‘Character issues’ (PDs) are frequent inside psychological well being providers 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 therapies can require appreciable time. For instance, therapy for borderline character dysfunction typically lasts greater than a 12 months (Setkowski et al., 2023). This creates an vital want to think about whether or not shorter interventions may be efficient.
We all know that opposed childhood experiences are strongly related to the event of character difficulties (Broekhof et al., 2024). Consequently, there’s rising curiosity in whether or not trauma-focused approaches reminiscent of Eye Motion Desensitisation and Reprocessing (EMDR) might enhance PD signs by focusing on distressing recollections that 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 individuals 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 quick course of EMDR might cut back ‘character dysfunction’ signs no matter whether or not contributors had PTSD. Secondary goals had been to look at whether or not EMDR improved character functioning and emotional regulation and whether or not contributors continued to fulfill diagnostic standards for a PD following therapy.
Strategies
This was a randomised managed trial involving 159 adults with a identified ‘character dysfunction’ recruited from two outpatient psychological well being providers within the Netherlands. Contributors had been randomly allotted to both EMDR (79 individuals) or a waiting-list management group (80 individuals). The EMDR intervention consisted of ten 90-minute periods delivered twice weekly over 5 weeks, focusing on traumatic or opposed recollections related to contributors’ essential 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, character functioning and difficulties regulating feelings. Assessors had been blind to therapy allocation.
Outcomes
General, the outcomes had been encouraging. Folks receiving EMDR improved considerably greater than these on the ready listing throughout all the essential areas examined, which included PD signs, character functioning and emotional regulation.
Following therapy, individuals receiving EMDR confirmed a higher discount within the quantity and severity of ‘character 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 significantly placing discovering involved diagnostic remission. Utilizing the clinician-rated SCID-5-PD evaluation, roughly 33% of the EMDR group not met standards for a ‘character 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.
Nevertheless, enchancment was broader than merely whether or not someone retained a analysis. Contributors receiving EMDR additionally demonstrated improved character functioning and fewer difficulties with emotional regulation. That is vital as a result of difficulties in how somebody experiences themselves, pertains to others and manages feelings are central features of character difficulties.
Curiously, advantages had been discovered throughout completely different character dysfunction shows and amongst contributors with and with out PTSD. This means that someone doesn’t essentially want to fulfill diagnostic standards for PTSD to probably profit from trauma-focused EMDR.
The therapy additionally appeared comparatively acceptable and protected inside this examine. Solely 4 contributors (5.1%) discontinued EMDR, and the authors reported no opposed occasions. Moreover, 16 contributors improved sufficiently throughout therapy to be categorised as early completers as a result of they not met PD diagnostic standards.
General, subsequently, ten periods 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 examine supplied encouraging proof {that a} temporary course of EMDR might cut back ‘character dysfunction’ signs and enhance character functioning and emotional regulation, even when PTSD is just not current.
- Nearly half of contributors receiving EMDR not met PD diagnostic standards at three-month follow-up.
- Nevertheless, EMDR was in contrast with a ready listing relatively than established PD therapies, and follow-up was solely three months, which means its comparative and longer-term effectiveness stays unsure.
- General, the examine helps contemplating EMDR as one other probably helpful part of individualised, integrative PD therapy relatively than assuming that prolonged interventions are at all times essential.
Strengths and limitations
There are a number of strengths to the examine. It used a randomised managed design, included 159 contributors from two medical providers 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 character functioning and emotional regulation. One other energy was the inclusion of individuals with completely different PD shows and contributors 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, vital limitations:
- Most importantly, EMDR was in contrast with a ready listing relatively than therapy as standard or one other evidence-based remedy. Ready-list comparisons might inflate therapy results as a result of the management group receives little lively intervention. This makes it troublesome to find out how a lot enchancment was particularly attributable to EMDR relatively than receiving structured remedy, therapist consideration or anticipating to enhance.
- The examine couldn’t be double-blinded, and three months can also be a comparatively quick follow-up interval when investigating difficulties historically understood as enduring.
