‘Personality disorders’ (PDs) are common within mental health services and can significantly affect individuals, their families and wider society (Volkert et al., 2018). Although psychotherapy is considered the first-line treatment, established treatments can require considerable time. For example, treatment for borderline personality disorder often lasts more than a year (Setkowski et al., 2023). This creates an important need to consider whether shorter interventions could also be effective.
We know that adverse childhood experiences are strongly associated with the development of personality difficulties (Broekhof et al., 2024). Consequently, there is increasing interest in whether trauma-focused approaches such as Eye Movement Desensitisation and Reprocessing (EMDR) could improve PD symptoms by targeting distressing memories that may contribute to current difficulties (Hafkemeijer et al., 2021). Importantly, EMDR is traditionally associated with post-traumatic stress disorder (PTSD), but emerging research suggests that it may also benefit people with PD who do not meet criteria for PTSD. Previous research found improvements following EMDR, but had not examined changes in PD symptom severity, diagnostic remission or emotional regulation (Hafkemeijer et al., 2021).
This paper by Hofman et al. (2025), therefore, investigated whether a brief course of EMDR could reduce ‘personality disorder’ symptoms regardless of whether participants had PTSD. Secondary aims were to examine whether EMDR improved personality functioning and emotional regulation and whether participants continued to meet diagnostic criteria for a PD following treatment.
Methods
This was a randomised controlled trial involving 159 adults with a diagnosed ‘personality disorder’ recruited from two outpatient mental health services in the Netherlands. Participants were randomly allocated to either EMDR (79 people) or a waiting-list control group (80 people). The EMDR intervention consisted of ten 90-minute sessions delivered twice weekly over five weeks, targeting traumatic or adverse memories associated with participants’ main PD symptoms. The control group received no trauma-focused or PD treatment during this period. Outcomes were assessed before treatment, afterwards and at three-month follow-up using measures of PD symptoms and diagnosis, personality functioning and difficulties regulating emotions. Assessors were blind to treatment allocation.
Results
Overall, the results were encouraging. People receiving EMDR improved significantly more than those on the waiting list across all of the main areas examined, which included PD symptoms, personality functioning and emotional regulation.
Following treatment, people receiving EMDR showed a greater reduction in the number and severity of ‘personality disorder’ symptoms than those who had not received EMDR. Importantly, these improvements did not disappear immediately after therapy ended. Participants continued to improve, with differences between the groups becoming somewhat larger by the three-month follow-up. The between-group effects were modest immediately after treatment (Cohen’s d 0.31 to 0.48) and larger at follow-up (d 0.43 to 0.62).
One particularly striking finding concerned diagnostic remission. Using the clinician-rated SCID-5-PD assessment, approximately 33% of the EMDR group no longer met criteria for a ‘personality disorder’ immediately after treatment, compared with approximately 8% of the control group. At three-month follow-up, this increased to 44.1% of the EMDR group, compared with 15.8% of controls. A separate PD measure, the ADP-IV, produced a similar pattern, strengthening confidence that this finding was not dependent upon one particular assessment.
However, improvement was broader than simply whether somebody retained a diagnosis. Participants receiving EMDR also demonstrated improved personality functioning and fewer difficulties with emotional regulation. This is important because difficulties in how someone experiences themselves, relates to others and manages emotions are central aspects of personality difficulties.
Interestingly, benefits were found across different personality disorder presentations and among participants with and without PTSD. This suggests that somebody does not necessarily need to meet diagnostic criteria for PTSD to potentially benefit from trauma-focused EMDR.
The treatment also appeared relatively acceptable and safe within this study. Only four participants (5.1%) discontinued EMDR, and the authors reported no adverse events. Furthermore, 16 participants improved sufficiently during treatment to be classified as early completers because they no longer met PD diagnostic criteria.
Overall, therefore, ten sessions of EMDR delivered over five weeks produced meaningful improvements which remained evident, and in some areas became stronger, at three-month follow-up.
