Laboratory-Assessed Mistrust in Borderline Personality Disorder: A Meta-Analytic Review

Abstract

Although a recent systematic review examined the relationship between mistrust and borderline personality disorder (BPD; Preti et al., 2023), it did not statistically quantify the strength of this association. This highlights the need for a meta-analytic review of mistrust in BPD. To address this gap, we conducted a meta-analysis comparing laboratory-based assessments of mistrust between individuals with BPD and control groups. This meta-analysis was preregistered with International Prospective Register of Systematic Reviews (CRD42023479031). The final database search was conducted on October 17, 2024, across Embase, MEDLINE, PsycINFO, Scopus, and Web of Science to identify relevant studies. We included studies published in English or translated into English that employed valid, reliable laboratory-based measures of mistrust and psychometrically sound tools for assessing BPD symptoms or features. A three-level meta-analytic model was used to assess mistrust differences between BPD and control groups. The risk of bias in the included records was evaluated using the Joanna Briggs Institute Critical Appraisal Checklists. Our search yielded 1,717 reports, of which 26 met the inclusion criteria (N = 3,716). Based on 70 effect sizes from these reports, the meta-analysis indicated a small-to-moderate effect size (g = 0.44, 95% confidence interval = [0.27, 0.61], p < .001), demonstrating that individuals with BPD exhibited significantly higher levels of mistrust compared to controls. Subgroup analyses identified the mistrust paradigm as a statistically significant moderator. These results underscore the significant role of mistrust in BPD. We suggest that assessing mistrust and fostering interpersonal trust during treatment could lead to more effective interventions for BPD.