Introduction: The construct of epistemic trust (ET) has gained wide acceptance and support in the field, although there is little empirical evidence to substantiate the theoretical assumed model. Studies of the assessment of ET were conducted in community samples only and the mediating role of attachment and mentalizing in addition to ET was not investigated. This study examines the theoretical assumed relationships between ET and attachment and mentalizing as well as the mediating role of attachment, mentalizing and ET in the association between childhood adversity and borderline personality disorder (BPD) in a heterogeneous sample containing also patients. Methods: The associations between ET and attachment, mentalizing, childhood maltreatment and BPD were explored in a sample of 245 participants, including subjects from the community as well as patients diagnosed with anxiety and personality disorders from two clinical samples. Multiple mediation analysis was performed to explore the mediating role of attachment (ECR-R), mentalizing (RFQ), and ET within the relationship between childhood trauma (CTQ-SF) and BPD (MSI-BPD). Results: Strong relationships between ET and attachment and mentalizing were found indicating that lower degrees of cET are associated with insecure attachment and lower reflective functioning. Attachment, mentalizing, and ET together accounted for 75% of the mediation between childhood adversity and BPD. Hypomentalizing and anxious attachment accounted for the largest share of the mediation. Conclusion: Our findings provide preliminary evidence for the theoretical supposed model of ET and suggest relevance of ET in the mediation between childhood adversity and PDs, although the role of ET seems smaller than assumed by recent theories.

1.
McKay
MT
,
Cannon
M
,
Chambers
D
,
Conroy
RM
,
Coughlan
H
,
Dodd
P
, et al
.
Childhood trauma and adult mental disorder: a systematic review and meta-analysis of longitudinal cohort studies
.
Acta Psychiatr Scand
.
2021
;
143
(
3
):
189
205
.
2.
Li
M
,
D’Arcy
C
,
Meng
X
.
Maltreatment in childhood substantially increases the risk of adult depression and anxiety in prospective cohort studies: systematic review, meta-analysis, and proportional attributable fractions
.
Psychol Med
.
2016
;
46
(
4
):
717
30
.
3.
Porter
C
,
Palmier-Claus
J
,
Branitsky
A
,
Mansell
W
,
Warwick
H
,
Varese
F
.
Childhood adversity and borderline personality disorder: a meta-analysis
.
Acta Psychiatr Scand
.
2020
;
141
(
1
):
6
20
.
4.
MacIntosh
H
,
Godbout
N
,
Dubash
N
.
Borderline personality disorder: disorder of trauma or personality, a review of the empirical literature
.
Can Psychol
.
2015
;
56
(
2
):
227
41
.
5.
Bender
DS
,
Morey
LC
,
Skodol
AE
.
Toward a model for assessing level of personality functioning in DSM-5, part I: a review of theory and methods
.
J Pers Assess
.
2011
;
93
(
4
):
332
46
.
6.
Luyten
P
,
Campbell
C
,
Allison
E
,
Fonagy
P
.
The mentalizing approach to psychopathology: state of the art and future directions
.
Annu Rev Clin Psychol
.
2020
;
16
:
297
325
.
7.
Bowlby
J
.
Attachment and loss
.
London
:
Penguin
;
1984
In: Attachment. Vol. 1Revised Ed.
8.
Bowlby
J
.
The role of attachment in personality development. A secure base: clinical applications of attachment theory
.
London
:
Routledge
;
1988
.
9.
Bateman
AW
,
Fonagy
P
.
Handbook of mentalizing in mental health practice
.
Arlington, VA, US
:
American Psychiatric Publishing, Inc.
;
2012
.
10.
Midolo
L
,
Santoro
G
,
Ferrante
E
,
Pellegriti
P
,
Russo
S
,
Costanzo
A
,
Schimmenti
A
.
Childhood trauma, attachment and psychopathology: a correlation network approach
.
Mediterr J Clin Psychol
.
2020
;
8
:
1
25
.
11.
Li
ET
,
Carracher
E
,
Bird
T
.
Linking childhood emotional abuse and adult depressive symptoms: the role of mentalizing incapacity
.
Child Abuse Negl
.
2020
;
99
:
104253
.
12.
Muller
RT
,
Thornback
K
,
Bedi
R
.
Attachment as a mediator between childhood maltreatment and adult symptomatology
.
J Fam Violence
.
2012
;
27
(
3
):
243
55
.
