Mediation of early maladaptive schemas between perceptions of parental rearing style and personality disorder symptoms

Early maladaptive schema, attachment style, and parenting style in a clinical population with personality disorder and normal individuals: a discriminant analysis model

INTRODUCTION

Researchers have shown various variables' role in forming personality disorders (PD). This study aimed to assess the role of early maladaptive schema (EMS), attachment style (AS), and parenting style (PS) in discriminating between personality disorders and normal individuals.

METHODS

In this study, 78 personality disorder patients and 360 healthy volunteers aged 18-84 were selected using convenience sampling. They completed the Schema Questionnaire-Short Form (SQ-SF), Revised Adult Attachment Scale (RAAS), and Baumrind's Parenting Styles Questionnaire (PSI). Data were analyzed using discriminant analysis with IBM SPSS 25.

RESULTS

The results showed higher mean scores in all early maladaptive schema domains, insecure attachment styles, and authoritarian parenting in the personality disorder group than in the normal group. Also, discriminant analyses revealed that the function was statistically significant and could distinguish between the two groups and a compound of essential variables, disconnection, impaired autonomy, and secure attachment, respectively, discriminating two groups. Given that all components were able to distinguish between the two groups.

CONCLUSION

Therefore, intervention based on these factors early in life may help reduce the characteristics of personality disorders. Also, considering the role of these factors, treatment protocols can be prepared.

Negative Parenting Styles and Psychological Crisis in Adolescents: Testing a Moderated Mediating Model of School Connectedness and Self-Esteem

Little is known about how rejecting and controlling parenting styles may influence adolescent psychological crisis and what conditions may buffer the detrimental effects of psychological crisis. By integrating multiple theories, this study investigated self-esteem as an underlying mediator and school connectedness as a potential moderator to explain the link between negative parenting and the two psychological crises among Chinese adolescents. In this study, the questionnaire method is adopted to examine the combined mechanism of rejecting parenting style and controlling parenting style on the psychological crisis of adolescents. In total, 1863 adolescents were involved in this study, ranging from 13 to 17 years old. The results showed that both the rejecting parenting style and the controlling parenting style can significantly and positively predict the level of psychological crisis of adolescents, but the predictive power of the rejecting parenting style was stronger. Self-esteem partially mediates the relationship between rejecting parenting style, controlling parenting style, and psychological crisis. School connectedness moderates both the effects of rejecting parenting styles on self-esteem and the effects of self-esteem on the psychological crisis. This study identifies the internal mechanisms by which negative parenting styles affect adolescents' psychological crisis, and reveals the mediating and moderating roles of self-esteem and school connectedness, providing additional explanatory paths for the mechanisms of adolescents' psychological crisis.

The association between adverse childhood events and cluster C personality disorders: A meta-analysis

INTRODUCTION

Studies suggest that adverse childhood events (ACEs) may contribute to the onset and development of cluster C personality disorders. However, the association between ACEs and these disorders remains unclear in terms of consistency across studies and effect magnitude, as well as generalizability within cluster C. The current meta-analysis aimed to examine the associations between ACEs and cluster C personality disorders based on the available literature.

METHODS

Systematic searches were conducted in PubMed, Scopus, Web of Science and PsychInfo. Forty-eight eligible studies were included in the analyses, and pooled effect sizes were estimated both at the level of cluster C and at the level of each specific disorder. Moderation and meta-regression analyses were also conducted.

RESULTS

ACEs were consistently associated with overall cluster C, as well as each of the specific disorders in this cluster. Sources of heterogeneity included type of instrument used to assess ACEs (questionnaires > interviews) and type of instrument used to assess the personality disorders (clinical interviews > questionnaires, as well as their combination with interview). The associations between ACEs and all cluster C personality disorders decreased with age.

CONCLUSIONS

ACEs are consistently associated with all cluster C personality disorders. Future work could approach the mechanisms underlying this association, preferably using longitudinal designs and considering the potential sources of effect variability identified in the present study.

The Relationship Between Early Maladaptive Schemas and Cluster C Personality Disorder Traits: A Systematic Review and Meta-Analysis

PURPOSE OF REVIEW

We systematically reviewed and meta-analyzed the literature on the relationship between early maladaptive schemas (EMSs) and Cluster C personality disorders (PDs). Our aim was to clarify which of the 18 EMSs exhibit the strongest associations and are most frequently endorsed in clinical and non-clinical samples with Cluster C PDs and traits.

RECENT FINDINGS

After initially screening 2622 records, 12 studies were selected with 5310 participants. Meta-analyses of the raw correlation coefficients for each EMS-Cluster C PD link (3-8 studies per meta-analysis) indicated that the 18 EMSs were significantly related to all three Cluster C PDs with r's ranging from .13 to .63. However, when considering endorsement rates among multiple regression studies that controlled for the EMSs intercorrelations and the effects of other PD traits and demographics, specific EMS constellations emerged for each Cluster C PD. Overall, the findings of the current paper suggest that Cluster C PDs might be conceptualized on the basis of a hybrid EMS model, in which all EMSs contribute to global personality dysfunction whereas specific EMS patterns reflect unique personality disorder style expressions. Longitudinal research with appropriate methodology is needed to draw more definite conclusions on the EMSs-Cluster C PDs relationships.

Early Maladaptive Schemas and Schema Modes among People with Histories of Suicidality and the Possibility of a Universal Pattern: A Systematic Review

BACKGROUND

The identification of variables affecting suicidality and the search for interventions to reduce suicide risk are priorities among mental health researchers. A promising direction for such research is schema therapy and its two main constructs, i.e., early maladaptive schemas (EMSs) and schema modes.

METHODS

This systematic review was designed in accordance with the PRISMA guidelines. It summarizes the studies conducted to date that describe the relationship between EMSs and schema modes and measures of suicidality in individuals over the age of 16.

