May is Borderline Personality Disorder Awareness Month, a time to raise awareness about borderline personality disorder (BPD) and how to incorporate EMDR therapy into BPD treatment. We asked Kimberly Wilder, LMHC, to expore how EMDR therapy can address attachment trauma, emotional dysregulation, and relational patterns associated with borderline presentations.

When Attachment Wounds Run Deep: EMDR Therapy in the Treatment of Borderline Personality Disorder

Guest Blog Post by Kimberly Wilder, LMHC

Tell us a little bit about yourself, your experience becoming an EMDR therapist, and your experience working with borderline personality disorder (BPD).

During my graduate program’s internship, I worked at a prevention program serving at-risk youth. This experience began to shape my foundation as a trauma-informed therapist. Many of the young people I worked with had histories of developmental trauma, including neglect, physical abuse, sexual abuse, and significant disruptions in family systems. 

After graduating, I moved to Haiti, where I volunteered with children living in institutional care while awaiting adoption. There, I encountered many of the same trauma patterns through different cultural lenses. When I later returned to the United States, I began working at a nonprofit Child Advocacy Center and sexual abuse treatment program. During that time, I trained in Trauma-Focused Cognitive Behavioral Therapy (TF-CBT) and became certified in Child Parent Psychotherapy (CPP). 

While these approaches were helpful, I continued to see many clients remain stuck despite long-term therapy. In February of 2017, I attended EMDR Basic Training and began implementing EMDR therapy with my clients. The change was immediate. I began to see meaningful progress with clients who had previously struggled to make gains in treatment. 

Prior to becoming trained in EMDR, I often discussed with my supervisor my hesitation about working with clients diagnosed with borderline personality disorder (BPD). After becoming certified and receiving consultation from an EMDR consultant experienced in dissociation and personality disorders, my perspective changed dramatically. I began to feel empowered in my work with these clients and now find working with this population deeply meaningful. 

Many EMDR clinicians initially feel hesitant about working with borderline personality disorder because the diagnosis is often associated with emotional volatility, complex relational dynamics, and concerns about stability during trauma processing. However, when borderline presentations are understood through a trauma-informed lens, many of the symptoms that clinicians encounter in therapy can be conceptualized as adaptations to unresolved attachment trauma and adverse developmental experiences. EMDR therapy provides a structured framework for accessing and reprocessing these experiences while strengthening emotional regulation and adaptive beliefs. 

Understanding borderline personality disorder through a trauma lens

Borderline personality disorder is a complex condition that affects emotional regulation, relationships, identity, and impulse control. According to the American Psychological Association, individuals with BPD often experience impairments in identity, self-direction, empathy, and intimacy alongside traits such as emotional instability, anxiety, fear of abandonment, and impulsive behaviors (American Psychological Association [APA], 2025). 

From the perspective of the Adaptive Information Processing (AIP) model used in EMDR therapy, many symptoms associated with borderline personality disorder can be understood as the result of maladaptively linked memories related to early attachment disruptions and adverse experiences. When these experiences remain insufficiently processed, they can continue to influence emotional regulation, relational expectations, and self-perception. 

Research increasingly highlights the role of early trauma and attachment disruptions in the development of BPD. Many individuals diagnosed with BPD have experienced adverse childhood experiences, chronic relational instability, or neglect during formative developmental periods (Bohus et al., 2021). Because of this, treatment often requires patience and a strong therapeutic alliance. While clinical skill in EMDR therapy is important, the quality of the therapeutic relationship is equally essential. Individuals with borderline presentations may experience intense relational dynamics characterized by rapid shifts between idealization and devaluation. These relational patterns often appear in therapy as well. 

For clinicians, this means rupture and repair often become an important part of treatment. For example, something as simple as a therapist cancelling a session due to illness may be experienced by the client as a significant relational rupture. How the clinician responds can have a profound impact. Acknowledging the missed session, reassuring the client that the cancellation was not related to them, and validating that the disruption may have been difficult can help repair the alliance while maintaining appropriate boundaries. Over time, these experiences of rupture and repair can help build relational safety and trust, which becomes especially important as treatment moves into more challenging phases of EMDR therapy. 

How can EMDR therapy help treat borderline symptoms?

Interest in EMDR therapy for borderline personality disorder has grown as clinicians increasingly recognize the role of trauma and attachment disruption in many borderline presentations. Emerging research suggests EMDR interventions may reduce core symptoms associated with borderline personality disorder, particularly when treatment targets early adverse experiences and attachment trauma. In one study, patients receiving EMDR treatment demonstrated reductions in psychological distress and improvements in emotion regulation that were maintained at follow-up (Hafkemeijer et al., 2023). Randomized controlled research has also found that EMDR therapy can significantly reduce symptoms associated with personality disorders when traumatic memories are directly targeted in treatment (Hofman et al., 2025). Clinicians working with borderline presentations often benefit from a phased treatment approach that emphasizes stabilization before trauma processing (Mosquera et al., 2014). This aligns closely with the eight-phase model of EMDR therapy and broader trauma treatment frameworks. 