13.
Fonagy
P
,
Luyten
P
,
Allison
E
,
Campbell
C
.
What we have changed our minds about: Part 1. Borderline personality disorder as a limitation of resilience
.
Borderline Personal Disord Emot Dysregul
.
2017
;
4
:
11
.
14.
Fonagy
P
,
Luyten
P
,
Allison
E
,
Campbell
C
.
What we have changed our minds about: Part 2. Borderline personality disorder, epistemic trust and the developmental significance of social communication
.
Borderline Personal Disord Emot Dysregul
.
2017
;
4
:
9
.
15.
Fonagy
P
,
Allison
E
.
The role of mentalizing and epistemic trust in the therapeutic relationship
.
Psychother (Chic)
.
2014
;
51
(
3
):
372
80
.
16.
Fonagy
P
,
Luyten
P
,
Allison
E
.
Epistemic petrification and the restoration of epistemic trust: a new conceptualization of borderline personality disorder and its psychosocial treatment
.
J Pers Disord
.
2015
;
29
(
5
):
575
609
.
17.
Jurist
EL
.
Mentalized affectivity
.
Psychoanal Psychol
.
2005
;
22
(
3
):
426
44
.
18.
Jurist
EL
.
Minds and yours: new directions for mentalization theory
.
New York, NY, US
:
Other Press
;
2008
.
19.
Knapen
S
,
van Diemen
R
,
Hutsebaut
J
,
Fonagy
P
,
Beekman
A
.
Defining the concept and clinical features of epistemic trust: a delphi study
.
J Nerv Ment Dis
.
2022
;
210
(
4
):
312
4
.
20.
Elklit
A
,
Michelsen
L
,
Murphy
S
.
Childhood maltreatment and school problems: a Danish national study
.
Scand J Educ Res
.
2018
;
62
(
1
):
150
9
.
21.
Germine
L
,
Dunn
EC
,
McLaughlin
KA
,
Smoller
JW
.
Childhood adversity is associated with adult theory of mind and social affiliation, but not face processing
.
PLoS One
.
2015
;
10
(
6
):
e0129612
.
22.
Hanson
JL
,
van den Bos
W
,
Roeber
BJ
,
Rudolph
KD
,
Davidson
RJ
,
Pollak
SD
.
Early adversity and learning: implications for typical and atypical behavioral development
.
J Child Psychol Psychiatry
.
2017
;
58
(
7
):
770
8
.
23.
Campbell
C
,
Tanzer
M
,
Saunders
R
,
Booker
T
,
Allison
E
,
Li
E
, et al
.
Development and validation of a self-report measure of epistemic trust
.
PLoS One
.
2021
;
16
(
4
):
e0250264
.
24.
Liotti
M
,
Milesi
A
,
Spitoni
GF
,
Tanzilli
A
,
Speranza
AM
,
Parolin
L
, et al
.
Unpacking trust: the Italian validation of the epistemic trust, mistrust, and credulity questionnaire (ETMCQ)
.
PLoS One
.
2023
;
18
(
1
):
e0280328
.
25.
Kampling
H
,
Kruse
J
,
Lampe
A
,
Nolte
T
,
Hettich
N
,
Brähler
E
, et al
.
Epistemic trust and personality functioning mediate the association between adverse childhood experiences and posttraumatic stress disorder and complex posttraumatic stress disorder in adulthood
.
Front Psychiatry
.
2022
;
13
:
919191
.
26.
Qualtrics. Provo
.
2019
.
27.
Knapen
S
,
Swildens
WE
,
Mensink
W
,
Hoogendoorn
A
,
Hutsebaut
J
,
Beekman
AT
.
The development and psychometric evaluation of the Questionnaire Epistemic Trust (QET): a self‐report assessment of epistemic trust
.
Clin Psychol Psychother
.
2023
;
31
(
1
).
28.
Bernstein
DP
,
Stein
JA
,
Newcomb
MD
,
Walker
E
,
Pogge
D
,
Ahluvalia
T
, et al
.
Development and validation of a brief screening version of the Childhood Trauma Questionnaire
.
Child Abuse Negl
.
2003
;
27
(
2
):
169
90
.
29.
Baker
A
,
Maiorino
E
.
Assessments of emotional abuse and neglect with the CTQ: issues and estimates
.
Child Youth Serv Rev
.