- Most contributors had avoidant, borderline, obsessive-compulsive or different specified PD, which can restrict how confidently the outcomes will be generalised to different PD shows.
- The authors subsequently acknowledge that longer-term outcomes stay unknown and advocate direct comparisons with established therapies.
Implications for follow
The findings problem the belief that character difficulties essentially require prolonged therapy earlier than significant change can happen. A comparatively temporary, five-week EMDR intervention produced reductions in ‘character dysfunction’ (PD) signs, alongside enhancements in character functioning and emotional regulation. The authors recommend that EMDR might probably be supplied earlier in therapy, adopted by reassessment to ascertain whether or not additional remedy is required. This doesn’t imply EMDR ought to substitute current therapies; some individuals might profit sufficiently from EMDR alone, whereas others may have further assist.
As a psychologist working integratively throughout the NHS, I discovered this significantly attention-grabbing. The advanced shows we see hardly ever match neatly inside one therapeutic mannequin, so having one other probably efficient intervention broadens the choices accessible when creating particular person formulations and therapy plans. EMDR might complement, relatively than essentially compete with, approaches reminiscent of Dialectical Behaviour Remedy (DBT).
This feels significantly related when desirous about therapy size and NHS ready lists. Complete DBT has a robust proof base however is comparatively prolonged and resource-intensive, whereas the EMDR intervention on this examine concerned solely ten periods over 5 weeks. This raises an attention-grabbing query about whether or not some individuals may profit from a shorter trauma-focused intervention earlier than, alongside, or probably as a substitute of an extended therapy. Nevertheless, the examine didn’t instantly evaluate EMDR with DBT or one other established remedy, so we can not conclude that it’s higher or equal.
Certainly one of my essential reflections was additionally round what we really imply by “enchancment”. Lowered PD signs and enhancements in emotional regulation and character functioning are encouraging, however what does this appear to be in somebody’s on a regular basis life? Are their relationships extra steady? Are they managing battle in another way, participating extra constantly with schooling or employment, or experiencing fewer crises? These outcomes had been past the scope of the examine however really feel vital when desirous about significant restoration from difficulties which can be typically advanced 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 providers, the place emotional dysregulation, self-harm and danger are frequent, there are comprehensible causes for prioritising security and stabilisation. Nevertheless, 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 might have to be individualised relatively than routinely phase-based (Lee et al., 2026). For me, this doesn’t reduce the significance of managing danger or interventions reminiscent of DBT. As a substitute, 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 increase an attention-grabbing 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 significantly related to NHS follow, the place longer-term follow-up after remedy is just not at all times attainable. If therapeutic positive aspects can proceed to develop after therapy ends, measuring outcomes primarily at discharge might solely inform a part of the story. Maybe follow-up doesn’t have to imply extra remedy, however might 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
Major paper
Simon Hofman, Laurian Hafkemeijer, Advert de Jongh, Cristina Slotema (2025). Eye motion desensitization and reprocessing remedy in individuals with character issues: A randomized medical trial. JAMA Community Open, 8(9), e2533421.
Different references
Broekhof, R., Nordahl, H. M., Eikenæs, I. U., & Selvik, S. G. (2024). Antagonistic childhood experiences are related to character Dysfunction: A Potential, longitudinal examine. 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. Melancholy 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 Reminiscences of Emotional Abuse, Neglect and Different Sorts of Antagonistic Occasions in Sufferers with a Character Dysfunction? Preliminary Information. Journal of Medical Drugs, 10(19), 4333.
Hafkemeijer, L., Slotema, Ok., De Haard, N., & De Jongh, A. (2023). Case report: Temporary, intensive EMDR remedy for borderline character 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 advanced PTSD: a scientific assessment 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 publish‐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 character dysfunction? A scientific assessment and community meta-analysis. Psychological Drugs, 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 attributable to childhood abuse: randomised medical trial. BJPsych Open, 7(6).
Volkert, J., Gablonski, T., & Rabung, S. (2018). Prevalence of character issues within the basic grownup inhabitants in Western international locations: systematic assessment and meta-analysis. The British Journal of Psychiatry, 213(6), 709–715.
