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Cognitive Therapy and Research

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21-02-2023 | Original Article

Relationships Between DSM-5 Personality Disorders and Early Maladaptive Schemas from the Perspective of Dimensional and Categorical Comorbidity

Auteurs: Bettina Steylaerts, Eva Dierckx, Chris Schotte

Gepubliceerd in: Cognitive Therapy and Research | Uitgave 3/2023

Abstract

Background

Personality disorders (PDs) are highly prevalent in clinical populations, causing patients to suffer from significant everyday impairment. According to Young’s schema theory, early maladaptive schemas (EMSs) are the driving force behind PDs.

Methods

Within a large clinical sample of 2043 psychiatric patients, we measured personality pathology through the ADP-IV and EMSs through the YSQ-SF. We provide new perspectives into the existing research by controlling for personality pathology that is highly comorbid within the sample, using dimensional (PD traits) and categorical (PD diagnoses) paradigms. Associations between EMS and ADP-IV dimensional scales were examined through partial correlations, while controlling for all other highly intercorrelated PD trait scales. Within the categorical paradigm, we investigated relationships between EMS scales and ADP-IV PD diagnoses by means of logistic regression analyses, while controlling for the three PDs that were most prevalent and comorbid in the sample, namely borderline, avoidant and obsessive–compulsive PD. In all analyses, we added gender and general psychopathology—assessed through the SCL-90-R total score—as extra control variables.

Results

Substantial results, supported by both the correlation and regression analyses, strengthen previous evidence for relationships between paranoid PD and Mistrust/abuse EMS, schizotypal PD and Social isolation EMS, borderline PD and Abandonment EMS, narcissistic PD and Entitlement EMS, avoidant PD and Emotional inhibition EMS, dependent PD and Abandonment EMS and obsessive–compulsive PD and Unrelenting standards EMS. Moreover, we found substantial evidence for previously underreported relationships between avoidant PD and Social Isolation EMS, avoidant PD and Failure to achieve EMS, dependent PD and Dependence/incompetence EMS and dependent PD and Subjugation EMS.

Conclusions

By taking into account the clinical reality of dimensional and categorical comorbidity, this research allows for a more purified image of the relations between PDs and EMSs, uncontaminated by the influence of comorbid PDs. Hence, our results provide relevant insights for the theoretical assumptions underlying PD-targeted cognitive-behavioral and schema therapy.

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Relationships are positive unless otherwise specified between brackets.

Social undesirability EMS is included in this Dutch version of the YSQ-SF, but this study does not make use of the scores on this EMS.

American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). American Psychiatric Association.CrossRef

Ansell, E. B., Sanislow, C. A., McGlashan, T. H., & Grilo, C. M. (2007). Psychosocial impairment and treatment utilization by patients with borderline personality disorder, other personality disorders, mood and anxiety disorders, and a healthy comparison group. Comprehensive Psychiatry, 48(4), 329–336. https://doi.org/10.1016/j.comppsych.2007.02.001CrossRefPubMed

Arntz, A., Rijkeboer, M., Chan, E., Fassbinder, E., Karaosmanoglu, A., Lee, C. W., & Panzeri, M. (2021). Towards a reformulated theory underlying schema therapy: Position paper of an international workgroup. Cognitive Therapy and Research, 45, 1007–1020. https://doi.org/10.1007/s10608-021-10209-5CrossRef

Arrindell, W. A., & Ettema, J. H. M. (1986). SCL-90. Handleiding bij een multidimensionele psychopathologie-indicator Lisse.

Aycicek, T. A. (2017). Een schematheoretisch verklaringsmodel voor grandioos en kwetsbaar narcisme (Unpublished master’s thesis). Universiteit Utrecht.

Ball, S. A., & Cecero, J. J. (2001). Addicted patients with personality disorders: Traits, schemas, and presenting problems. Journal of Personality Disorders, 15(1), 72–83. https://doi.org/10.1521/pedi.15.1.72.18642CrossRefPubMed

Bamelis, L. L. M., Evers, S. M. A. A., Spinhoven, P., & Arntz, A. (2014). Results of a multicenter randomized controlled trial of the clinical effectiveness of schema therapy for personality disorders. The American Journal of Psychiatry, 171(3), 305–322. https://doi.org/10.1176/appi.ajp.2013.12040518CrossRefPubMed