Conclusions
- This study provided encouraging evidence that a brief course of EMDR may reduce ‘personality disorder’ symptoms and improve personality functioning and emotional regulation, even when PTSD is not present.
- Almost half of participants receiving EMDR no longer met PD diagnostic criteria at three-month follow-up.
- However, EMDR was compared with a waiting list rather than established PD treatments, and follow-up was only three months, meaning its comparative and longer-term effectiveness remains uncertain.
- Overall, the study supports considering EMDR as another potentially valuable component of individualised, integrative PD treatment rather than assuming that lengthy interventions are always necessary.
Strengths and limitations
There are several strengths to the study. It used a randomised controlled design, included 159 participants from two clinical services and used assessors who were blind to treatment allocation. Multiple outcomes were considered, including both self-report and clinician-rated PD measures alongside measures of personality functioning and emotional regulation. Another strength was the inclusion of people with different PD presentations and participants both with and without PTSD. Retention was relatively high, and treatment dropout was low. The authors highlight the broad range of PDs, high retention and use of both dimensional and categorical measures as strengths that increase confidence in the findings.
There are, however, important limitations:
- Most significantly, EMDR was compared with a waiting list rather than treatment as usual or another evidence-based therapy. Waiting-list comparisons may inflate treatment effects because the control group receives little active intervention. This makes it difficult to determine how much improvement was specifically attributable to EMDR rather than receiving structured therapy, therapist attention or expecting to improve.
- The study could not be double-blinded, and three months is also a relatively short follow-up period when investigating difficulties traditionally understood as enduring.
- Most participants had avoidant, borderline, obsessive-compulsive or other specified PD, which may limit how confidently the results can be generalised to other PD presentations.
- The authors therefore acknowledge that longer-term outcomes remain unknown and recommend direct comparisons with established treatments.
Implications for practice
The findings challenge the assumption that personality difficulties necessarily require lengthy treatment before meaningful change can occur. A relatively brief, five-week EMDR intervention produced reductions in ‘personality disorder’ (PD) symptoms, alongside improvements in personality functioning and emotional regulation. The authors suggest that EMDR could potentially be offered earlier in treatment, followed by reassessment to establish whether further therapy is needed. This does not mean EMDR should replace existing treatments; some people may benefit sufficiently from EMDR alone, while others may need additional support.
As a psychologist working integratively within the NHS, I found this particularly interesting. The complex presentations we see rarely fit neatly within one therapeutic model, so having another potentially effective intervention broadens the options available when developing individual formulations and treatment plans. EMDR could complement, rather than necessarily compete with, approaches such as Dialectical Behaviour Therapy (DBT).
This feels particularly relevant when thinking about treatment length and NHS waiting lists. Comprehensive DBT has a strong evidence base but is relatively lengthy and resource-intensive, whereas the EMDR intervention in this study involved only ten sessions over five weeks. This raises an interesting question about whether some people might benefit from a shorter trauma-focused intervention before, alongside, or potentially instead of a longer treatment. However, the study did not directly compare EMDR with DBT or another established therapy, so we cannot conclude that it is better or equivalent.
One of my main reflections was also around what we actually mean by “improvement”. Reduced PD symptoms and improvements in emotional regulation and personality functioning are encouraging, but what does this look like in someone’s everyday life? Are their relationships more stable? Are they managing conflict differently, engaging more consistently with education or employment, or experiencing fewer crises? These outcomes were beyond the scope of the study but feel important when thinking about meaningful recovery from difficulties that are often complex and multifaceted. More broadly, it reminded me that when evaluating any therapy, symptom reduction matters, but so does remaining curious about its wider impact on someone’s life.
The paper also made me reconsider assumptions about stability and trauma-focused work. Within NHS services, where emotional dysregulation, self-harm and risk are common, there are understandable reasons for prioritising safety and stabilisation. However, evidence increasingly questions whether everyone requires a separate period of stabilisation before trauma processing (De Jongh et al., 2016; Van Vliet et al., 2021), with more recent research suggesting that treatment sequencing may need to be individualised rather than routinely phase-based (Lee et al., 2026). For me, this does not lessen the importance of managing risk or interventions such as DBT. Instead, it encourages a slightly different question: rather than simply asking whether someone is “stable enough” for trauma work, what does this particular person need, what is maintaining their difficulties, and which intervention, or combination of interventions, makes most sense now?
