[Trauma-focused treatments in people with personality disorders: comments on the evidence and on often-heard claims].

Abstract

Background: For several years, especially in the Netherlands, there has been a lot of attention for the use of trauma-focused treatments, such as EMDR, in the treatment of personality disorders. Trauma-focused treatments are said to be shorter, more directly focused on the etiology of the personality disorder and less stigmatizing. What evidence do we have for the role of trauma-focused treatment and how should that evidence be interpreted?

Aim: To discuss and interpret in a balanced way the evidence for the role of trauma treatment in people with personality disorder and to discuss some comments on the commonly made distinction between trauma-focused and personality disorder treatment.

Method: A pragmatic literature search was conducted and the results were placed in the context of the broader evidence in the treatment of personality disorders RESULTS: Trauma-focused treatments show positive treatment outcomes for a subset of people with personality disorder. There is no evidence that those outcomes are better than the outcomes of other brief treatments, nor is there evidence that these studies show that people truly recover from personality disorder in the broader sense.

Conclusion: Short-term treatments, including trauma-focused treatments, can achieve important positive outcomes in people with personality disorder in the short term. Perhaps the active mechanisms behind trauma-focused treatment are not fundamentally different from the working mechanisms behind personality disorder treatment. In this regard, one of the most important aspects is that people can actively relate to their history. Also, as professionals, we must be careful not to paint clients too rosy a picture of the possible outcomes of brief treatments.