Making a case for using MDMA-assisted psychotherapy for borderline personality disorder and complex PTSD: a descriptive systematic review of the literature

Summary

MDMA-assisted psychotherapy (MDMA-AP) shows potential benefits for treating borderline personality disorder (BPD) and complex PTSD (CPTSD), in addition to its established efficacy for PTSD. A systematic review of 24 studies involving 335 participants found that while none specifically assessed MDMA-AP for BPD or CPTSD, many reported improvements in emotional regulation and interpersonal functioning. Adverse reactions were generally mild to moderate, indicating that MDMA-AP may be a promising avenue for future research.

Study at a glance

Abstract

Background: 3,4-Methylenedioxymethamphetamine (MDMA)-assisted psychotherapy (MDMA-AP) has demonstrated considerable efficacy in treating post-traumatic stress disorder (PTSD). PTSD and complex PTSD (CPTSD) frequently co-occur with borderline personality disorder (BPD), a complex disorder marked by emotional dysregulation, interpersonal difficulties and abandonment fears - often accompanied by suicidal and non-suicidal self-injury. While MDMA-AP is beneficial for PTSD and hypothesised to be effective for BPD, its application to CPTSD and BPD has not been systematically reviewed. Objectives: To systematically evaluate primary evidence on the use of MDMA-AP in treating PTSD, CPTSD, and BPD. Design: Descriptive systematic review. Data sources and methods: A systematic search of four databases (Ovid Medline, Embase, APA PsycINFO and CENTRAL) identified 24 eligible peer-reviewed studies published before 17 February 2025. Risk of bias and data extraction were conducted independently using standardised methods. Results: Of the 24 studies involving 335 participants, 15 reported outcomes from seven clinical trials, four were case reports, and five were non-randomised interventions. Four studies included participants with multiple forms of trauma, and three included those with dissociative PTSD. Most reported reduced PTSD symptoms post-intervention; some noted decreased dissociative symptoms at higher MDMA doses. Six studies did not exclude participants with BPD. Although none directly assessed MDMA-AP for CPTSD or BPD, improvements in emotional regulation, interpersonal functioning, identity coherence and abandonment concerns were reported. Adverse drug reactions were mild to moderate, although specific safety concerns remain. Conclusion: Findings from this review suggest that MDMA-AP may have applicability beyond PTSD, with potential benefits for CPTSD and BPD, offering preliminary insights to inform future research and clinical considerations. Protocol registration: PROSPERO ID: CRD42025594896.

Tags