RESULTS

The review confirmed that there are many significant associations between EMSs (especially from the Disconnection/Rejection domain) and suicide risk. Although only one study was found that explores the association between schema modes and suicidality, the correlations it identified are also confirmed here.

DISCUSSION

The results show the unquestionable importance of EMSs and schema modes in assessing suicide risk. The co-occurrence of these variables represents the first step in further assessing causality and introducing schema therapy techniques into work with patients who are at risk of suicide. This issue requires more extensive experimental research.

Do self and interpersonal dysfunction cross-sectionally mediate the association between adverse childhood experiences and personality pathology?

Two primary limitations of research on the association between adverse childhood experiences (ACEs) and personality disorder (PD) are (1) failure to consider mechanisms of association and (2) inconsistent results due, in part, to inconsistent approaches to quantifying ACE exposure. The current study will address these limitations by examining the cross-sectional mediating role of self- and interpersonal dysfunction on the association between ACE and three PDs (antisocial, schizotypal, and borderline) using three quantifications of ACE exposure (cumulative, individual, and unique risk). Participants were 149 current or recent psychiatric patients, and data analyses were performed through estimation of a series of cross-sectional mediation models. Taken together, results suggest that (1) the association between ACE and PD is moderate, (2) self- and interpersonal dysfunction cross-sectionally mediate this association, (3) after accounting for variance shared among ACEs, associations between specific ACE subtypes and PD were negligible, (4) much of the association between ACE and PD is accounted for by general processes impacted by all forms of ACE and implicated in all forms of PD, and (5) emotional neglect may uniquely contribute to self- and interpersonal dysfunction and thereby, PD risk.

Anger and psychological symptoms relationship: mediator role of maladaptive schemas

Trait anger is the strong predictor of various psychological symptoms like anxiety, depression, and hostility. Explaining how and why this relationship occurs is crucial to come up with more effective prevention and intervention strategies in the field. To this end, the current study aimed to reveal the mediating effect of early maladaptive schemas, which is the basic concept of schema therapy, on the relations of trait anger and psychological symptoms. Data was collected from 301 university students by using the measurement tools of Brief Symptom Inventory, Trait Anger Scale and Young Schema Scale. Findings revealed that trait anger positively predicted psychological symptoms. Secondly, a set of predictive models were prepared to detect the mediating effect of early maladaptive schemas. According to the analysis in the last stage, early maladaptive schemas fully mediated the relationship between trait anger and psychological symptoms.

The effect of parenting styles on Chinese undergraduate nursing students' academic procrastination: the mediating role of causal attribution and self-efficacy

Background

Academic procrastination is common among college students, but there is a lack of research on the influencing mechanism of academic procrastination among nursing students. The purpose of this study was to explore the influence of parental rearing patterns on academic procrastination of nursing students, and the mediating role of causal attribution and self-efficacy.

Methods

Using Parental Bonding Instrument, Aitken Procrastination Inventory, Multidimensional Multi-Attribution Causality Scale and General Self-Efficiency Scale, the data of 683 nursing undergraduates from two universities in China were collected. Moreover, path analysis for structural equation modeling via AMOS 26.0 to evaluate mediation path model.

Results

Positive parenting style was negatively associated with academic procrastination (r = -0.350) and negative parenting style was positively associated with academic procrastination (r = 0.402). Positive parenting style directly or indirectly predicted academic procrastination through the mediating effect of internal attributional style (β = -0.10, 95% CI: -0.18 to -0.04) and self-efficacy (β = -0.07, 95% CI: -0.11 to -0.03), and this mediating effect accounted for 41.46% of the total effect. Positive parenting style directly or indirectly predicted academic delay through the mediating effect of external attributional style (β = 0.12, 95% CI: 0.07 to 0.17) and self-efficacy (β = 0.05, 95% CI: 0.03 to 0.08), and this mediating effect accounted for 42.5% of the total effect. In addition, causal attribution and self-efficacy of nursing students play a chain intermediary role between parenting style and academic procrastination.

Conclusion

Parents should give students more care and autonomy and reduce control. In addition, educators should give students attribution training, which is helpful to improve students' self-efficacy and reduce academic procrastination.

Parenting styles and obsessive-compulsive symptoms in college students: the mediating role of perfectionism

Introduction

Obsessive-compulsive symptoms is a common psychological phenomenon among early adulthood college students, which are closely related to their parents' parenting styles. Theoretical and some empirical studies have suggested the mediating role of perfectionism in this process, but this has not been confirmed, and the binary perspective of positive-negative perfectionism has not been addressed in this issue.

Methods

This study aimed to investigate the mediating role of perfectionism in the relationship between parenting styles and obsessive-compulsive symptoms among college students. A total of 661 college students participated in this study.

Results

Negative perfectionism mediated the relationship between negative parenting style and obsessive-compulsive symptoms among college students. Negative parenting style predicted obsessive-compulsive symptoms through its positive predictive effect on negative perfectionism. However, the mediating effect of positive perfectionism was not significant in this process.

Discussion

This study provides further evidence of the mechanisms underlying the occurrence of obsessive-compulsive symptoms, and offers new ideas for interventions for OCD.

Early Maladaptive Schemas and Their Impact on Parenting: Do Dysfunctional Schemas Pass Generationally?-A Systematic Review

There are several factors that play a key role in the development of early maladaptive schemas, i.e., temperament, unmet core emotional needs, and adverse childhood events (e.g., traumatization and victimization, overindulgence, overprotection). Thus, the parental care that a child experiences has a substantial impact on the potential development of early maladaptive schemas. Negative parenting can range from unconscious neglect to overt abuse. Previous research supports the theoretical concept that there is a clear and close relationship between adverse childhood experiences and the development of early maladaptive schemas. Maternal mental health problems have been proven to be a factor that has strengthened the link between a mother's history of negative childhood experiences and subsequent negative parenting. Consistent with the theoretical background, early maladaptive schemas are associated with a wide variety of mental health problems. Clear links have been found for EMSs and personality disorders, depression, eating disorders, anxiety disorders, obsessive-compulsive disorder, and post-traumatic stress disorder. In light of these theoretical and clinical connections, we decided to summarize the available literature on the multigenerational transmission of early maladaptive schemas, which is also an introduction to our research project.

