Eye Movement Desensitization and Reprocessing with and without Dialectical Behavior Therapy for Posttraumatic Stress Disorder and Comorbid Borderline Personality Disorder Symptoms: A Randomized Controlled Trial

Aishah Cecile Snoek; Arne van den End; Aartjan T F Beekman; Jack Dekker; Inga Aarts; Matthijs Blankers; Chris Vriend; Odile A van den Heuvel; Nick Lommerse; Kathleen Thomaes

doi:10.1159/000544918

Eye Movement Desensitization and Reprocessing with and without Dialectical Behavior Therapy for Posttraumatic Stress Disorder and Comorbid Borderline Personality Disorder Symptoms: A Randomized Controlled Trial

Psychother Psychosom. 2025;94(3):175-193. doi: 10.1159/000544918. Epub 2025 Feb 27.

Authors

Aishah Cecile Snoek^{1

2}, Arne van den End^{1

2}, Aartjan T F Beekman¹, Jack Dekker^{3

4}, Inga Aarts^{2

5}, Matthijs Blankers³, Chris Vriend^{1

5

6}, Odile A van den Heuvel^{1

5

6}, Nick Lommerse³, Kathleen Thomaes^{1

2

5}

Affiliations

¹ Amsterdam UMC, Psychiatry, Amsterdam, The Netherlands.
² Sinai Centrum, Amstelveen, The Netherlands.
³ Arkin Mental Health Care, Amsterdam, The Netherlands.
⁴ VU University, Clinical Psychology, Amsterdam, The Netherlands.
⁵ Amsterdam UMC, Anatomy and Neurosciences, Amsterdam, The Netherlands.
⁶ Amsterdam Neuroscience, Compulsivity Impulsivity and Attention Program, Amsterdam, The Netherlands.

Abstract

Introduction: Comorbidity between posttraumatic stress disorder (PTSD) and borderline personality disorder (BPD) is prevalent. Despite evidence-based therapies, high rates of nonresponse and dropout persist. This study therefore aimed to examine whether the concurrent application of eye movement desensitization and reprocessing (EMDR) for PTSD and dialectical behavior therapy (DBT) for BPD yields better results than EMDR alone.

Methods: Patients with a PTSD diagnosis and at least four BPD symptoms were randomly assigned to EMDR (n = 63) or concurrent EMDR-DBT (n = 61). Over 1 year, changes in PTSD symptoms were measured using the Clinician-Administered PTSD Scale for DSM-5. Secondary outcomes included BPD symptoms, global functioning, and quality of life.

Results: Both treatments led to large reductions in PTSD symptoms, without significant differences after 1 year (p = 0.312, d = -0.23, 95% CI = -0.6, 0.1). Both treatments also yielded large and comparable reductions in BPD symptoms and improved quality of life. Global functioning improved only in the EMDR condition according to one measure (World Health Organization Disability Assessment Schedule 2.0), while the other measure (Outcome Questionnaire 45) showed improvements in both groups. Additionally, patients in the EMDR-DBT condition were twice as likely to drop out from EMDR treatment compared to those in the EMDR-only condition.

Conclusion: Stand-alone EMDR demonstrated safety and efficacy in alleviating PTSD and BPD symptoms, as well as enhancing quality of life. These findings support the use of EMDR as a strong therapeutic option for patients with PTSD and comorbid BPD symptoms. Further research is needed to assess longer-term outcomes beyond 1 year.

Keywords: Borderline personality disorder; Posttraumatic stress disorder; Treatment.

Publication types

Randomized Controlled Trial
Research Support, Non-U.S. Gov't

MeSH terms

Adult
Borderline Personality Disorder* / epidemiology
Borderline Personality Disorder* / therapy
Combined Modality Therapy
Comorbidity
Dialectical Behavior Therapy* / methods
Eye Movement Desensitization Reprocessing* / methods
Female
Humans
Male
Middle Aged
Quality of Life
Stress Disorders, Post-Traumatic* / epidemiology
Stress Disorders, Post-Traumatic* / therapy
Treatment Outcome