Attachment trauma and developmental trauma frequently play a central role in BPD presentations. When these early experiences are targeted and processed through EMDR therapy, clinicians may observe improvements in emotional regulation, self-concept, and relational functioning. These dynamics often become clearer during EMDR therapy when early relational memories are accessed. In my own clinical work, I once worked with a client who had long struggled with intense fears of abandonment and rapid emotional shifts in relationships. During EMDR therapy, early memories emerged involving repeated childhood experiences of emotional rejection by a caregiver. As these memories were processed, the client began to develop new insights about their reactions in present-day relationships. Over time, the intensity of emotional responses decreased, and the client reported feeling more capable of tolerating relational uncertainty without experiencing overwhelming distress. 

Assessing for dissociation

In my clinical experience, one of the most important considerations when working with borderline presentations is assessing dissociation. Dissociation is common among individuals with BPD and can significantly influence how EMDR therapy unfolds. Research has highlighted the high prevalence of dissociation among individuals with borderline personality disorder and its implications for treatment planning (Korzekwa et al., 2009). For example, clients who experience dissociative amnesia may have memory networks that are not initially accessible. These memories may emerge unexpectedly during desensitization in Phase 4. Preparing clients during Phase 2 for this possibility can help them feel less overwhelmed if new material surfaces. 

Other clients may experience depersonalization or derealization. Depersonalization and derealization are dissociative experiences involving a disruption in how a person relates to themselves or their environment. Depersonalization involves a sense of detachment from one’s self (e.g., feeling like an observer of one’s thoughts, body, or actions). Derealization involves a sense of detachment from the external world (e.g., surroundings feel unreal, dreamlike, or visually altered). These experiences are characterized by a profound sense of disconnection from self or environment, often described as an “estranged” or altered state of awareness (Murphy, 2023). 

From an Adaptive Information Processing (AIP) perspective, these states can be understood as protective responses that emerge when the system is overwhelmed and unable to fully integrate experiences in the present moment. Rather than processing information adaptively, the system creates distance from internal or external experience to reduce distress (Wilkhoo et al., 2024). 

Dissociative experiences, including depersonalization and derealization, are strongly associated with trauma exposure, particularly childhood interpersonal trauma, and tend to exist on a continuum from transient stress responses to more persistent clinical presentations (Sar et al., 2007; Murphy, 2023). It is important to distinguish that clinical concern arises when these experiences become persistent, distressing, and interfere with functioning, at which point they may meet criteria for depersonalization/derealization disorder (Wilkhoo et al., 2024). Helping clients recognize early signs of dissociation and practice grounding strategies during preparation can support the maintenance of dual awareness during processing. 

Another important component of preparation involves developing internal resources and strengthening self-compassion. González and Mosquera (2012) describe self-care as involving three elements: valuing oneself, the absence of self-defeating behaviors, and engaging in actions that support growth and wellbeing. Strengthening these internal resources and encouraging their use in and out of session can significantly enhance readiness for trauma processing. 

Clinical considerations when using EMDR with borderline presentations

Some areas to consider with clients presenting with borderline presentations include:

  • Stabilization and preparation – Clients with borderline presentations often benefit from extended preparation phases that focus on emotional regulation and stabilization before trauma reprocessing begins. 
  • Assessing dissociation – Because dissociation is common in individuals with borderline personality disorder, clinicians should carefully assess dissociative symptoms and support clients in developing grounding skills that help maintain dual awareness during reprocessing (Korzekwa et al., 2009). 
  • Resource Development and Installation (RDI) – Resource Development and Installation can help clients build internal resources, such as nurturing figures, protective figures, or experiences of competence. These resources provide important support during trauma processing and may also strengthen the effectiveness of cognitive interweaves (Momeni Safarabad et al., 2018). 

Addressing common myths about EMDR and borderline personality disorder

One persistent myth is that individuals with borderline personality disorder are “too unstable” for trauma-focused therapy. Historically, clinicians were often advised to avoid trauma processing with this population. 

However, emerging research suggests that trauma-focused approaches can be beneficial when delivered within a structured and carefully paced treatment framework. Because many individuals with BPD have extensive trauma histories, addressing traumatic memory networks may be an essential component of effective treatment. 

When clinicians prioritize stabilization, assess dissociation, and maintain a strong therapeutic alliance, EMDR therapy can be implemented safely and effectively. 

Multicultural considerations

Cultural context is important when working with borderline presentations. Diagnostic labels such as BPD may sometimes reflect cultural misunderstandings about emotional expression, relational expectations, or trauma responses. Clinicians ideally approach assessment with cultural humility and curiosity about the client’s cultural background, family dynamics, and community support systems. 