The mediating effects of coping style and resilience on the relationship between parenting style and academic procrastination among Chinese undergraduate nursing students: a cross-sectional study

BACKGROUND

How to kindle the learning enthusiasm of nursing students and reduce the incidence of academic procrastination is an important factor in reducing student attrition and improving the quality of nursing education.

OBJECTIVES

To investigate the mediating role of coping style and resilience on the association between parenting styles and academic procrastination among nursing undergraduates.

METHODS

A cross-sectional study of 683 nursing undergraduates was conducted in China from March to May 2022. Parenting styles, coping style, resilience, and academic procrastination were measured using questionnaires. Descriptive analysis, Pearson's correlation analysis and Hayes' PROCESS Macro in SPSS 25.0 were used to test the model.

RESULTS

Positive parenting style had a significantly direct effect on academic procrastination and through three significantly indirect pathways: (1) through positive coping style (B =  - 0.048, 95% CI: - 0.074 to - 0.025), accounting for 14.71% of the total effect; (2) through negative coping style (B =  - 0.044, 95% CI: - 0.071 to - 0.021), accounting for 13.64% of the total effect; and (3) through resilience (B =  - 0.074, 95% CI: - 0.107 to - 0.044), accounting for 22.82% of the total effect. Moreover, negative parenting style had a significantly direct effect on academic procrastination and through two significantly indirect pathways: (1) through negative coping style (B = 0.056, 95% CI: 0.032 to 0.086), accounting for 21.73% of the total effect, and (2) through resilience (B = 0.028, 95% CI: 0.004 to 0.055), accounting for 10.93% of the total effect.

CONCLUSIONS

Intervention measures to reduce the academic procrastination of nursing undergraduates should include the evaluations of coping styles and resilience of nursing students and cultivation strategies to promote their positive coping styles and resilience.

Development and Validation of the Young Parenting Inventory (YPI-R3) for Measuring Past Deviant and Normal Variations in Parenting

Most measures of past parenting patterns have a restricted range of about two to three negative parenting constructs. The Young Parenting Inventory (YPI-R2) provides a more nuanced framework that measures a fuller spectrum of these negative parenting patterns and, therefore, holds the potential of being a more useful guide to parents and caretakers. The YPI-R2 is made up of six validated subscales. An additional four were identified but were not sufficiently robust to be included. The purpose of this study is to determine if these four scales can be strengthened through the development of additional items and be empirically validated. Using non-clinical, English-speaking community samples from Singapore (n = 592, 628) and Malaysia (n = 222, 229), these revised scales were tested using multiple exploratory factor analyses with fathers and mothers rated separately. After further scale refinement, the final model, which consisted of 10 subscales and 41 items, was then subjected to confirmatory factor analysis using 4 other non-clinical international samples with separate ratings for fathers and mothers—USA (n = 259, 281), South Africa (n = 318, 372), Nigeria (n = 328, 344) and India (n = 277, 289). The results show that the YPI-R3 with 10 subscales is a robust and cross-culturally acceptable model. Correlations and hierarchical multiple regression analyses showed that the YPI-R3 has good convergent validity and predictive capabilities with measures of psychopathology, personality traits, emotional distress, negative schemas and other distal measures of functioning in everyday life—gratitude, humor and satisfaction with life.

The experience of loneliness among people with a "personality disorder" diagnosis or traits: a qualitative meta-synthesis

BACKGROUND

Loneliness is prevalent among people with a "personality disorder" diagnosis or who have related personality traits, but the experience of loneliness among people with "personality disorder" diagnoses/traits has not been well described. A qualitative approach has potential to help understand the experience of loneliness among people with "personality disorder" diagnoses/traits, and to develop interventions that promote recovery. We therefore aimed to synthesise the qualitative literature relevant to this topic.

METHOD

We conducted a meta-synthesis of qualitative studies exploring the subjective experience of loneliness as reported by people with "personality disorder" diagnoses/traits. We searched four databases using pre-formulated search terms, selected eligible articles, appraised the quality of each, and analyzed data from eligible studies using thematic synthesis.

RESULT

We identified 39 articles that described the experience of loneliness in people with "personality disorder" diagnoses/traits. From extracted data, we identified seven themes: (1) disconnection and emptiness: a "haunting alienation", (2) alienation arising from childhood experiences, (3) thwarted desire for closeness and connection, (4) paradox: for both closeness and distance, (5) experiences of existential loneliness, (6) recovery, embedded in a social world, and (7) group therapy: a setback. Our results suggest that for our sample early alienating and traumatic experiences may pave the way for experiences of loneliness, which further exacerbate "personality disorder" symptoms and distress.

CONCLUSION

Despite describing a need to belong and efforts to cope with unmet social needs, people with "personality disorder" diagnoses/traits (particularly "emotionally unstable personality disorder") report experiencing an intense disconnection from other people. This seems rooted in early adversities, reinforced by later traumatic experiences. Given the apparent salience of loneliness to people with "personality disorder" diagnoses/traits, interventions focused on helping people connect with others, which may include both psychological and social components, have potential to be beneficial in reducing loneliness and promoting recovery.