Baranoff, J., Oei, T. P. S., Cho, S. H., & Kwon, S. M. (2006). Factor structure and internal consistency of the young schema questionnaire (short form) in Korean and Australian samples. Journal of Affective Disorders, 93(1–3), 133–140. https://doi.org/10.1016/j.jad.2006.03.003CrossRefPubMed

Barazandeh, H., Kissane, D. W., Saeedi, N., & Gordon, M. (2016). A systematic review of the relationship between early maladaptive schemas and borderline personality disorder/traits. Personality and Individual Differences, 94, 130–139. https://doi.org/10.1016/j.paid.2016.01.021CrossRef

Beckwith, H., Moran, P. F., & Reilly, J. (2014). Personality disorder prevalence in psychiatric outpatients: A systematic literature review. Personality and Mental Health, 8(2), 91–101. https://doi.org/10.1002/pmh.1252CrossRefPubMed

Carr, S. N., & Francis, A. J. P. (2010a). Do early maladaptive schemas mediate the relationship between childhood experiences and avoidant personality disorder features? a preliminary investigation in a non-clinical sample. Cognitive Therapy and Research, 34(4), 343–358. https://doi.org/10.1007/s10608-009-9250-1CrossRef

Carr, S. N., & Francis, A. J. P. (2010b). Early maladaptive schemas and personality disorder symptoms: An examination in a non-clinical sample. Psychology and Psychotherapy: Theory, Research and Practice, 83(4), 333–349. https://doi.org/10.1348/147608309X481351CrossRef

Cui, L., Lin, W., & Oei, T. P. S. (2011). Factor structure and psychometric properties of the young schema questionnaire (short form) in Chinese undergraduate students. International Journal of Mental Health and Addiction, 9(6), 645–655. https://doi.org/10.1007/s11469-010-9283-4CrossRef

First, M. B., Gibbon, M., Spitzer, R. L., Williams, J. B. W., & Benjamin, L. (1997). User’s guide for the Structured Clinical Interview for DSM-IV Axis II Personality Disorders (SCID-II). American Psychiatric Association.

Fribourg, O., Martinussen, M., Kaiser, S., Øvergard, K. T., & Rosenveinge, J. H. (2013). Comorbidity of personality disorders in anxiety disorders: A meta-analysis of 30 years of research. Journal of Affective Disorders, 145(2), 143–155. https://doi.org/10.1016/j.jad.2012.07.004CrossRef

Fusar-Poli, P., Solmi, M., Brondino, N., Davies, C., Chae, C., Politi, P., Borgwardt, S., Lawrie, S. M., Parnas, J., & McGuire, P. (2019). Transdiagnostic psychiatry: A systematic review. World Psychiatry, 18(2), 192–207. https://doi.org/10.1002/wps.20631CrossRefPubMedPubMedCentral

Giesen-Bloo, J., Van Dyck, R., Spinhoven, P., Van Tilburg, W., Dirksen, C., Van Asselt, T., Kremers, I., Nadort, M., & Arntz, A. (2006). Outpatient psychotherapy for borderline personality disorder: Randomized trial of schema-focused therapy vs transference-focused psychotherapy. Archives of General Psychiatry, 63(6), 649–658. https://doi.org/10.1001/archpsyc.63.6.649CrossRefPubMed

Gignac, G. E., & Szodorai, E. T. (2016). Effect size guidelines for individual differences researchers. Personality and Individual Differences, 102, 74–78. https://doi.org/10.1016/j.paid.2016.06.069CrossRef

Glaser, B. A., Campbell, L. F., Calhoun, G. B., Bates, J. M., & Petrocelli, J. V. (2002). The early maladaptive schema questionnaire- short form: A construct validity study. Measurement and Evaluation in Counseling and Development, 35(1), 2–13. https://doi.org/10.1080/07481756.2002.12069043CrossRef

Goddard, E., Wingrove, J., & Moran, P. (2015). The impact of comorbid personality difficulties on response to IAPT treatment for depression and anxiety. Behaviour Research and Therapy, 73, 1–7. https://doi.org/10.1016/j.brat.2015.07.006CrossRefPubMed

Godt, K. (2002). Personality disorders and eating disorders: The prevalence of personality disorders in 176 female outpatients with eating disorders. European Eating Disorders Review, 10(2), 102–109. https://doi.org/10.1002/erv.441CrossRef

