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Are my trust issues the sign of a mental health condition? What experts say

By Elle Warren

Oct 3, 20237 min read minute read

Reviewed byApril Kilduff, MA, LCPC

Trust issues are talked about often, but exactly what the phrase means is unclear. “Trust” indicates that something or someone else is involved, which can be another person, the world at large, or oneself. “Issues” can imply a wide range of severity and a wide range of topics. 

On every season of every reality dating show, there is at least one contestant whose storyline of the season is structured around their “trust issues.” They’re a central theme in more than one romantic comedy, too. In the end—whether in reality shows and romantic comedies—the protagonist burdened with trust issues finds love, despite their vaguely defined struggle. For better or worse, neither of those forms of media allow for much nuance or depict true, full reality. 

So when we talk about “trust issues,” what are we really talking about? What led to them and what maintains them? Trust issues could be a symptom related to a variety of mental health conditions, or could mask these conditions and make it harder for people to understand what’s really going on. I spoke with Dr. Patrick McGrath, Chief Clinical Officer at NOCD, to help me get to the bottom of it.

What are “trust issues”?

The term “trust issues” is most often used to describe one’s mistrust of other people within romantic contexts. It’s common to have difficulty letting people into a vulnerable, emotionally and/or physically intimate relationship with you. This is especially true if you’ve experienced heartbreak or betrayal in the past—infidelity from past partners is often a major contributor to such trust issues.

Trust issues can extend beyond romantic relationships. They can come up in platonic and familial relationships, too. You might also feel a mistrust of the world around you and of strangers. If you have experienced trauma, have PTSD, an anxiety disorder, or obsessive-compulsive disorder (OCD), you may have an ongoing feeling that you’re constantly waiting for something bad to happen. You might experience hypervigilance—an intensified awareness of what’s happening around you—or find it difficult to accept and trust good things that are happening in your life, as if you’re just waiting for the next bad thing to happen. 

You can also have trust issues with yourself. Mistrusting oneself is a common phenomenon, and it happens for a multitude of reasons. People with a variety of mental health conditions have a difficult time trusting themselves, as their illness leads them to think they can’t trust their perception and experience of the world, nor their ability to cope with it. Individuals with low self-esteem are prone to mistrusting themselves, too, as they don’t have stock in their own worthiness. It can also happen if you’ve experienced extensive gaslighting from another person; you might have internalized the discrediting and dismissal that was placed on you. 

Dr. McGrath emphasizes that sometimes, mistrust can simply be a part of someone’s personality and is not always a sign of a mental health condition or any other issue. However, if your trust issues are consistently impacting your relationships, your ability to live a life in accordance with your values, your mood, your relationship with yourself, or having a negative impact on your daily life, you could be experiencing an underlying mental health condition. Read on for possibilities of what those may be.

What mental health conditions might trust issues be a sign of?


Trauma is defined as any deeply distressing or disturbing experience. We hear most often about being the victim of abuse or witnessing violence, but experiences that can qualify as traumatic may cast a much wider net. For example, losing a close loved one is often traumatic, even if the loss was not violent. This can extend to a romantic, friendship, or familial breakup, too. For example, if you lived with a romantic partner whom you planned to marry and then discovered they were being unfaithful for years, that experience can be traumatic. 

Because you experienced significant betrayal and loss, it only makes sense that you might experience issues with trust in relationships moving forward. Even if your trauma wasn’t related to a relationship, trauma in general is known to foster a mistrust of other people and the world around you. If you’re experiencing ongoing, distressing feelings, and even physical symptoms related to the trauma, you could be experiencing post-traumatic stress disorder (PTSD).  

Personality disorders

Personality disorders are characterized by an inability to adapt to and cope with one’s environment. People with personality disorders tend to have a hard time understanding their emotions or handling distress, tend to act impulsively, and are prone to thinking that others are out to get them or will abandon them. For these reasons, it can be a challenge to maintain relationships, deal with conflict at work or school, and function healthily overall. Borderline personality disorder (BPD) in particular is marked by a fear of being alone or abandoned, so it’s hard for people suffering from BPD to find trust and security in relationships. Another personality disorder that a mistrust of others is prominent in is paranoid personality disorder, where one is chronically suspicious of others’ intentions.

Obsessive-compulsive disorder

Obsessive-compulsive disorder (OCD) consists of obsessions—intrusive thoughts, images, feelings, sensations or urges—followed by compulsions done to relieve oneself of the distress caused by obsessions or to prevent something bad from happening. Contrary to popular belief, obsessions can latch onto a variety of themes, well beyond cleanliness and order—and nearly every theme could come with a mistrust of others and/or yourself. One theme that causes its sufferer to doubt the validity of their relationship, their feelings for their partner, and/or their partner’s feelings for them is relationship OCD (ROCD). It comes with intrusive thoughts such as “What if we break up?” “What if they cheat on me in the future?” “What if they don’t love me enough?” or “What if I’m not attracted to them enough?” Another is Real Event OCD, or “False Memory” OCD, in which people become extremely distrustful of their own memories and experiences.

OCD is sometimes dubbed “the doubting disorder,” because it causes you to doubt everything you know to be true—including your own values and intentions and the intentions of others. Obsessions often come in the form of “what ifs,” so people with OCD can have difficulty coping with the uncertainty that comes from trusting others.

When and how should I get help for trust issues?

If your trust issues are hindering your ability to live a full, thriving life that includes joy, healthy relationships, and peace within yourself, it may be time to seek help.

I’ll go over the evidence-based treatment options for the conditions mentioned above, but of course it is best to speak with a licensed mental health professional with training and experience in your specific area of concern in order to get an assessment and decide what course of treatment is best for you.

Trauma, and more specifically PTSD, is effectively treated through prolonged exposure (PE) therapy. PE guides you through the feelings and memories associated with the trauma, reducing, over time, the power that those feelings and memories hold over you.

Across personality disorders, the most effective form of treatment is dialectical behavior therapy (DBT). It’s designed for those who experience emotions particularly intensely. It guides the client in accepting uncomfortable emotions while working with them to change their problematic behaviors. There are a variety of other treatments that have proven successful specifically in the treatment of borderline personality disorder, including mentalization-based treatment (MBT), schema-focused therapy (SFT), transference-focused psychotherapy (TFP), and systems training for emotional predictability and problem solving (STEPPS). Read more information on these modalities here.

All themes of OCD are treated with exposure and response prevention therapy (ERP). ERP works by exposing one to their feared stimuli—in other words, the people, places, or activities that trigger intrusive thoughts—and helping them learn to resist engaging in compulsions as a way to reduce their distress or prevent unwanted outcomes. This helps them become desensitized to intrusive thoughts and teaches their brain not to see them as real threats. For example, if you have intrusive thoughts about your partner’s feelings for you and are triggered by intimacy, your first exposure may be to hold hands without reacting to the resulting intrusive worries by asking your partner for reassurance about their feelings. Dr. McGrath says that ERP serves to help one live their lives how they want to, not how OCD wants them to.

No matter where your trust issues are coming from, there are treatment options that can help you develop more secure, trusting attachments to the people in your life, the world around you, and yourself. Remember that you’re not “broken.” Being a human is hard and complicated—it’s not a personal failure to have difficulty developing trust.

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