The Young Parenting Inventory (YPI-R3), and the Baumrind, Maccoby and Martin Parenting Model: Finding Common Ground

The parenting typology of Baumrind, Maccoby and Martin is based on variations in warmth and control and consists of three negative parenting styles labelled authoritarian, neglectful, and permissive. This parenting typology is based on normal variations of parenting but did not include dimensions arising from deviant parenting (e.g., abuse and neglect). A parenting typology has emerged based on the schema therapy model through the development of the Young Parent Inventory (YPI-R3), which represents a fuller range of maladaptive parenting spanning the deviant to normal range of the parenting continuum. Using six international, community, nonclinical samples with separate ratings for mothers and fathers from the USA, n = 259, 281; South Africa, n = 318, 372; Nigeria, n = 328, 344; India, n = 277, 289; Singapore, n = 592, 628; and Malaysia, n = 222, 229, results showed that the best second order higher factor solution of the ten YPI-R3 subscales was a three factor solution that runs parallel to, and resembles, the three negative parenting styles of Baumrind, Macobby and Martin. This factor structure was also shown to be a consistent and cross-culturally acceptable model among the countries from which the samples were drawn. The resemblance and implications of both parenting models were discussed.

Adverse childhood experiences and early maladaptive schemas in adulthood: A systematic review and meta-analysis

BACKGROUND

Schema Therapy is based on the theory that trauma and neglect in childhood lead to early maladaptive schemas and psychopathology in adulthood. The aim of this review was to evaluate support for this theory by synthesizing the literature on childhood adversity and schemas.

METHODS

A systematic review and meta-analysis were completed in compliance with PRISMA. PsycInfo, CINAHL and PubMed were searched to identify eligible studies that reported unadjusted association(s) between adverse childhood events and schema scores when participants were 18 years or older. Meta-analyses were conducted to estimate the pooled effect size of associations between schemas and experiences of childhood adversity.

RESULTS

A total of 33 studies met inclusion criteria and provided sufficient data for meta-analyses on childhood experiences relating to toxic frustration of needs (emotional neglect and physical neglect) and trauma and victimization (emotional abuse, physical abuse and sexual abuse). Of the 124 meta-analyses, 65 indicated that schemas show small to large correlations with emotional neglect (range: r = .16 [Failure] to r = .51 [Emotional Deprivation]); small to moderate correlations with emotional abuse (range: r = .20 [Vulnerability to Harm] to r = .44 [Emotional Deprivation]); and small correlations with physical neglect, physical abuse and sexual abuse (range: r = .16 [Vulnerability to Harm] to .26 [Emotional Deprivation and Social Isolation]).

CONCLUSIONS

Of the 33 included studies, only one used a longitudinal design. However, based on the correlational studies available, early maladaptive schemas in adulthood are associated with a history of childhood abuse and neglect.

Association between childhood parental rearing, sexual partnerships, social support and posttraumatic stress disorders (PTSD) among young HIV-positive MSM

We aimed to assess the effect of childhood parental rearing on post-traumatic stress disorder (PTSD) among young HIV-positive men who have sex with men (MSM), as well as the mediation effect of social support on this association. A convenient sampling method and questionnaire-based survey were used to recruit eligible participants from the Wuhan Medical Treatment Center from 20 December 2018 to 28 February 2019. Bivariate analyses were used to investigate the correlations between PTSD and childhood parental rearing, the number of sexual partners and social support. Mediation analyses were used to investigate the mediation of social support. Totally, 142 eligible MSM participated in our study, with prevalence of PTSD being 33.10%. It was found that maternal warmth (M1) and maternal favoring (M5) were positively correlated with social support. Paternal rejection (F5) was positively correlated with PTSD. The effects of M1 and M5 on PTSD were completely mediated by social support. The effects of paternal favoring (F4) and M5 on PTSD were completely mediated by subjective social support, and the effects of F5 and M1 were completely mediated by social support utility. Social support was an important mediator between parental rearing and PTSD.

Temperament, parenting styles and the intensity of early maladaptive schemas: assessment of correlations in a non-clinical adult group

BACKGROUND

Prior research has partially verified the significance of child temperament and styles of upbringing for schema intensity. However, there is still a lack of understanding of the inter-relations between them.

AIM

The present study examined how temperament (stable and labile) and style of parenting (positive and negative) are related to each other, and to early maladaptive schemas.

METHOD

Participants (395 healthy adults) completed the Young Schema Questionnaire YSQ-S3 and the Retrospective Assessment of Parents' Attitudes and Formal Characteristic of Behaviour - Temperament Inventory (FCB-TI). Structural equation modelling was used to verify hypotheses.

RESULTS

Temperament and parental styles together explain more than 59% of the variance of schema intensity. The obtained path coefficients show one-way directions of inter-relations. Stable temperament connects to schemas directly with a negative path coefficient. Labile temperament shows a significant positive association with negative parental attitudes, but not directly with schemas. Negative parenting is positively connected with schemas. A positive style of parenting is not significantly connected with temperament and schemas.

CONCLUSIONS

Results show evidence that negative style of parenting and labile temperament features are more important for schema developing and may be treated as risk factors. Because temperament seems to be a relatively persistent feature, it may play a similar role in adulthood, reinforcing emotions and feelings in the context of environment, and then maintain the schemas.

Schema therapy versus cognitive behavioral therapy versus individual supportive therapy for depression in an inpatient and day clinic setting: study protocol of the OPTIMA-RCT

BACKGROUND

Major depressive disorder represents (MDD) a major cause of disability and disease burden. Beside antidepressant medication, psychotherapy is a key approach of treatment. Schema therapy has been shown to be effective in the treatment of psychiatric disorders, especially personality disorders, in a variety of settings and patient groups. Nevertheless, there is no evidence on its effectiveness for MDD in an inpatient nor day clinic setting and little is known about the factors that drive treatment response in such a target group.

