Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Randomized Controlled Trial
. 2025;94(3):175-193.
doi: 10.1159/000544918. Epub 2025 Feb 27.

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  1   2 , Arne van den End  1   2 , Aartjan T F Beekman  1 , Jack Dekker  3   4 , Inga Aarts  2   5 , Matthijs Blankers  3 , Chris Vriend  1   5   6 , Odile A van den Heuvel  1   5   6 , Nick Lommerse  3 , Kathleen Thomaes  1   2   5
Affiliations
Randomized Controlled Trial

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 et al. Psychother Psychosom. 2025.

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.

PubMed Disclaimer

Conflict of interest statement

The authors have no conflicts of interest to declare.

Figures

Fig. 1.
Fig. 1.
Flow chart for the study design.
Fig. 2.
Fig. 2.
Patient flow through enrollment, randomization, and treatment.
See this image and copyright information in PMC

References

    1. Pagura J, Stein MB, Bolton JM, Cox BJ, Grant B, Sareen J. Comorbidity of borderline personality disorder and posttraumatic stress disorder in the U.S. population. J Psychiatr Res. 2010;44(16):1190–8. - PMC - PubMed
    1. Frías Á, Palma C. Comorbidity between post-traumatic stress disorder and borderline personality disorder: a review. Psychopathology. 2015;48(1):1–10. - PubMed
    1. Barnicot K, Crawford M. Posttraumatic stress disorder in patients with borderline personality disorder: treatment outcomes and mediators. J Trauma Stress. 2018;31(6):899–908. - PubMed
    1. Hastrup LH, Jennum P, Ibsen R, Kjellberg J, Simonsen E. Societal costs of Borderline Personality Disorders: a matched‐controlled nationwide study of patients and spouses. Acta Psychiatr Scand. 2019;140(5):458–67. - PubMed
    1. Bothe T, Jacob J, Kröger C, Walker J. How expensive are post-traumatic stress disorders? Estimating incremental health care and economic costs on anonymised claims data. Eur J Health Econ. 2020;21(6):917–30. - PMC - PubMed

Publication types