EMDR in the treatment of borderline personality disorder with its roots in post-traumatic stress disorder

Individuals diagnosed with borderline personality disorder usually show impulsive behavior, difficulty in affect regulation, interpersonal difficulties. Other symptoms include intense fear of abandonment, intense anger and irritability. People with BPD often engage in idealization and devaluation of others which alternates between high regard and great disappointment. Self-mutilation and suicidal behavior are common. This pattern is seen in early adulthood and occurs across variety of situations and contexts. They also have poor early attachment. A 20 year old girl presented with instability of affect, difficulty in interpersonal relationship, self-mutilation and suicidal ideation. She had poor early attachment because her mother was suffering from bipolar disorder. There were also incidents of abuse in her childhood. Her presenting complaints were uncontrollable weeping episodes and difficulty in starting and maintaining relationship. Method Used: A recognized trauma therapy EMDR was considered the treatment of choice because of childhood incidents of abuse and trauma. Course of Treatment: A total of 40 sessions were done over a period of two years. The major chunk of these sessions was allotted to preparation, resource instillation and grounding techniques. Subjective units of disturbance came down to zero and positive cognition of “I can be successful” and “I am healthy” were instilled. Challenges Faced: Positive effects of EMDR were noted but there were concerns over;  Adherence to the time of session.  The client abreacted during sessions  Attempts at self-harm were seen during sessions.  Suicidal ideas were discussed and proper precautions were taken. Learning Points:  Given the emotional dysregulation issues associated with BPD the preparation phase of EMDR treatment is of critical importance because it provides the client with affect management skills  Treatment targets should be clearly defined before starting EMDR.  This case study demonstrates that therapist should only start EMDR once the client is able to deal with intense emotions that may accompany the therapy.

Conference

English

Khadija

Khadija (2014, January). EMDR in the treatment of borderline personality disorder with its roots in post-traumatic stress disorder. In EMDR in the treatment of fears and phobias/eating disorders/borderline disorder (Derek Farrell, Chair). Presentation at the 2nd EMDR Asia International Conference, Manila, The Philippines