps process stuck memories by recalling them while attention is diverted, for example, with eye movements or clicking sounds. This reduces the emotional charge. The method is globally recognized for PTSD but is not routinely applied to personality disorders without PTSD. "For a long time, the perception was that we should be cautious with this group because it might destabilize them more quickly," says Hafkemeijer. "Although the individual always comes first, these results show that EMDR therapy can be encouraging."

Measurable Improvements

For her doctoral research, Hafkemeijer conducted two controlled studies on people with personality disorders, both with and without a PTSD diagnosis. The therapy was generally well tolerated. In the first study at GGZ Delfland, EMDR therapy led to a clear reduction in symptoms for most patients, such as anxiety and problems in daily functioning. For some participants, personality functioning was also mapped, and there were indications of improvement in interpersonal functioning and self-image. During EMDR treatment, symptoms could temporarily increase, but 98 percent of patients showed overall improvement.

In the second study, the TEMPO study at GGZ Delfland and Parnassia Group, specific attention was given to PTSD symptoms such as flashbacks. The presence of a PTSD diagnosis at the start made no demonstrable difference in outcome. According to Hafkemeijer, this suggests that it is worthwhile to look beyond diagnoses alone.

No One-Size-Fits-All

Hafkemeijer emphasizes that EMDR therapy does not solve everything. "The findings are encouraging, but it's not a one-size-fits-all solution." It is important that there is a clear connection between unresolved experiences and current symptoms and patterns. Then EMDR can help reduce the influence of the past. "It's also not a quick fix: processing takes time, and every recovery process unfolds in its own way."

What touches her as a therapist are the moments when patients feel that something is truly changing. One patient said, "I suddenly have freedom of choice again, whereas before I was driven by the things I experienced." "The past doesn't change," says Hafkemeijer, "but the emotional charge from back then can decrease, allowing someone to experience more control in the here and now. That's what EMDR therapy is about."

Space for Recovery

About one in ten Dutch people meet the criteria for a personality disorder. Many of them are in long-term treatment. Recovery often occurs in steps. "The beauty of this approach is looking together at what someone has experienced and how it colors the present," says Hafkemeijer. "By reducing the emotional charge of memories, space can be created to think, feel, and react differently." She emphasizes that more research is needed, including comparisons with other treatment methods, long-term effects, and what works best for whom.

Broader Application, Relieving Pressure on Mental Health Services

Hafkemeijer hopes that the findings will contribute to a faster and broader deployment of EMDR therapy for people with personality disorders, even without a PTSD diagnosis. The outcomes suggest that EMDR therapy can be a promising approach within the treatment of people with personality disorders. This is important at a time when the pressure on mental health services is high: the insights can help further personalize treatments and potentially shorten them.