Incremental validity of maladaptive schemas over five-factor model facets in the prediction of personality disorder symptoms

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Abstract

The present study investigated the prediction of personality disorder symptoms from early maladaptive schemas (EMSs) and the facets of the five-factor model of personality (FFM). The hypothesis that EMSs add to the understanding of personality disorder symptoms beyond normal personality traits was tested. One hundred and forty-five psychiatric outpatients completed the NEO PI-R, the SQ-SF, and the DIP-Q. Results showed a high degree of overlap of EMSs and FFM facets with personality disorder symptomatology. Hierarchical regression analyses indicated that EMSs contributed significantly to the prediction of personality disorder symptoms beyond FFM facets. Implications of the findings for the understanding of personality disorders are discussed.

Introduction

In the fourth edition of the American Psychiatric Association’s (APA) Diagnostic and Statistical Manual of Mental Disorders (DSM-IV-TR, American Psychiatric Association, 2000), a personality disorder (PD) is defined as “an enduring pattern of inner experience and behavior that deviates markedly from the expectations of the individual’s culture, is pervasive and inflexible, has an onset in adolescence or early adulthood, is stable over time, and leads to distress or impairment” (p. 685). DSM-IV-TR (APA, 2000) includes ten personality disorder categories that are grouped in three clusters: paranoid, schizoid, schizotypal (cluster A); antisocial, borderline, histrionic, narcissistic (cluster B); and avoidant, dependent, and obsessive–compulsive PD (cluster C).

The shortcomings of the conceptualization of PDs in DSM-IV are well-documented. They include a weak scientific base, high diagnostic co-occurrence, inadequate coverage of maladaptive personality functioning, instability of personality disorder symptoms, heterogeneity within diagnostic categories, and arbitrary diagnostic thresholds (Widiger & Trull, 2007). In response to these limitations, alternative models for the description and classification of personality psychopathology have been proposed. As an integrative framework, the five-factor model of personality (FFM) has received a prominent role (Clark, 2007, Widiger and Mullins-Sweatt, 2009). The FFM is a dimensional model of general personality structure, originally derived from empirical studies of trait terms (Goldberg, 1993). In Costa and McCrae’s (1992) conceptualization, the FFM is composed of the five broad domains neuroticism (N), extraversion (E), openness (O), agreeableness (A), and conscientiousness (C). Each domain is further subdivided into six facets. The factor of neuroticism includes the facets of anxiety, hostility, depression, self-consciousness, impulsiveness, and vulnerability. The facets of extraversion are warmth, gregariousness, assertiveness, activity, excitement-seeking, and positive emotions. Agreeableness is comprised of the facets of trust, straightforwardness, altruism, compliance, modesty, and tender-mindedness. The facets of openness are fantasy, aesthetics, feelings, actions, ideas, and values. The factor of conscientiousness includes the facets of competence, order, dutifulness, achievement striving, self-discipline, and deliberation.

From an FFM perspective, adult personality pathology can be understood as constellations of extreme variants of FFM traits (Costa and Widiger, 2002, Widiger and Mullins-Sweatt, 2009). Numerous studies have investigated the relationships between the FFM and DSM-IV PDs. Meta-analyses of these studies (Samuel and Widiger, 2008, Saulsman and Page, 2005) have found a high degree of overlap between FFM domains and facets and PDs. Moreover, it has been shown that trait change predicts change in PD symptoms, but not vice versa, giving additional support to the hypothesis that normal personality traits are a central part of PDs (Warner et al., 2004).

However, despite the predictive power of FFM domains and facets with respect to DSM-IV PDs, a considerable proportion of unexplained variance consistently remains (Clark, 2007). Samuel and Widiger (2008) acknowledge that it would not be expected that measures of normal personality fully account for all the variance in a measure of abnormal personality. Further, McCrae (2006) argues that extreme levels of personality traits do not necessarily imply psychopathology in need of treatment. He proposes that personality-related disorders are caused by misperceptions of reality or cognitive distortions that interfere with the individual’s attempts to deal effectively with life problems that are related to the individual’s personality traits. Similarly, Tackett and colleagues (Tackett, Balsis, Oltmanns, & Krueger, 2009) suggest that PDs are distinguished from personality traits by deficits in self-other conceptualization (i.e., extreme, inflexible, and maladaptive ways of thinking about self and others) leading to an inability to pursue age-appropriate life goals. McCrae (2006) notes that his requirement of misperceptions of reality is consistent with cognitive-behavioral models in which PDs are understood in terms of dysfunctional cognitive schemas (Beck et al., 2004, Young et al., 2003). Thus, it can be hypothesized that the construct of dysfunctional schemas adds to the understanding of PDs.

