The relationship between early maladaptive schemas and eating-disorder symptomatology among individuals seeking treatment for substance dependence

Drunkorexia Among a Sample of Lebanese Adults: The Role of Early Maladaptive Schemas

Background: Drunkorexia is a food and alcohol disturbance described as being a range of disordered and compensatory eating behaviors that co-occur with excessive alcohol consumption. The remarkable correlation, highlighted in the literature, between dysfunctional cognitions and both eating disorders and substance use disorders is able to emphasize that cognitive phenomena can be an intrapersonal factor linked to drunkorexia disorder. The aim of this study was to assess the correlation between early maladaptive schemas (EMSs) and drunkorexia among a sample of Lebanese adults.Method: We conducted a cross-sectional study across all the Lebanese governorates (September-December 2020; N = 258). The Drunkorexia Motives and Behaviors Scales, Drunkorexia Fails Scale, Drunkorexia during an Alcohol Consumption Event Scale, and Post-Drinking Compensation Scale were used to assess drunkorexia, whereas the Young Schema Questionnaire-Short Form three was used to measure EMSs.Results: Emotional deprivation and subjugation were significantly associated with more drunkorexia motives, whereas emotional inhibition was significantly associated with less drunkorexia motives. Failure was significantly associated with more drunkorexia behaviors. Abandonment and mistrust were significantly associated with more drunkorexia fails, whereas unrelenting standards was significantly associated with less drunkorexia fails. Subjugation was significantly associated with more drunkorexia during alcohol consumption on events. Social isolation was significantly associated with more post-drinking compensation, whereas unrelenting standards was significantly associated with less post-drinking compensation.Conclusion: Our findings showed that drunkorexia is positively associated with EMSs, delineating as well the specific relationships between dysfunctional cognitive schemas and drunkorexia's maladaptive behavioral aspects. They support the hypothesis that EMSs might play an important role in drunkorexia's development and perpetuation. This study could therefore serve healthcare professionals for the cognitive approach of patients with concomitant alcohol misuse and eating disorders while emphasizing the value of cognitive-behavioral interventions-namely schema therapy.

Potential applications of Schema Therapy in the treatment of adolescents with anorexia nervosa: a theoretical analysis

Purpose

The main purpose of the article is to present basic theoretical assumptions on Schema Therapy and its hypothetical application among adolescents suffering with anorexia nervosa.

Views

Anorexia nervosa is a very deadly mental disease, more frequently suffered by females than males, with the mean age of onset at approximately 14-15. Studies underline the relatively poor effectiveness of currently applied treatment methods and the need for new approaches that could be recommended for adolescent patients suffering with this disease. The results of studies conducted to date lead to the conclusion that Schema Therapy is a promising approach for this group. It is a transdiagnostic method of work that compiles elements known in other therapeutic approaches, aiming at an increase in the individual's awareness of their feelings and emotional needs, applied both in adolescent and adult groups of patients. Since the symptoms of eating disorders observed in adolescents are strongly connected with family systems it seems reasonable to use treatment techniques that rigorously address the unmet needs and rejected emotions of the individual.

Conclusions

Based on the data published so far it might be hypothesized that the techniques characteristic for Schema Therapy (e.g. imagery rescripting, chairwork, limited reparenting) could be eligible for use with adolescent patients with anorexia nervosa.They address unmet needs, rejected emotions, and early maladaptive schemas that are very frequent in patients with AN. Since the analysis presented provides only hypotheses and the discussion of theoretical aspects, empirical research in this area is needed.

Early maladaptive schemas and addictive behaviours: A systematic review and meta-analysis

BACKGROUND

Recently, early maladaptive schemas have been increasingly focused as the underlying factor of several psychopathologies. The primary objective is to systematically review and meta-analytically analyse the evidence on the relationship between early maladaptive schemas and types of addictive behaviours. Additionally, the secondary objective was to examine potential moderators of the effect sizes.

METHODS

The systematic search was conducted on three databases including 'Scopus', 'Web of Science' and 'PubMed'. They were searched for quantitative studies investigating the relationship between early maladaptive schemas and addictive behaviours. The studies that were non-English and had insufficient information to calculate effect sizes were excluded. The random-effect model was utilized to estimate the pool effect sizes, and the meta-regression was used for moderation analysis.

RESULTS

Thirty-three studies with 12,577 participants were included for analyses. Most of included studies were conducted in the United States (k = 12, 36.36%). The mean ages of participants varied from 13.32 to 46.09 years. The findings indicated that all of early maladaptive schemas and schema domains positively correlated with addictive behaviours. The disconnection and rejection, impaired limits and impaired autonomy were the domains with the highest association with substance addictions (pool r = 0.338, 3.26 and 3.16, respectively). Furthermore, disconnection and rejection and impaired autonomy were the schema domains with the highest association with behavioural addictions (0.310 and 0.304, respectively). The moderation analysis demonstrated that study design was the factor affecting the effect sizes between schema domain and addictive behaviours.

LIMITATION

All included studies were from peer-reviewed journals in English. Moreover, the number of research examining the relationship between early maladaptive schemas and behavioural addictions was limited.