Cultural beliefs may also influence how individuals understand trauma, healing, and relationships. EMDR therapy’s flexible structure allows clinicians to incorporate culturally meaningful resources and adapt stabilization strategies that align with the client’s worldview. 

What would you like people outside the EMDR community to know?

Perhaps the most important thing to understand is that borderline personality disorder is often rooted in profound trauma and attachment disruption. While individuals with borderline presentations are sometimes described as difficult to treat, many of the behaviors associated with this diagnosis can be understood as adaptive survival strategies developed in response to overwhelming experiences. 

EMDR therapy provides a structured approach for accessing and reprocessing the memory networks that contribute to these patterns while strengthening adaptive beliefs and emotional regulation. With careful preparation, a strong therapeutic alliance, and thoughtful pacing, EMDR therapy can support individuals with borderline personality disorder in moving toward greater stability, self-understanding, and relational safety. 

 

Kimberly Wilder, LMHC, is an EMDRIA Certified Therapist™ and Consultant,™ and professional practice content specialist with EMDRIA. She specializes in trauma, complex PTSD, spiritual abuse, disordered eating, marginalized communities, and narrative-informed healing, integrating clinical expertise, writing, and education to help transform survival into meaning, voice, and post-traumatic growth.

 

References 

American Psychological Association. (2025, April). Treating patients with borderline personality disorder. Monitor on Psychology, 56(3). https://www.apa.org/monitor/2025/04-05/treating-borderline-personality 

Bohus, M., Stoffers-Winterling, J., Sharp, C., Krause-Utz, A., Schmahl, C., & Lieb, K. (2021). Borderline personality disorder. The Lancet, 398(10310), 1528–1540. https://doi.org/10.1016/S0140-6736(21)00476-1 

Gonzalez, A. & Mosquera, D. (2012). EMDR and dissociation: the progressive approach. [English edition]. Amazon Imprint.

Hafkemeijer, L., Slotema, K., de Haard, N., & de Jongh, A. (2023). Case report: Brief intensive trauma-focused therapy with EMDR for borderline personality disorder: Results of two case studies with one-year follow-up. Frontiers in Psychiatry, 14, 1283145. https://doi.org/10.3389/fpsyt.2023.1283145

Korzekwa, M. I., Dell, P. F., & Pain, C. (2009). Dissociation and borderline personality disorder: An update for clinicians. Current Psychiatry Reports, 11(1), 82–88. https://doi.org/10.1007/s11920-009-0013-1 

Momeni Safarabad, N., Asgharnejad Farid, A. A., Gharraee, B., & Habibi, M. (2018). Treatment of a patient with borderline personality disorder based on a phase-oriented model of eye movement desensitization and reprocessing: A case report. Iranian Journal of Psychiatry, 13(1), 80–83. https://pmc.ncbi.nlm.nih.gov/articles/PMC5994230/

Mosquera, D., Leeds, A. M., & González, A. (2014). Application of EMDR therapy for borderline personality disorder. Journal of EMDR Practice and Research, 8(2), 74–89. https://doi.org/10.1891/1933-3196.8.2.74 

Hofman, S., Hafkemeijer, L., de Jongh, A., & Slotema, C. W. (2025). Eye movement desensitization and reprocessing therapy in persons with personality disorders: A randomized clinical trial. JAMA Network Open, 8(9) e2553421. https://doi.org/10.1001/jamanetworkopen.2025.33421

Murphy, R. J. (2023). Depersonalization/derealization disorder and neural correlates of trauma-related pathology: A critical review. Innovations in Clinical Neuroscience, 20(1-2), 53-59. https://pmc.ncbi.nlm.nih.gov/articles/PMC10132272/  

Sar, V., Akyuz, G., Kugu, N., Ozturk, E., & Ertem-Vehid, H. (2007). Axis I dissociative disorder comorbidity in borderline personality disorder and reports of childhood trauma. The Journal of Clinical Psychiatry, 67(10), 1583-1590. https://doi.org/10.4088/JCP.v67n1014  

Wilkhoo, H. S., Wasama Islam, A., Reji, F., Sanghvi, L., Potdar, R., & Solanki, S. (2024). Depersonalization-derealization disorder: Etiological mechanism, diagnosis and management. Discoveries, 12(2):e190. https://pmc.ncbi.nlm.nih.gov/articles/PMC11910194/  

 

 

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Basic Info Collapse

Date
May 1, 2026

Contributor(s)
Kimberly Wilder, LMHC

Topics
Dissociation, Personality Disorders

More Info Collapse

Audience
EMDR Therapists

Language
English

Content Type
Blog/Blog Post

Access Type
Open Access

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