METHODS

In the current protocol, we outline OPTIMA (OPtimized Treatment Identification at the MAx Planck Institute): a single-center randomized controlled trial of schema therapy as a treatment approach for MDD in an inpatient and day clinic setting. Over the course of 7 weeks, we compare schema therapy with cognitive behavioral therapy and individual supportive therapy, conducted in individual and group sessions and with no restrictions regarding concurrent antidepressant medication, thus approximating real-life treatment conditions. N = 300 depressed patients are included. All study therapists undergo a specific training and supervision and therapy adherence is assessed. Primary outcome is depressive symptom severity as self-assessment (Beck Depression Inventory-II) and secondary outcomes are clinical ratings of MDD (Montgomery-Asberg Depression Rating Scale), recovery rates after 7 weeks according to the Munich-Composite International Diagnostic Interview, general psychopathology (Brief Symptom Inventory), global functioning (World Health Organization Disability Assessment Schedule), and clinical parameters such as dropout rates. Further parameters on a behavioral, cognitive, psychophysiological, and biological level are measured before, during and after treatment and in 2 follow-up assessments after 6 and 24 months after end of treatment.

DISCUSSION

To our knowledge, the OPTIMA-Trial is the first to investigate the effectiveness of schema therapy as a treatment approach of MDD, to investigate mechanisms of change, and explore predictors of treatment response in an inpatient and day clinic setting by using such a wide range of parameters. Insights from OPTIMA will allow more integrative approaches of psychotherapy of MDD. Especially, the identification of intervention-specific markers of treatment response can improve evidence-based clinical decision for individualizing treatment.

TRIAL REGISTRATION

Identifier on clinicaltrials.gov : NCT03287362 ; September, 12, 2017.

Early maladaptive schemas and their relation to personality disorders: A correlational examination in a clinical population

Personality disorder (PD) pathology has been linked to early maladaptive schemas (EMSs). Because of a large heterogeneity in study populations, sample size, statistical analyses and conceptualizations in the literature, the exact relationships between PDs and EMSs are still unclear. The current study examined the relationship between borderline, dependent, avoidant and obsessive–compulsive PDs, represented dimensionally as number of traits, and 15 different EMSs as measured by the Young Schema Questionnaire (YSQ). A total of N = 130 inpatients took part in the study (M^age = 43.6, gender = 51.5% female). Stepwise regressions indicated that borderline, dependent, avoidant and obsessive–compulsive PD traits were partly characterized by specific EMSs and EMSs grouped as domains (i.e., other‐directedness domain for dependent PD and overvigilance for obsessive–compulsive PD) and that relations with a variety of domains and EMSs were overlapping for the PD dimensions (i.e., disconnection and rejection for both borderline and avoidant PDs). This suggests that PDs are reflected by a hybrid model of EMSs, with some EMSs and domains that relate to a broader vulnerability factor for PDs, and other domains that differentially relate to the independent PDs. Findings are informative for clinicians, as various EMSs per PD may be targeted in therapy.

Schema modes mediate the effect of emotional abuse in childhood on the differential expression of personality disorders

BACKGROUND

There is sound evidence that childhood maltreatment increases the likelihood of developing personality disorders (PDs). However, research on the possible mechanisms involved in the relationship between childhood maltreatment and PDs is scarce. One potential mediator of the maltreatment-PD relationship are schema modes, reflecting dynamic states of cognition, emotion, and behaviour.

AIMS

The current study aimed to explore the mediating effect of schema modes on the association between childhood maltreatment and the expression of Cluster B (borderline and antisocial) and C (avoidant and dependent) PDs.

METHOD

Within a mixed sample of N = 120 clinical PD patients and non-clinical participants, a multivariate path model including interview-assessed childhood maltreatment (emotional abuse, emotional neglect, sexual abuse, and physical abuse), schema modes (child, parent, coping and healthy modes), and borderline, antisocial, avoidant and dependent PDs was explored.

RESULTS

The path model depicted five significant indirect links from emotional abuse on PDs via distinct schema modes. The impact of emotional abuse on borderline PD was mediated by child and coping modes, while parent modes mediated the link to antisocial PD. Healthy modes acted as a mediator on dependent and avoidant PDs.

CONCLUSIONS

The results indicate emotional abuse as a main predictor of schema mode clusters and emphasize the mediating role of schema modes on the maltreatment-related pathways towards PDs. Therapeutic implications are discussed with a special focus on healthy modes.

Early maladaptive schemas and harm avoidance as mediating factors between early life stress and psychiatric symptoms in adults

Objective:

This study investigated how factors of temperament and early maladaptive schemas predict psychiatric symptoms, as well as how they mediate the relation between early life stress and psychiatric symptoms in adults.

Methods:

A cross-sectional study was conducted with a sample of 200 university students. Data was collected through a sociodemographic questionnaire, the Adult Self-Report Inventory, the Childhood Trauma Questionnaire, the Young Schema Questionnaire, and the Temperament and Character Inventory-Revised.

Results:

A model including early maladaptive schemas, harm avoidance (temperament factor), and early life stress explained 69% of the variation of the psychiatric symptoms; among the predictors, early maladaptive schemas explained 31% of psychiatric symptoms, while harm avoidance explained 25%. Most of the predictive power associated with early life stress can be better explained by early maladaptive schemas and, to a lesser extent, harm avoidance.

Conclusion:

By managing these processes therapeutically, deleterious effects associated with early life stress can be minimized.

The effects of parental rearing styles and early maladaptive schemas in the development of personality: a systematic review

INTRODUCTION

The present paper aims to identify and characterize studies that assess the repercussions of parental rearing styles on development of psychopathological symptoms and to examine the possible relations between parental rearing behaviors and development of early maladaptive schemas (EMS).

METHODS

A systematic search was conducted on the PsychNet, BVS, Scopus, Web of Science and PubMed databases for empirical studies published up to 2018 in Portuguese, English, or Spanish that investigated and characterized the effects of parental rearing styles.

RESULTS

The electronic search identified 321 articles on the various different databases, only 22 of which met the criteria for inclusion and were read in full. Correlations were found between EMS and maternal rejection, parental rearing styles and depression in the studies. EMS were also found to act as mediators in the relationship between parental rearing styles and/or education and dysfunctional symptoms during personality development.