CONCLUSION

The findings provide evidence supporting the idea that substance addictions and behavioural addictions have shared risk factors, supporting the validity of the schema model, which can be applied for targeting and preventing addictive behaviours.

Factor structure of the Young Positive Schema Questionnaire in an eating disorder sample

PURPOSE

The Young Positive Schema Questionnaire (YPSQ) measures early adaptive schemas (EAS) which could be used to develop positive psychology and schema-based interventions to benefit the treatment of eating disorders (EDs).

METHODS

The present study investigated the factor structure of the YPSQ in a sample of 826 participants (18-73 years; n = 753 women) with ED symptomatology (e.g., restricting, binging, and purging). The sample was randomly split into two groups for exploratory and confirmatory factor analyses. Full sample analysis using Pearson correlations was conducted to explore convergent validity of the new YSPQ factor structure with ED symptomatology, emotional regulation, and cognitive flexibility.

RESULTS

A nine-factor model was found, demonstrating good fit indices and internal consistency (α = 0.77-0.92). The YPSQ showed an inverse relationship to ED symptomatology and emotional suppression, and a positive relationship with cognitive flexibility and emotion reappraisal.

CONCLUSION

Further research is needed to explore the clinical benefits of the YPSQ to identify EAS deficits in individuals with EDs to improve treatment outcomes.

LEVEL OF EVIDENCE

Level V, descriptive study.

Exploring the association between early adaptive schemas and self-reported eating disorder symptomatology

OBJECTIVE

The current study aimed to examine the relationship between early adaptive schemas and eating disorder symptomatology in adults.

METHOD

A cross-sectional, correlational design was used to collect data from 352 females and 36 males aged between 18 and 49 years (M = 25.70, SD = 7.04). Participants completed an online questionnaire, which included The Young Positive Schema Questionnaire (YPSQ), Eating Disorder Examination-Questionnaire (EDE-Q) and demographic measures.

RESULTS

Four separate hierarchical multiple regression analyses showed that high levels of Healthy Boundaries and low levels of Optimism significantly predicted lower Restraint, Eating Concern, Shape Concern and Weight Concern scores. Additionally, higher scores in Emotional Openness and Social Belonging significantly predicted lower Eating Concern, while higher scores in Self-Care significantly predicted lower levels of Shape Concern.

CONCLUSION

The findings highlight the protective function that certain early adaptive schemas may play in mitigating eating disorder symptomatology. Moreover, the findings allude to potential modifiable therapy targets in the treatment of eating disorders. Further research is needed to investigate any differences in early adaptive schemas between eating disorder diagnoses.

Maladaptive Cognitive Schemas as Predictors of Disordered Eating: Examining the Indirect Pathway through Emotion Regulation Difficulties

A scarcity of research has looked into the association of maladaptive core beliefs with dysfunctional eating patterns. Moreover, no prior study has considered the potential role of difficulties in negative emotion regulation when disentangling the complex correlations between early maladaptive schemas and disturbed eating habits. Our study aimed at exploring the distinct relationships between early maladaptive schemas and disordered eating, while investigating the indirect role of emotion regulation difficulties within these associations. We collected data from 982 Lebanese young adults (18-30 years old), distributed across the five Lebanese governorates, who completed the Eating Attitudes Test (EAT-26), the Young Schema Questionnaire-Short Form 3 (YSQ-SF3), and the Difficulties in Emotion Regulation Scale-16 Item Version (DERS-16). The results showed that the disconnection and rejection schema domain, under which the early maladaptive schema of mistrust was the most predictive of disordered/inappropriate eating attitudes. All the remaining maladaptive schema domains (i.e., the impaired autonomy/performance, impaired limits, other-directedness, and overvigilance/inhibition schema domains) exerted significant indirect effects on disordered eating attitudes through difficulties in emotion regulation. Our findings gave prominence to a potential intrinsic mechanism through which maladaptive cognitive schemas are linked to disordered eating behaviors, emphasizing the role of emotion dysregulation as a cardinal actor within this model. They sustain the surmise that cognitively and emotionally vulnerable individuals exhibit stronger propensities for inappropriate dietary patterns, as a means to offset their inner weakness. This study broadens the medical community's insights into the underpinning processes behind eating disorder psychopathology and could therefore make a step towards the adoption of innovative therapeutic approaches that promote emotion regulation skills in the context of schema therapy.

Early maladaptive schemas in eating disorders: A systematic review

OBJECTIVE

Research and theory suggest the aetiological nature and symptomatic profile of eating disorders (EDs) can be explained by multiple factors, including the development of early maladaptive schemas (EMS). Yet, there is lack of consensus regarding the evidence supporting the relationship between EMS and EDs. Therefore, this systematic review aimed to examine existing literature concerning the relationship between different ED diagnoses and EMS to provide a synthesis and evaluation of relevant research.

METHOD

A comprehensive literature search of four electronic databases was conducted and studies were included that examined the association between EMS and EDs. Studies were required to use a variant of Young Schema Questionnaire and establish ED diagnosis or symptomology using self-report questionnaires or clinical interview.