Generally, a schema can be understood as consisting of “organized elements of past reactions and experiences that form a relatively cohesive and persistent body of knowledge capable of guiding subsequent perception and appraisals” (Segal, 1988 p. 147). In cognitive therapy, the schema concept is essential for the understanding and treatment of PDs (Beck et al., 2004, Young et al., 2003). In order to conceptualize the schemas of individuals with longstanding characterological problems and PDs, Young (Young et al., 2003) defined a subgroup of schemas, so-called early maladaptive schemas (EMSs). EMSs consist of memories, emotions, cognitions, and bodily sensations that are thought to develop in childhood when psychological core needs (e.g., secure attachment, realistic limits, and freedom to express valid needs) are repeatedly frustrated (Young et al., 2003). Over time, EMSs become deeply entrenched and self-perpetuating patterns of distorted thinking that cause psychological distress.

Based on clinical experience, Young (1999) developed a list of EMSs and self-report inventories for assessing them, the Schema Questionnaire (SQ) and the Schema Questionnaire-Short Form (SQ-SF). The scales of the SQ-SF are described in brief in Table 1. The relationships between the FFM domains and EMSs for the present sample have been reported in Thimm (2010).

The purpose of the present study is to investigate whether EMSs add to the prediction of PD symptoms beyond the FFM. Studies comparing the predictive power of FFM domains and facets (e.g., Bagby, Costa, Widiger, Ryder, & Marshall, 2005) repeatedly found that the FFM facets account for a higher proportion of variance in PD measures than the FFM domains. Lynam and Widiger (2001) reported expert FFM facet descriptions of each DSM-IV PD (see Appendix). Further, Beck et al. (2004) provided cognitive profiles and models of each DSM-IV PD category. On the basis of these cognitive conceptualizations of PDs and Young et al.’s (2003) descriptions of the specific EMSs, it is hypothesized that the following EMSs add significantly to the prediction of PD symptoms beyond the respective expert-generated prototypic FFM facets from the Lynam and Widiger (2001) study: mistrust (paranoid PD); emotional inhibition, social isolation (schizoid PD); mistrust, social isolation (schizotypal PD); entitlement (antisocial PD); dependence, abandonment, insufficient self-control, emotional deprivation, enmeshment, defectiveness, mistrust (borderline PD); entitlement, dependence (histrionic PD); entitlement, unrelenting standards (narcissistic PD); defectiveness, social isolation, failure, subjugation, insufficient self-control, emotional deprivation (avoidant PD); dependence, abandonment, subjugation (dependent PD); and unrelenting standards, emotional inhibition (obsessive–compulsive PD).

Section snippets

Participants

The sample consisted of 145 outpatients (107 women and 38 men) receiving treatment at the Helgeland Hospital Trust Mo i Rana and Levanger Hospital in Norway. Patients participated in a research project on the concept of EMSs. Exclusion criteria were mental retardation, acute psychosis, or insufficient reading skills. Out of 211 patients who signed an informed consent form, 149 (71%) returned the study measures. Four participants were excluded from the current investigation due to missing data.

Results

Agreement with the meta-analytic findings of Samuel and Widiger (2008) were high (>.85) for most PD categories, moderate for narcissistic (.60) and obsessive–compulsive PD (.69), and low (.41) for histrionic PD. Therefore, the DIP-Q histrionic PD scale was excluded from further analysis.

Results of hierarchical regression analyses are shown in Table 4, Table 5, Table 6. Step 2 ΔR2 values in model 1 analyses show that the predicted FFM facets accounted for a considerable proportion of variance in

Discussion

Based on McCrae’s (2006) and Tackett et al.’s (2009) proposal that dysfunctional cognitions play an important role in distinguishing extreme but normal personality traits from PDs, the current study examined the incremental validity of EMSs in the prediction of symptoms of PDs beyond FFM facets in an adult psychiatric outpatient sample.

Hierarchical regression analysis showed that, consistent with expectations, EMSs contributed to the prediction of PD symptoms beyond FFM facets. These gains

Acknowledgements

The author is indebted to the participating patients. The study was supported by a Grant from the Psychiatric Research Center of Northern Norway.

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