Grant, B. F., Chou, S. P., Goldstein, R. B., Huang, B., Stinson, F. S., Saha, T. D., Smith, S. M., Dawson, D. A., Pulay, A. J., Pickering, R. P., & Ruan, W. J. (2008). Prevalence, correlates, disability, and comorbidity of DSM-IV borderline personality disorder: Results from the wave 2 national epidemiologic survey on alcohol and related conditions. The Journal of Clinical Psychiatry, 69(4), 533–545. https://doi.org/10.4088/JCP.v69n0404CrossRefPubMedPubMedCentral

Grant, B. F., Hasin, D. S., Stinson, F. S., Dawson, D. A., Patricia Chou, S., June Ruan, W., & Huang, B. (2005). Co-occurrence of 12-month mood and anxiety disorders and personality disorders in the US: Results from the national epidemiologic survey on alcohol and related conditions. Journal of Psychiatric Research, 39(1), 1–9. https://doi.org/10.1016/j.jpsychires.2004.05.004CrossRefPubMed

Grilo, C. M., McGlashan, T. H., Quinlan, D. M., Walker, M. L., Greenfeld, D., & Edell, W. S. (1998). Frequency of personality disorders in two age cohorts of psychiatric inpatients. The American Journal of Psychiatry, 155(1), 140–142. https://doi.org/10.1176/ajp.155.1.140CrossRefPubMed

Hemphill, J. F. (2003). Interpreting the magnitude of correlation coefficients. American Psychologist, 58(1), 78–79. https://doi.org/10.1037/0003-066X.58.1.78CrossRefPubMed

Johansen, M., Karterud, S., Pedersen, G., Gude, T., & Falkum, E. (2004). An investigation of the prototype validity of the borderline DSM-IV construct. Acta Psychiatrica Scandinavica, 109(4), 289–298. https://doi.org/10.1046/j.1600-0447.2003.00268.xCrossRefPubMed

Johnson, J. G., Cohen, P., Skodol, A. E., Oldham, J. M., Kasen, S., & Brook, J. S. (1999). Personality disorders in adolescence and risk of major mental disorders and suicidality during adulthood. Archives of General Psychiatry, 56(9), 805–811. https://doi.org/10.1001/archpsyc.56.9.805CrossRefPubMed

Jovev, M., & Jackson, H. J. (2004). Early maladaptive schemas in personality disordered individuals. Journal of Personality Disorders, 18(5), 467–478. https://doi.org/10.1521/pedi.18.5.467.51325CrossRefPubMed

Kenan, M. M., Kendjelic, E. M., Molinari, V. A., Williams, W., Norris, M., & Kunik, M. E. (2000). Age-related differences in the frequency of personality disorders among inpatient veterans. International Journal of Geriatric Psychiatry, 15(9), 831–837.CrossRefPubMed

Keown, P., Holloway, F., & Kuipers, E. (2002). The prevalence of personality disorders, psychotic disorders and affective disorders amongst the patients seen by a community mental health team in London. Social Psychiatry and Psychiatric Epidemiology, 37(5), 225–229. https://doi.org/10.1007/s00127-002-0533-zCrossRefPubMed

Kovanicova, M., Kubasovska, Z., & Pallayova, M. (2020). Exploring the presence of personality disorders in a sample of psychiatric inpatients. Journal of Psychiatry and Psychiatric Disorders, 4, 118–129. https://doi.org/10.26502/jppd.2572-519x0099CrossRef

Kunst, H., Lobbestael, J., Candel, I., & Batink, T. (2020). Early maladaptive schemas and their relation to personality disorders: A correlational examination in a clinical population. Clinical Psychology & Psychotherapy, 27(6), 1–10. https://doi.org/10.1002/cpp.2467CrossRef

Loranger, A. W., Sartorius, N., Andreoli, A., Berger, P., Buchheim, P., Channabasavanna, S. M., Coid, B., Dahl, A., Diekstra, R. F., Ferguson, B., & Jacobsberg, L. B. (1994). The international personality disorder examination: The world health organization/alcohol, drug abuse, and mental health administration international pilot study of personality disorders. Archives of General Psychiatry, 51(3), 215–224. https://doi.org/10.1001/archpsyc.1994.03950030051005CrossRefPubMed

Marinangeli, M. G., Butti, G., Scinto, A., Di Cicco, L., Petruzzi, C., Daneluzzo, E., & Rossi, A. (2000). Patterns of comorbidity among DSM-III-R personality disorders. Psychopathology, 33(2), 69–74. https://doi.org/10.1159/000029123CrossRefPubMed

