Clinicians' Perspectives on the Model of Trust Processes in Borderline Personality Disorder: A Qualitative Evaluation

ABSTRACT Background Trust is a fundamental aspect of human relationships, crucial for navigating social interactions and forming meaningful connections. While the ability to accurately assess and update trust appraisals is essential for adaptive functioning, individuals with borderline personality disorder (BPD) experience significant challenges in trust processing that contribute to interpersonal dysfunction and treatment complications. Despite growing recognition of trust difficulties in BPD, a comprehensive understanding of these processes remains limited. Methods The present study aimed to evaluate and refine this model through a qualitative analysis of interviews with 25 Italian therapists specialising in personality disorders. Using thematic analysis, we explored clinicians' observations of trust dynamics in BPD patients, focusing on developmental factors, situational perceptions, emotional influences, prior beliefs, behaviours and trust learning capacity. Our findings largely aligned with and extended the theoretical model of trust impairments in BPD proposed by Preti et al. in 2023. Results Results revealed a complex interplay between long‐term and immediate factors in shaping trust processes: developmental experiences, rigid perceptions, emotional volatility, distorted beliefs, maladaptive behaviours, and impairment in trust learning were central to the trust dysfunctions in BPD. Two significant additions to the model emerged: emotional consequences of trust misattribution and behavioural activation triggered by emotional arousal. Conclusions These findings suggest that trust difficulties in BPD involve both planned behavioural consequences and immediate emotion‐driven reactions. The study provides important implications for clinical practice, emphasising the need for interventions that address both primary trust issues and secondary emotional‐behavioural responses.