Finally, I was struck by the finding that improvement did not necessarily stop when EMDR ended. This reminded me of the DECRYPT trial of cognitive therapy for PTSD in children and adolescents carried out by Meiser‐Stedman et al. (2025), which I previously discussed in another Mental Elf blog earlier this year. Although these are very different studies, both raise an interesting question about what happens after trauma-focused therapy finishes. Hofman et al. (2025) found that improvements were maintained and, for some outcomes, continued to develop during follow-up.
This feels particularly relevant to NHS practice, where longer-term follow-up after therapy is not always possible. If therapeutic gains can continue to develop after treatment ends, measuring outcomes primarily at discharge may only tell part of the story. Perhaps follow-up does not need to mean more therapy, but could involve checking in several months later and considering not only symptom scores, but relationships, functioning, emotional wellbeing and quality of life. If change can continue beyond the therapy room, perhaps our evaluation of therapy needs to extend beyond it too.
Statement of interests
Lisa Lloyd is a clinical psychologist. She has no conflicts of interest to declare.
Editor
Edited by Dr Dafni Katsampa.
Links
Primary paper
Simon Hofman, Laurian Hafkemeijer, Ad de Jongh, Cristina Slotema (2025). Eye movement desensitization and reprocessing therapy in persons with personality disorders: A randomized clinical trial. JAMA Network Open, 8(9), e2533421.
Other references
Broekhof, R., Nordahl, H. M., Eikenæs, I. U., & Selvik, S. G. (2024). Adverse childhood experiences are associated with personality Disorder: A Prospective, longitudinal study. Journal of Personality Disorders, 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, K., Broeke, E. T., Feeny, N., Rauch, S. A., Chard, K. M., Mueser, K. 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. Depression and Anxiety, 33(5), 359–369.
Hafkemeijer, L., Starrenburg, A., Van Der Palen, J., Slotema, K., & De Jongh, A. (2021). Does EMDR Therapy Have an Effect on Memories of Emotional Abuse, Neglect and Other Types of Adverse Events in Patients with a Personality Disorder? Preliminary Data. Journal of Clinical Medicine, 10(19), 4333.
Hafkemeijer, L., Slotema, K., De Haard, N., & De Jongh, A. (2023). Case report: Brief, intensive EMDR therapy for borderline personality disorder: results of two case studies with one year follow-up. Frontiers in Psychiatry, 14, 1283145.
Lee, Y., Park, S., & Cho, Y.-E. (2026). Phase-based versus non-phase-based psychological interventions for complex PTSD: a systematic review 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, K., Mahoney‐Davies, G., Miles, S., Moore, J., Morant, N., … Smith, P. (2025). A pragmatic randomized controlled trial of cognitive therapy for post‐traumatic stress disorder in children and adolescents exposed to multiple traumatic stressors: the DECRYPT trial. World Psychiatry, 24(3), 422–434.
Setkowski, K., 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 most effective and acceptable in the treatment of adults with a (sub)clinical borderline personality disorder? A systematic review and network meta-analysis. Psychological Medicine, 53(8), 3261–3280.
Van Vliet, N. I., Huntjens, R. J. C., Van Dijk, M. K., Bachrach, N., Meewisse, M., & De Jongh, A. (2021). Phase-based treatment versus immediate trauma-focused treatment for post-traumatic stress disorder due to childhood abuse: randomised clinical trial. BJPsych Open, 7(6).
Volkert, J., Gablonski, T., & Rabung, S. (2018). Prevalence of personality disorders in the general adult population in Western countries: systematic review and meta-analysis. The British Journal of Psychiatry, 213(6), 709–715.