2010
;
32
(
5
):
740
8
.
30.
Grassi-Oliveira
R
,
Cogo-Moreira
H
,
Salum
GA
,
Brietzke
E
,
Viola
TW
,
Manfro
GG
, et al
.
Childhood Trauma Questionnaire (CTQ) in Brazilian samples of different age groups: findings from confirmatory factor analysis
.
PLoS One
.
2014
;
9
(
1
):
e87118
.
31.
Thombs
BD
,
Bernstein
DP
,
Lobbestael
J
,
Arntz
A
.
A validation study of the Dutch Childhood Trauma Questionnaire-Short Form: factor structure, reliability, and known-groups validity
.
Child Abuse Negl
.
2009
;
33
(
8
):
518
23
.
32.
Fonagy
P
,
Luyten
P
,
Moulton-Perkins
A
,
Lee
YW
,
Warren
F
,
Howard
S
, et al
.
Development and validation of a self-report measure of mentalizing: the reflective functioning questionnaire
.
PLoS One
.
2016
;
11
(
7
):
e0158678
.
33.
De Meulemeester
C
,
Vansteelandt
K
,
Luyten
P
,
Lowyck
B
.
Mentalizing as a mechanism of change in the treatment of patients with borderline personality disorder: a parallel process growth modeling approach
.
Personal Disord
.
2018
;
9
(
1
):
22
9
.
34.
Fraley
RC
,
Waller
NG
,
Brennan
KA
.
An item response theory analysis of self-report measures of adult attachment
.
J Pers Soc Psychol
.
2000
;
78
(
2
):
350
65
.
35.
Sibley
CG
,
Fischer
R
,
Liu
JH
.
Reliability and validity of the revised experiences in close relationships (ECR-R) self-report measure of adult romantic attachment
.
Pers Soc Psychol Bull
.
2005
;
31
(
11
):
1524
36
.
36.
Kooiman
CG
,
Klaassens
ER
,
van Heloma Lugt
JQ
,
Kamperman
AM
.
Psychometrics and validity of the Dutch Experiences in Close Relationships-Revised (ECR-r) in an outpatient mental health sample
.
J Pers Assess
.
2013
;
95
(
2
):
217
24
.
37.
Zanarini
MC
,
Vujanovic
AA
,
Parachini
EA
,
Boulanger
JL
,
Frankenburg
FR
,
Hennen
J
.
A screening measure for BPD: the McLean screening instrument for borderline personality disorder (MSI-BPD)
.
J Pers Disord
.
2003
;
17
(
6
):
568
73
.
38.
André
JA
,
Verschuere
B
,
Lobbestael
J
.
Diagnostic value of the Dutch version of the McLean screening instrument for BPD (MSI-BPD)
.
J Pers Disord
.
2015
;
29
(
1
):
71
8
.
39.
Verschuere
B
,
Tibboel
H
.
The Dutch version of the McLean Screening Instrument for borderline personality disorder (MSI-BPD)
.
Psychol Gezondh
.
2011
;
39
(
4
):
243
8
.
40.
Hayes
AF
.
Introduction to mediation, moderation, and conditional process analysis: a regression-based approach
.
New York, US
:
Guilford Press
;
2013
.
41.
Santoro
G
,
Midolo
LR
,
Costanzo
A
,
Schimmenti
A
.
The vulnerability of insecure minds: the mediating role of mentalization in the relationship between attachment styles and psychopathology
.
Bull Menninger Clin
.
2021
;
85
(
4
):
358
84
.
42.
Morandotti
N
,
Brondino
N
,
Merelli
A
,
Boldrini
A
,
De Vidovich
GZ
,
Ricciardo
S
, et al
.
The Italian version of the Reflective Functioning Questionnaire: validity data for adults and its association with severity of borderline personality disorder
.
PLoS One
.
2018
;
13
(
11
):
e0206433
.
43.
Müller
S
,
Wendt
LP
,
Spitzer
C
,
Masuhr
O
,
Back
SN
,
Zimmermann
J
.
A critical evaluation of the reflective functioning questionnaire (RFQ)
.
J Pers Assess
.
2022
;
104
(
5
):
613
27
.
44.
Scott
LN
,
Levy
KN
,
Pincus
AL
.
Adult attachment, personality traits, and borderline personality disorder features in young adults
.
J Pers Disord
.
2009
;
23
(
3
):
258
80
.