CONCLUSIONS

In the studies selected, parental rearing styles stood out from other variables that influence personality development and activation of schematic patterns. It is therefore important to highlight the importance of conducting studies in this area to provide information that can promote care and prevention strategies in early childhood.

Schema therapy conceptualization of personality functioning and traits in ICD-11 and DSM-5

PURPOSE OF REVIEW

Schema therapy conceptualizes personality disorders in terms of modes and underlying schemas. This article reviews the literature on schema therapy conceptualization of personality disorder functioning and traits, and proposes how these findings apply to novel personality disorder classification in ICD-11 and the DSM-5 Alternative Model of Personality Disorders (AMPD).

RECENT FINDINGS

Maladaptive schemas and modes are generally associated with personality dysfunction and traits in conceptually coherent ways. The healthy adult mode, a transdiagnostic core concept in schema therapy, corresponds to the ICD-11 and DSM-5-AMPD features of core personality functioning. Modes and underlying schemas substantially overlap with specific ICD-11 and DSM-5-AMPD traits, which denote individual themes and styles of personality dysfunction.

SUMMARY

The dimensional personality disorder framework in ICD-11 and DSM-5-AMPD is largely compatible with the schema therapy model. The ICD-11 and DSM-5-AMPD provide a scientifically derived and theory-free framework for all practitioners, which may be connected to clinical theory of schema therapy in a coherent manner. Level of personality functioning can be conceptualized as healthy adult functioning (e.g. sense of identity, self-worth, emotion regulation, intimacy, and fulfillment), which inform intensity of treatment. Trait qualifiers can be conceptualized by associated modes (e.g., compliant surrender) and underlying schemas (e.g. abandonment), which inform focus and style of treatment.

Psychometric validation of the Young Parenting Inventory - Revised (YPI-R2): Replication and Extension of a commonly used parenting scale in Schema Therapy (ST) research and practice

This study aimed at developing a revised validated version of the Young Parenting Inventory (YPI) known as YPI-R2 that had 17 theoretical subscales. Using separate ratings for fathers and mothers samples from Singapore (n = 582, 617), Manila (n = 520, 538), Jakarta (n = 366, 383), and the USA (n = 204, 214), exploratory and confirmatory factor analysis (CFA) were conducted. This resulted in five subscales for fathers and six for mothers. The 17 theoretical subscales were not supported. Construct, convergent, and divergent validity of this new revised alternative YPI-R2 were also demonstrated. The stringent incremental validity test showed that the YPI-R2 accounted for additional statistically significant variance over and above that contributed by gender and three other established parenting instruments in predicting clinically relevant outcomes. Partial invariance of its factor structure was demonstrated through multigroup CFA using Eastern and Western samples. Finally, significant correlations with the 18 Early Maladaptive Schemas (EMSs) supported a central tenet of schema therapy that these are associated with early negative parenting patterns. Parenting norms in both Eastern and Western cultures that were associated with ill-being were also discussed thus showing the cross-cultural relevance of the YPI-R2.

Maladaptive schemas as mediators of the relationship between previous victimizations in the family and dating violence victimization in adolescents

This study examined whether exposure to family violence, both in the form of direct victimization and witnessing violence, predicted dating violence victimization in adolescents through maladaptive schemas. A sample of 933 adolescents (445 boys and 488 girls), aged between 13 and 18 (M = 15.10), participated in a three-year longitudinal study. They completed measures of exposure to family violence, maladaptive schemas of disconnection/rejection, and dating violence victimization. The findings indicate that witnessing family violence predicts the increase of dating violence victimization over time, through the mediation of maladaptive schemas in girls, but not in boys. Direct victimization in the family predicts dating violence victimization directly, without the mediation of schemas. In addition, maladaptive schemas contribute to the perpetuation of dating violence victimization over time. These findings provide new opportunities for preventive interventions, as maladaptive schemas can be modified.

Co-rumination, anxiety, and maladaptive cognitive schemas: when friendship can hurt

Background

This study investigated maladaptive cognitive schemas as mediators of the relationship between co-rumination and anxiety.

Methods

Self-report measures of co-rumination, trait cognitive and somatic anxiety, and early maladaptive cognitive schemas were provided to a nonclinical sample of 461 young adults. Mediation of co-rumination and trait somatic and cognitive anxiety by each early maladaptive schema domain was tested using nonparametric, bootstrap-based resampling.

Results

Significant associations between co-rumination and trait and cognitive anxiety were mediated by schema domains related to Rejection and Disconnection, Overvigilance and Inhibition, and Impaired Autonomy. The association between co-rumination and somatic anxiety was mediated by domains related to Rejection and Disconnection and Impaired Autonomy.

Conclusion

The results of this study showed that those who engage in co-rumination, potentially resulting in clinical levels of anxiety, might benefit from treatment that focuses on themes of rejection sensitivity and belonging, beliefs about autonomy, and when the anxiety is more cognitive, treatment that focuses on hypercriticalness and emotional inhibition too.

A new look at the schema therapy model: organization and role of early maladaptive schemas

This study reexamined the organization of Young's 18 early maladaptive schemas and their hypothesized associations with experiences of need-thwarting parental experiences in childhood and the "vulnerable child" mode of emotional distress in adulthood. A large Danish sample (N = 1054) of 658 clinical- and 391 nonclinical adults completed measures of early maladaptive schemas, parenting styles, and the vulnerable child mode. We identified four higher-order schema domains as most appropriate in terms of interpretability and empirical indices ("Disconnection & Rejection", "Impaired Autonomy & Performance", "Excessive Responsibility & Standards", and "Impaired Limits"). All four schema domains were differentially associated with conceptually relevant need-thwarting parental experiences. Apart from "Impaired Limits", the schema domains meaningfully accounted for the association between need-thwarting parental experiences in childhood and emotional states of feeling like a "vulnerable child" in adulthood. We conclude that four domains of early maladaptive schemas are empirically and conceptually consistent with Young's schema therapy model of personality pathology and longstanding emotional disorders. Findings warrant replication using different populations and if possible a prospective multi-method design. A scoring key for computing the four schema domains is provided.

