EMDR in older adults with PTSD and comorbid personality disorders

Abstract

Objectives:Approximately one third of older adults (≥ 60 years) with a posttraumatic stress disorder (PTSD) also suffer from a comorbid personality disorder. Emerging evidence shows that in Eye Movement Desensitization and Reprocessing (EMDR) therapy can be beneficial for personality disorders. Since personality disorders are associated with several adverse events, the present study aims to investigate whether EMDR in older adults with PTSD will improve personality functioning.Methods:A multi-center feasibility study was conducted with 24 older PTSD-patients (60-83 years). PTSD was assessed with the Clinician-Administered PTSD Scale-5 (CAPS-5). All participants received weekly 1-hour sessions of EMDR therapy for PTSD up to a maximum of 9 months. The primary outcome was change in personality dysfunction, assessed by Severity Indices of Personality Problems–Short Form (SIPP-SF) at baseline and end of treatment. Secondary outcome was pre-post difference in the presence of (any) personality disorder according to DSM-IV criteria as measured with the Structured Clinical Interview for DSM-IV Axis-II PDs (SCID-II). All analyses were adjusted for PTSD severity, therapy duration, and other treatment (co-interventions) which was kept constant.Results:A linear mixed model approach showed an increase in SIPP-SF scores from pre- to posttreatment, a significant influence of pre-post CAPS-5 for the total sample (F(1,37.5)=6.95), p=.012) and a marginal significant effect of other treatment (F(1,21.9)=4.04), p=.057). No significant main effects of time, therapy duration (3, 6, or 9 months), CAPS-5 by time was found (all p>.05).Conclusions:EMDR treatment resulted in improved personality functioning. Other treatment next to EMDR had a negative impact on the increased of personality functioning.