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

MDMA-assisted psychotherapy (MDMA-AP) may help treat not only PTSD but also complex PTSD and borderline personality disorder. A systematic review of 24 studies involving 335 participants found that most reported reduced PTSD symptoms after MDMA-AP, with some noting decreased dissociative symptoms at higher doses. Although no studies directly assessed MDMA-AP for complex PTSD or borderline personality disorder, improvements in emotional regulation, interpersonal functioning, identity coherence, and abandonment concerns were reported. Adverse drug reactions were mild to moderate, though specific safety concerns remain. These findings offer preliminary insights for future research and clinical considerations.

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.