Early maladaptive schemas and suicidal risk in an Iranian sample of patients with obsessive-compulsive disorder

There are few studies on suicidal risk and its related factors in patients diagnosed with obsessive-compulsive disorder (OCD). This study investigated the associations of early maladaptive schemas, OC symptom dimensions, OCD severity, depression and anxiety with suicidality (i.e., suicidal ideation and suicide attempts) in OCD patients. Sixty OCD outpatients completed the Scale for Suicide Ideation (SSI), the Young Schema Questionnaire-Short Form (YSQ-SF), the Yale-Brown Obsessive Compulsive Scale (Y-BOCS), the Dimensional Obsessive-Compulsive Scale (DOCS) and the Depression Anxiety Stress Scales (DASS-21). 51.7% of patients had lifetime suicide attempts and 75% had suicidal ideation. OCD patients with lifetime suicide attempts exhibited significantly higher scores on early maladaptive schemas than those without such attempts. Logistic regression analysis revealed that the mistrust/abuse schema and the OC symptom dimension of unacceptable thoughts explained lifetime suicide attempts. The mistrust/abuse schema, unacceptable thoughts and depression significantly predicted suicidal ideation. These findings indicated that the mistrust/abuse schema may contribute to high suicidality in OCD patients. Also, patients suffering from unacceptable thoughts need to be assessed more carefully for warning signs of suicide.

Perceived parental child rearing and attachment as predictors of anxiety and depressive disorder symptoms in children: The mediational role of attachment

The present study aimed to examine (a) the relative contribution of perceived parental child-rearing behaviors and attachment on anxiety and depressive symptoms, and (b) the role of attachment as a possible mediator of the association between parental rearing and anxiety and depression. A sample of 1002 children (aged 9-12 years) completed a booklet of self-report questionnaires measuring parental rearing behaviors, attachment towards peers, and DSM anxiety and depressive disorder symptoms. We found that parental aversiveness, parental neglect, and fearful/preoccupied attachment, each accounted for a significant amount of the variance in both anxiety and depressive symptoms. In addition, parental overcontrol was found to account for unique variance in anxiety whereas communication/warmth accounted for a significant proportion of the variance in depression. A relevant finding was that fearful/preoccupied attachment was found to mediate the association between parental rearing behaviors and both anxiety and depression. Parental rearing behaviors and attachment to peers may act as risk factors to the development and/or maintenance of anxiety and depressive symptomatology in children. Findings may contribute to outline preventive and/or treatment programs to prevent or reduce both clinical anxiety and depression during childhood.

Procrastination and suicide proneness: A moderated-mediation model for cognitive schemas and gender

This study examined the direct and indirect paths between procrastination and suicide proneness while considering gender differences. Participants included 547 undergraduates from a southeastern university. Procrastination was positively related to suicide proneness for both genders, although this relation was stronger for women. Moderated-mediation analyses with bootstrapping highlighted insufficient self-control schemas as a mediator in the relation between procrastination and suicide proneness. However, indirect pathways did not vary by gender. Results represent an extension of the Procrastination-Health Model by highlighting the contribution of cognitive factors in explaining the relation between procrastination and suicide proneness.

Elucidating the role of Early Maladaptive Schemas for psychotic symptomatology

Although cognitive accounts postulate negative self-concepts as a causal factor in the emergence of psychotic symptoms, little is known about the role of specific self-schemas for psychotic symptomatology. Building on a differentiated and treatment-informed schema model, we aimed to elucidate the role of Early Maladaptive Schemas (EMS) for psychotic symptomatology, particularly their specificity to patients with psychosis and their association with positive versus negative symptoms. We assessed EMS with the Young Schema Questionnaire in patients with psychosis (n=81), patients with depression (n=28) as well as healthy participants (n=60). In the psychosis sample symptoms were rated using the Positive and Negative Syndrome Scale. In comparison to healthy participants, patients with either psychosis or depression showed a higher overall number and intensity of EMS whereas the psychosis and the depression sample did not significantly differ. The overall number and intensity of EMS were significantly associated with positive but not with negative symptoms. Contrary to previous findings, patients with psychosis and patients with depression did not differ in the EMS subscale Mistrust/Abuse. The results suggest that EMS are particularly relevant to positive symptoms. Our findings imply that addressing maladaptive schemas in patients with psychosis by making use of the schema-concept holds potential.

Perceived Parental Bonding, Early Maladaptive Schemas and Outcome in Schema Therapy of Cluster C Personality Problems

OBJECTIVE

The objective of this paper was to examine the relationships between perceived parental bonding, Early Maladaptive Schemas (Young et al., 2003), and outcome of schema therapy of Cluster C personality problems and whether the perceptions of parental bonding could be influenced by schema therapy.

METHOD

The sample consisted of 45 patients with panic disorder and/or agoraphobia and Diagnostic and Statistical Manual of Mental Disorders, fourth edition, Cluster C personality traits who participated in an 11-week inpatient programme consisting of two phases; the first was a 5-week panic/agoraphobia-focused cognitive therapy, whereas the second phase was a personality-focused schema therapy. The patients were assessed at pre-treatment, mid-treatment and post-treatment and at 1-year follow-up.

RESULTS

Opposite to our hypothesis, lower paternal care at pre-treatment was related to more reduction in Cluster C personality traits from pre-treatment to 1-year follow-up. Maternal protection was related to the schema domains of impaired autonomy and exaggerated standards. Overall schema severity and the schema emotional inhibition at pre-treatment were associated with less change in Cluster C traits. Perceived maternal care was reduced from pre-treatment to 1-year follow-up, and more reduction in maternal care was related to less reduction in Cluster C traits.

