Borderline personality disorder (BPD) is a severe mental disorder characterized by four major symptomatological domains: interpersonal instability, perceptive and identity disorders, emotional and behavioural dysregulation. Considering a multifactorial etiological model, it has been suggested that the interaction between behavioral, environmental and genetic factors may promote the development of BPD. Early life stress events (ELS) in childhood and adolescence are highly prevalent in this population and constitute an environmental risk factor for the development of BPD. This correlates with the fact that Post-traumatic Stress Disorder (PTSD) is frequently comorbid in BPD leading to more severe symptoms and worse psychosocial functioning. At the therapeutic level, the treatment of BPD is an open challenge as psychotherapeutic interventions are of limited effectiveness and characterized by high drop-out rates. Eye Movement Desensitization and Reprocessing (EMDR) is the gold standard for treating PTSD. However, scientific evidence on the application of EMDR in patients with BPD is limited. This study aims to assess the feasibility and effectiveness of an EMDR protocol on the nuclear symptomatology of BPD (emotional and behavioral dysregulation) in a group of DBP patients with/without PTSD comorbidity, through a systematic assessment of the peculiar dimensions of the disorder. The basic hypothesis is that EMDR, through a short-term intervention, can act both on the traumatic PTSD-like experiences reported by patients and on the clinical manifestations peculiar to DBP, in particular by improving the emotional regulation capacity of patients with BPD.
Patients must be over 18 years old
A current diagnosis of PBD according to the DSM-5 was confirmed using the SCID-5-CV and SCID-5-PD diagnostic scale
Suicidal ideation in the last 3 months (suicidal thoughts active intentionally but without specific planning or suicidal thoughts active with planning and intentionality)
Intellectual disability
Any active disturbance from use of substances or alcohol
Any other diagnosis of Axis I, except for Depressive Disorders, Anxious Spectrum Disorders, Obsessive-Compulsive Disorder.
Factorial
Trauma focused psychotherapy: EMDR
Other intervention14 sessions of psychotherapy with EMDR will be carried out with patients. One session per week, lasting 90 minutes. The first two sessions will be used for the description of the EMDR method and for stabilization, then there will be treatment sessions.
Core symptoms of BPD
The primary outcome is the improvement of the core symptoms of BPD, measured by the Zanarini Rating Scale for Borderline Personality Disorder (ZAN-BPD). The scale ranges from 0 to 36, with higher scores indicating greater severity.
Self perception of BPD symptoms
Self perception of BPD symptoms measured by the Borderline Symptom List 23 (BSL-23). The scale ranges from 0 to 4, with higher scores indicating greater severity.
Emotion disregulation
Emotion disregulation measured by the Difficulties in emotion regulation scale (DERS-36). The scale ranges from 36 to 180, with higher scores indicating greater difficulties in emotion regulation.
Ruminative thinking
Ruminative thinking measured by the Rumination Response Scale (RRS). The scale ranges from 22 to 88, with higher scores indicating greater rumination.
Dissociative symptoms
Dissociative symptoms measured by the Dissociative Experiences Scale (DES). The scale ranges from 0 to 100, with higher scores indicating greater dissociative experiences.
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