Trust and Borderline Personality Disorder

Objective. Borderline Personality Disorder (BPD) is a clinical condition characterized by impairments in relationships and dysfunctional interactions with others. Trust is a core feature of human interpersonal transactions and evidences suggest that BPD includes a decreased disposition towards attributing trustworthiness to others. The present review summarizes recent results regarding abnormalities in trust processes in BPD that might predispose them to develop dysfunctions in interpersonal behaviors. Method. We reviewed papers relevant in the investigation of trust issues in BPD published until 2017 using specific keywords such as “trust”, “trustworthiness”, “social cognition”, “trust game”, “neuroeconomics” and “Borderline Personality Disorder” in PubMed and PsycINFo databases. Results. We found evidences for impairments in the early stages of the cognitive process that leads to untrustworthiness judgements in BPD (i.e., maladaptive beliefs and facial appraisal of others’ trustworthiness). In particular, some researches focused on the influence of Rejection Sensitivity (another main dysfunctional core of social cognition in BPD) on untrustworthiness bias, resulting in mixed findings. Studies that investigated behavioral alterations of BPD in economic games report that alterations in trustworthiness attributions in BPD are due to the exposure to emotionally arousing material (i.e., faces) rather than to any specific cognitive alteration. Finally, from the neuroscientific contributions, it seems that the untrustworthiness bias is linked to alterations in both amygdala activation and oxytocin activity. Conclusions. Despite many contributions regarding alterations in trust in BPD patients, there is still a lack of consensus on a proper definition of the untrustworthiness bias. As a main consequence, an adequate measurement tool for the phenomenon is still missing. We conclude stressing the need for further research to clarify the meaning, the predictors, and the clinical implications of such bias.