DISCUSSION

Parental bonding failed to predict treatment outcome in the expected direction, but maternal protection was related to two of the schema domains. Overall schema severity and the particular schema emotional inhibition predicted outcome. Furthermore, perceived maternal care was reduced from before to after treatment. Future studies should examine these questions in larger samples of Cluster C patients receiving schema therapy of a longer duration.

KEY PRACTITIONER MESSAGE

Most schemas within the impaired autonomy domain and the schema self-sacrifice seem to be related to low perceived maternal protection. Overall schema severity and the schema emotional inhibition predict a poorer outcome of schema therapy of Cluster C personality problems, and therapy should give priority to emotional inhibition when this schema is endorsed. Therapists should be aware that schema therapy carries the risk to lead to a more negative view of mother's care during upbringing and this risk is accentuated with less benefit of therapy.

Emotional abuse as a predictor of early maladaptive schemas in adolescents: contributions to the development of depressive and social anxiety symptoms

The schema therapy model posits that maltreatment generates early maladaptive schemas (EMSs) that lead to the development of emotional disorders throughout the life span. The model also stipulates that temperament moderates the influence of maltreatment on EMSs. This study examines (a) whether emotional abuse perpetrated by parents and peers, both alone and interactively with temperament, predicts the worsening of EMSs; and (b) whether EMSs in turn predict an increase in depressive and social anxiety symptoms in adolescents. A total of 1,052 adolescents (Mage=13.43; SD=1.29) were assessed at three time points, each of which was separated by 6 months. The subjects completed measures of emotional abuse by parents and peers, neuroticism, extraversion, EMSs, depressive symptoms, and social anxiety. The findings indicate that emotional bullying victimization and neuroticism predict a worsening of all schema domains over time. Contrary to expectations, there was no significant interaction between temperament dimensions and emotional abuse. The results confirmed the mediational hypothesis that changes in EMSs mediated the predictive association between bullying victimization and emotional symptoms. This study provides partial support for the schema therapy model by demonstrating the role of emotional abuse and temperament in the genesis of EMSs.

Effects of education on very mild dementia among Chinese people in Hong Kong: potential mediators in the Cantonese Mini-Mental State Examination tasks

BACKGROUND

In Hong Kong, older Chinese adults generally have a low level of education. This study examined the effect of education on very mild Alzheimer's disease (AD), as quantified by Clinical Dementia Rating (CDR) scale (CDR 0.5 versus 0), in a Chinese community. The Cantonese version of the Mini-Mental State Examination (C-MMSE) was used to estimate cognitive abilities that were related to the level of education, and that in turn serve as protective factors for AD.

METHODS

A total of 788 community-dwelling older adults (383 CDR 0 and 405 CDR 0.5) were recruited in this cross-sectional study, which was derived from a population-based prevalence project. The participants' number of years of education and C-MMSE scores were used to predict their CDR scores using logistic regression and the mediation effects of C-MMSE scores were analyzed.

RESULTS

Consistent with previous studies, the chance of being rated as having very mild AD increased with age, but decreased with years of education, among the older adult community of Hong Kong. The effect of education on very mild dementia was weakened substantially when C-MMSE scores were included as mediating variables.

CONCLUSIONS

The findings indicate that the protective effects of education on dementia were mediated by an enhancement of older adults' performance on some C-MMSE items, including attention and orientation to time and place.

Role of father-child relational quality in early maladaptive schemas

Background

Primary maladaptive schemas, which are the basis of high-risk behavior and psychological disorders, result from childhood experiences with significant objects, such as fathers, in different developmental phases.

Objectives

This endeavor examined the role of the father in predicting these schemas.

Patients and Methods

A total of 345 Islamic Azad University students (Qom Branch) who were chosen through convenience sampling completed the Young Schema Questionnaire, the Parental Bonding Instrument, and the Parent–Child Relationship Survey.

Results

A multivariate regression analysis indicated that anumber of aspects of the father–child relationship, including care, emotional interaction, positive affection, the effective relationship, and excessive support, predict particular schemas.

Conclusions

Therefore, these findings suggested that psychotherapists examine the different aspects of the father–child relationship when restructuring schemas.

Negative life experiences and the development of cluster C personality disorders: a cognitive perspective

Early negative experiences have long been thought to play an important role in the development of personality disorders. Most of the literature regarding these early life experiences has focused on borderline personality disorder, with only occasional focus on other personality disorders. Utilizing cognitive theory of personality disorders (Beck et al., 2004), the authors conceptualize cluster C personality disorders (avoidant, dependent, and obsessive-compulsive). They then critically review the relevant literature on early negative life experiences and later development of these disorders to determine whether the theory is supported by the empirical data. The theory regarding avoidant and dependent personality disorders has limited support, whereas data relating to obsessive-compulsive personality disorder are much weaker. Implications and future research suggestions are discussed.

Associations linking parenting styles and offspring personality disorder are moderated by parental personality disorder, evidence from China

The aim of the study is to examine the association linking parenting and personality disorder controlling for parental personality disorder, and whether this association is moderated by parental PD. Data were from community-dwelling high school students aged 18 and above and their parents living in Beijing, China. A total of 181 cases and 2,605 controls were included in this study. Personality disorder in students was assessed via a two-stage approach, Personality Diagnostic Questionnaire as a screening tool and International Personality Disorder Examination as the diagnostic tool. Information about parenting was collected from students using Egna Minnen av. Betraffande Uppfostran. Negative parenting styles, e.g. rejective or over-protective parenting, were found to be associated with the occurrence of personality disorder. Conflictive parenting styles were also found to be associated with personality disorder. Generally stronger associations were found for students with parental personality disorder as compared to students without parental personality disorder. Findings from this study support the role of parenting in the occurrence of PD, especially for children with family history of personality disorder.