A theory-driven rationale for EMDR therapy among patients with a personality disorder

Personality disorders (PDs) are prevalent and debilitating conditions characterised by enduring disturbances in self-functioning, affect regulation, impulse control, and interpersonal relationships. Although several evidence-based psychotherapies are available, their accessibility and efficiency remain limited due to long treatment durations, high intensity, substantial dropout rates, and restricted treatment capacity. The purpose of the present paper is to present an alternative developmental and treatment perspective on PDs and to review the available literature on the effects of eye movement desensitization and reprocessing (EMDR) therapy in this population. This approach is grounded in evidence indicating that adverse childhood experiences, including emotional abuse, neglect, and other forms of early adversity, are highly prevalent among individuals with a PD and are strongly associated with the development and persistence of personality pathology. Shapiro's Adaptive Information Processing model provides a theoretical framework for understanding this association. In line with this trauma-focused perspective, EMDR therapy is increasingly being studied as a treatment for PDs. The available research on the treatment of PDs indicates that EMDR therapy is associated with significant reductions in posttraumatic stress symptoms, alongside meaningful improvements in PD symptomatology and overall personality functioning. Remission rates for PDs were substantial in several studies, including those of patients without comorbid posttraumatic stress disorder (PTSD). In addition, EMDR therapy was found to be safe, with low dropout rates in most studies and no evidence of increased self-harm, suicidality, or hospitalization. Accordingly, the existing findings support the hypothesis that trauma-related pathogenic memories play a central role in PD pathology and suggest that EMDR therapy may be an effective, efficient, and accessible treatment option for individuals with a PD. Furthermore, large-scale comparative studies are needed to clarify its role in standard PD care.