Defining the concept and clinical features of epistemic trust: A Delphi study

Saskia Knapen*, Roos van Diemen, Joost Hutsebaut, Peter Fonagy, Aartjan Beekman

*Corresponding author for this work

Research output: Contribution to journalArticleScientificpeer-review

4 Citations (Scopus)
189 Downloads (Pure)


Early identification of "patients at risk" for not completing regular treatment or not benefitting (sufficiently) from treatment might be among the most cost-effective strategies in mental health care. The recently introduced concept of epistemic trust (ET) may have the potential value to predict patients at risk and therefore act as a marker of treatment outcome. We argue that ET may be the final common pathway through which aversive relational experiences in the past result in interpersonal dysfunctioning, which in turn result in dysfunctional therapeutic relationships, rendering it difficult for patients to trust whatever is offered to learn in therapy. Hence, the concept of ET can play an essential role in personalized medicine, allowing for a more tailored treatment assignment to specific patients' characteristics, which may improve treatment outcomes. In this brief report, we define the clinical features of ET by describing its core domains based on consensus of expert opinion on the concept. The response rate was high, and there was a high level of agreement across experts, demonstrating a strong consensus between experts on the definition and clinical features of ET and mistrust and its significance to the understanding of personality disorders. By means of having a clear definition of the clinical features of ET, we hope to make it accessible for assessment.

Original languageEnglish
Pages (from-to)312-314
JournalJournal of Nervous and Mental Disease
Issue number4
Publication statusPublished - 2022


  • Personality disorders
  • epistemic trust
  • outcome
  • personalized medicine
  • psychomarker


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