45.
Smith
M
,
South
S
.
Romantic attachment style and borderline personality pathology: a meta-analysis
.
Clin Psychol
.
2020
;
75
:
101781
.
46.
Cohen
LJ
,
Ardalan
F
,
Tanis
T
,
Halmi
W
,
Galynker
I
,
Von Wyl
A
,
Hengartner
MP
.
Attachment anxiety and avoidance as mediators of the association between childhood maltreatment and adult personality dysfunction
.
Attach Hum Dev
.
2017
;
19
(
1
):
58
75
.
47.
Erkoreka
L
,
Zamalloa
I
,
Rodriguez
S
,
Muñoz
P
,
Mendizabal
I
,
Zamalloa
MI
, et al
.
Attachment anxiety as mediator of the relationship between childhood trauma and personality dysfunction in borderline personality disorder
.
Clin Psychol Psychother
.
2022
;
29
(
2
):
501
11
.
48.
Zhang
X
,
Li
J
,
Xie
F
,
Chen
X
,
Xu
W
,
Hudson
NW
.
The relationship between adult attachment and mental health: a meta-analysis
.
J Pers Soc Psychol
.
2022
;
123
(
5
):
1089
137
.
49.
Knapen
S
,
Hutsebaut
J
,
van Diemen
R
,
Beekman
A
.
Epistemic trust as a psycho-marker for outcome in psychosocial interventions
.
J Infant Child Adolesc Psychother
.
2020
;
19
(
4
):
417
26
.
50.
Nolte
T
,
Hutsebaut
J
,
Sharp
C
,
Campbell
C
,
Fonagy
P
,
Bateman
A
.
The role of epistemic trust in mentalization-based treatment of borderline psychopathology
.
J Pers Disord
.
2023
;
37
(
5
):
633
59
.
51.
Maxwell
SE
,
Cole
DA
,
Mitchell
MA
.
Bias in cross-sectional analyses of longitudinal mediation: partial and complete mediation under an autoregressive model
.
Multivar Behav Res
.
2011
;
46
(
5
):
816
41
.
52.
Maughan
B
,
Rutter
M
.
Retrospective reporting of childhood adversity: issues in assessing long-term recall
.
J Pers Disord
.
1997
;
11
(
1
):
19
33
.
53.
Locati
F
,
Milesi
A
,
Conte
F
,
Campbell
C
,
Fonagy
P
,
Ensink
K
,
Parolin
L
.
Adolescence in lockdown: the protective role of mentalizing and epistemic trust
.
J Clin Psychol
.
2023
;
79
(
4
):
969
84
.
54.
Locati
F
,
Benzi
IMA
,
Milesi
A
,
Campbell
C
,
Midgley
N
,
Fonagy
P
, et al
.
Associations of mentalization and epistemic trust with internalizing and externalizing problems in adolescence: a gender-sensitive structural equation modeling approach
.
J Adolesc
.
2023
;
95
(
8
):
1564
77
.
55.
Scott
KM
,
McLaughlin
KA
,
Smith
DA
,
Ellis
PM
.
Childhood maltreatment and DSM-IV adult mental disorders: comparison of prospective and retrospective findings
.
Br J Psychiatry
.
2012
;
200
(
6
):
469
75
.
56.
Kessler
RC
,
Wittchen
H-U
,
Abelson
J
,
Zhao
S
,
Stone
A
.
Methodological issues in assessing psychiatric disorders with self-reports
. In:
Stone
AA
, editor, et al
, editors.
The science of self-report: implications for research and practice
.
New York
:
Psychology Press
;
2000
. p.
229
55
.
57.
Silva
M
,
Loureiro
A
,
Cardoso
G
.
Social determinants of mental health: a review of the evidence
.
Eur Psychiatry
.
2016
;
30
:
259
92
.
58.
Allen
J
,
Balfour
R
,
Bell
R
,
Marmot
M
.
Social determinants of mental health
.
Int Rev Psychiatry
.
2014
;
26
(
4
):
392
407
.
59.
Sharp
C
,
Wright
AG
,
Fowler
JC
,
Frueh
BC
,
Allen
JG
,
Oldham
J
, et al
.
The structure of personality pathology: both general (“g”) and specific (“s”) factorsJ
.
Abnorm Psychol
.
2015
;
124
(
2
):
387
98
.
You do not currently have access to this content.