RESULTS

A total of 29 studies were included in the review. Compared to healthy controls and varying clinical populations, individuals with EDs generally reported significantly higher scores across all EMS except for Entitlement. Furthermore, Unrelenting Standards consistently appeared as a significant EMS across all ED diagnoses whilst Insufficient Self-Control was significantly lower in ED diagnoses with restrictive behaviour compared to diagnoses with binge eating or purging behaviour.

DISCUSSION

Research supports significant associations between EMS and EDs, which may contribute to our understanding of ED aetiology, including different diagnostic categories. This review underscores the need for studies to explore more gender and age diverse samples and highlights important implications for practitioners.

Binge eating and psychostimulant addiction

Many of the various factors, characteristics, and variables involved in the addictive process can determine an individual’s vulnerability to develop drug addiction. Hedonic eating, based on pleasure rather than energy needs, modulates the same reward circuits, as do drugs of abuse. According to the last report of the World Health Organization, the worldwide obesity rate has more than doubled since 1980, reaching especially critical levels in children and young people, who are overexposed to high-fat, high-sugar, energy-dense foods. Over the past few decades, there has been an increase in the number of studies focused on how eating disorders can lead to the development of drug addiction and on the comorbidity that exists between the two disorders. Herein, we review the most recent research on the subject, focusing especially on animal models of binge eating disorders and drug addiction. The complex profile of patients with substance use and binge eating disorders requires an integrated response to dually diagnosed patients. Nutritional patterns should be considered an important variable in the treatment of substance use disorders, and future studies need to focus on specific treatments and interventions in individuals who show a special vulnerability to shift from one addiction to the other.

Early maladaptive schemas: Similarities and differences between female patients with eating versus substance use disorders

Personality features are considered to be important factors in the pathogenesis of both eating disorder (ED) and substance use disorder (SUD). This study investigates similarities and differences between these early maladaptive schemas (EMSs) (a) between female patients with ED (N = 179) or SUD (N = 169) and (b) between ED subtypes of the restrictive (N = 52), bulimic type (N = 127), or SUD. In total, 348 female patients (M_age  = 29.95; SD_age  = 8.40) completed the Young Schema Questionnaire. Multivariate analyses of covariance with EMS scales as dependent variables and (a) ED versus SUD and (b) ED subtypes versus SUD as independent variables and age and psychopathology as control variables revealed that ED patients scored significantly higher on Unrelenting Standards, Defectiveness, Social Undesirability, and Failure than did SUD patients. Additionally, when comparing ED subtypes and SUD, bulimic and SUD patients scored significantly higher on Insufficient Self-Control than did restrictive patients. These results confirm the role of EMSs in ED (subtypes) and SUD.

The relationship between mindfulness and compulsive sexual behavior in a sample of men in treatment for substance use disorders

Substance use disorders (SUDs) are a serious worldwide problem. Despite years of research on the treatment of SUDs, relapse remains high. One factor that may complicate SUDs treatment for some patients is compulsive sexual behavior. Factors that are related to both SUDs and compulsive sexual behavior could be targeted in SUDs treatment. In the current study, we examined dispositional mindfulness, a protective factor for a range of mental health problems, and its relationship to compulsive sexual behavior in a SUDs treatment sample. This is the first study to examine this relationship in a SUDs sample. Medical records from men in residential SUDs treatment were reviewed for the current study (N = 271). Upon admission to treatment, men completed self-report measures on alcohol and drug use, dispositional mindfulness, and compulsive sexual behavior. Bivariate correlations demonstrated dispositional mindfulness to be negatively associated with a variety of indicators of compulsive sexual behavior. After controlling for alcohol and drug use and problems in hierarchical regression analyses, which were both associated with compulsive sexual behaviors, dispositional mindfulness remained negatively associated with all of the compulsive sexual behavior indicators. Our results provide the first empirical association between dispositional mindfulness and compulsive sexual behavior in a SUDs sample. Although continued research is needed in this area, our findings suggest that it may be beneficial for SUDs treatment to incorporate mindfulness-based interventions for individuals with comorbid compulsive sexual behavior.

Are Borderline Personality Symptoms Associated With Compulsive Sexual Behaviors Among Women in Treatment for Substance Use Disorders? An Exploratory Study

OBJECTIVE

Extant literature has documented a significant relationship between borderline symptoms and substance use disorders. As supported in past work, there is a significant theoretical relationship between borderline symptoms and compulsive sexual behaviors because both disorders share common underlying behaviors and traits. There is no known research that has examined the empirical relationship between borderline symptoms and compulsive sexual behaviors in a population with substance use disorders. To fill this important gap in the literature, this relationship was examined in the current study.

METHOD

Medical records from 120 women admitted to a private, residential treatment program for substance use disorders were reviewed for the current study.

RESULTS

Hierarchical multiple regression analysis demonstrated that borderline symptoms were significantly associated with compulsive sexual behaviors after controlling for alcohol use and problems, drug use and problems, age, and positive impression management.

CONCLUSION

Results from this study provide potentially important research and clinical implications, which could ultimately aid treatment and reduce relapse. However, continued research is needed to further examine the relationship between symptoms and compulsive sexual behaviors.