By Sidney D.R.

Oxborough

EMDR in the Treatment

of Borderline Personality
Disorder Symptom
Clusters
 Problem
Statement:
EMDR is effective at treating PTSD which shares symptoms with
BPD. An effective treatment for targeting specific BPD symptoms
is still needed.
 Research Question
& Hypotheses
Is EMDR effective at reducing intrapersonal
and interpersonal symptom clusters in
patients with BPD?

H0: Internalizing symptoms will improve first,

but improvement will occur in both clusters
from the EMDR treatment.

H1: Externalizing symptoms will also improve

with correlation to primary reduction in
internalizing symptoms. As participants
improve their relationship with themselves,
they will have less difficulty managing affect in
interpersonal relationships.
 Purpose Statement
To test the effect of EMDR on BPD symptoms grouped into an
internalization/intrapersonal symptom cluster and an
externalization/interpersonal symptom cluster.
Literature Review
Borderline Personality Disorder & EMDR

● BPD defined by Adolph Stern in 1938

○ Characterized by a pattern of instability in relationships, self-image, and emotions
(APA, 2013)
● EMDR developed by Francine Shapiro in 1989
○ Uses bilateral stimulation, typically in the form of saccadic eye movements, to help
patients to increase emotional distance and objectivity from intrusive traumatic
memories
● Numerous studies have now proven the safety and efficacy of EMDR in the treatment of BPD
specifically (Brown & Shapiro, 2006; Gielkens et al., 2018; Safarabad et al., 2018; Slotema et
al., 2019; Snoek et al., 2020; Wilhelmus et al., 2023)
○ Through the course of the COVID-19 pandemic, EMDR has proven effective when
administered virtually (Lenferink et al., 2020)
 Feminist Psychology
● Feminist psychology first explored prominently by Karen Horney, neo-Freudian who noted male-
centric perspective of Freud in a series of articles collected as Feminine Psychology in 1927.
Horney posited Freud and other psychoanalysts wrote specifically from a male point of view, for
example the ‘opposite sex.’

● Horney and Juliet Mitchell, in her book, Psychoanalysis and Feminism (1974), contended that
women could and should be both subjects and practitioners of psychoanalysis, men were simply
making assumptions as though their theories were objective science without their own male
psychological influence.

● BPD is diagnosed 75% in women (APA, 2013). This may be due to assessment bias in gendered
norms of behavior and possibly a criterion bias in DSM-5 & ICD-11.

● This study will use feminist psychology to question gender preconceptions and deconstruct
assessment bias based on sex and gender.
 Methods / Study Design

This study will use quasi-experimental pre-post convergent mixed methods cohort study design to ascertain the

severity and frequency of specific symptom clusters of BPD before and after EMDR treatment through surveys

and interviews.
 Setting, Sampling Strategy

● convenience-quota sampling through ads to telehealth DBT groups and patients across North America

● 150 adult males, 150 adult females, and at least 50 gender non-conforming individuals. Minimum needed to move forward with the study

will be at least 25 males and 75 females

● EMDR and all measures will be conducted remotely

● Inclusion criteria will be whether participants are enrolled in DBT and pass MSI-BPD screening with BPD diagnosis.

● Exclusion criteria will be based on intellectual comprehension based on standardized testing.

 Instrumentation
● McLean Screening Instrument for Borderline Personality Disorder
○ Initial assessment for BPD will be made using MSI-BPD (Zanarini et al., 2003)
○ 10-item, self-report screening measure for BPD, yes or no questions indicating a symptom is present or absent, such as
“Have you felt extremely moody?”
○ Cronbach’s alpha = 0.78.
● Difficulties in Emotion Regulation Scale
○ Emotion regulation will be measured on DERS (Gratz & Roemer, 2004)
○ Participants are asked to rate emotion regularity and severity of statements, such as “When I’m upset, I feel out of control,”
on a five-point Likert scale as to how true or accurate they feel.
○ Cronbach’s alpha = 0.90
● Dissociative Experiences Scale - II
○ Dissociative experiences will be measured on DES-II, a 28-item, self-report survey measuring three subscales of: amnesia,
depersonalization/derealization, and absorption of attention (Zingrone & Alvarado, 2001)
○ Questions such as “Some people have the experience of feeling that their body does not seem to belong to them,” are
rated based on percentage of time the respondent feels that way.
○ Cronbach’s alpha = 0.92
● PTSD Symptom Checklist
○ Baseline effect of EMDR on PTSD will be measured on PCL-5 (Blevins et al., 2015)
○ 20-question survey asks “In the past month, how much were you bothered by:_”. Participants rate their PTSD distress over
the past month on a scale of ‘0 - Not at all’ to ‘4 - Extremely’
○ Cronbach’s alpha “ranging from 0.56 to 0.77” (Sveen et al., 2016)
 Ethical Considerations
● Some risk of increased symptom severity and frequency including increased risk of suicidality
● EMDR uses external bilateral stimulation to reprocess traumatic memories to reduce associated
mental sensitivity and distress, which is a form of exposure therapy.
● Group or individual DBT sessions following each treatment and for up to 12 weeks after conclusion of
treatment will be offered.
● This is a cohort study because it would be unethical to withhold EMDR from any participants.
● People with BPD have heightened sensitivity to perceived judgment, participants in this study will be
treated individually and equally with respect to individual trauma and triggers.
● Only researchers will have access to data and instruments, which will be encrypted and stored
securely no more than two years after publication of this study.
● This researcher declares no conflict of interest and no vested interest in the study’s outcome.
 Limitations & Threats to Validity
● Enrollment only open to DBT patients. This limits the range of the sample and also confounds results
by introducing another effective treatment.
○ EMDR requires some type of regulation skills, having participants already in DBT reduces our
cost of additional EMDR preparation.
○ DBT is not the only treatment for BPD, but it is currently the most recommended.
● Quasi-experimental non-randomized design reduces validity.
○ This study is not to test the efficacy of EMDR on BPD, which has been proven elsewhere, but to
investigate its effects on internalizing and externalizing symptoms.
 Future Implications and Conclusion
● Without the knowledge discovered in this study, BPD research will continue to focus on diagnostics
rather than how treatment contributes to different areas of personal growth over time.
● This study will show that overall symptom reduction can be achieved when key symptoms begin to
improve. This research could lead to finding a targeted treatment for specific subtypes of BPD.
● Future research should compare how effective EMDR is on symptom clusters in a control group of
individuals with dual-diagnosed PTSD and BPD alongside a group with BPD who do not meet clinical
criteria for PTSD, continuing the investigation into EMDR’s effect on BPD symptoms that do not co-
occur in PTSD.
● We can expand on these results to treat those who do not meet the threshold for BPD. Individuals
with generalized anxiety disorder, major depression, dissociative disorders as well as other disorders
share many symptoms with BPD and will benefit from further symptomatological research into BPD.
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