McCarter, K. L., Halpin, S. A., Baker, A. L., Kay-Lambkin, F. J., Lewin, T. J., Thornton, L. K., Kavanagh, D. J., & Kelly, B. J. (2016). Associations between personality disorder characteristics and treatment outcomes in people with co-occurring alcohol misuse and depression. BMC Psychiatry, 16(210), 1–13. https://doi.org/10.1186/s12888-016-0937-zCrossRef

McGlashan, T. H., Grilo, C. M., Skodol, A. E., Gunderson, J. G., Shea, M. T., Morey, L. C., Zanarini, M. C., & Stout, R. L. (2000). The collaborative longitudinal PDs study: Baseline axis I/II and II/II diagnostic co-occurrence. Acta Psychiatrica Scandinavica, 102(4), 256–264. https://doi.org/10.1034/j.1600-0447,2000.102004256.xCrossRefPubMed

Murphy, R., & Hallahan, B. (2016). Differences between DSM-IV and DSM-5 as applied to general adult psychiatry. Irish Journal of Psychological Medicine, 33(3), 135–141. https://doi.org/10.1017/ipm.2015.54CrossRefPubMed

Nakao, K., Gunderson, J. G., Phillips, K. A., Tanaka, N., Yorifuji, K., Takaishi, J., & Nishimura, T. (1992). Functional impairment in personality disorders. Journal of Personality Disorders, 6(1), 24–33. https://doi.org/10.1521/pedi.1992.6.1.24CrossRef

Nordahl, H. M., Holthe, H., & Haugum, J. A. (2005). Early maladaptive schemas in patients with or without personality disorders: Does schema modification predict symptomatic relief? Clinical Psychology and Psychotherapy, 12(2), 142–149. https://doi.org/10.1002/cpp.430CrossRef

Paulhus, D. (1991). Measurement and control of response bias. In J. Robinson, P. R. Shaver, & L. S. Wrightsman (Eds.), Measures of Personality and Social Psychological Attitudes. Elsevier.

Pauwels, E. (2018). The Validation of the Young Schema Questionnaire . Focus on Early Maladaptive Schemas and their Relationship with Eating and Substance Use Disorder Symptoms. Vrije Universiteit Brussel

Pauwels, E., Claes, L., Smits, D., Dierckx, E., Muehlenkamp, J. J., Peuskens, H., & Vandereycken, W. (2013). Validation and reliability of the young schema questionnaire in a flemish inpatient eating disorder and alcohol and substance use disorder sample. Cognitive Therapy and Research, 37(3), 647–656. https://doi.org/10.1007/s10608-012-9501-4CrossRef

Pauwels, E., Dierckx, E., Smits, D., Janssen, R., & Claes, L. (2018). Validation of the young schema questionnaire-short form in a flemish community sample. Psychologica Belgica, 58(1), 34–50. https://doi.org/10.5334/pb.406CrossRefPubMedPubMedCentral

Petrocelli, J. V., Glaser, B. A., Calhoun, G. B., & Campbell, L. F. (2001). Early maladaptive schemas of personality disorder subtypes. Journal of Personality Disorders, 15(6), 546–559. https://doi.org/10.1521/pedi.15.6.546.19189CrossRefPubMed

Pfohl, B., Coryell, W., Zimmerman, M., & Stangl, D. (1986). DSM-III personality disorders: Diagnostic overlap and internal consistency of individual DSM-III criteria. Comprehensive Psychiatry, 27(1), 21–34. https://doi.org/10.1016/0010-440X(86)90066-0CrossRefPubMed

Reeves, M., & Taylor, J. (2007). Specific relationships between core beliefs and personality disorder symptoms in a non-clinical sample. Clinical Psychology and Psychotherapy, 14(2), 96–104. https://doi.org/10.1002/cpp.519CrossRef

Reich, J. H., & de Girolamo, G. (1997). Epidemiology of DSM-Ill personality disorders in the community and in clinical populations. In A. Loranger, A. Janca, & N. Sartorius (Eds.), Assessment and diagnosis of personality disorders: The ICD-l0 international personality disorder examination (IPDE) (pp. 18–42). Cambridge University Press.CrossRef

Reich, J., & Troughton, E. (1988). Frequency of DSM-III personality disorders in patients with panic disorder: Comparison with psychiatric and normal control subjects. Psychiatry Research, 26(1), 89–100. https://doi.org/10.1016/0165-1781(88)90091-1CrossRefPubMed

Rijkeboer, M. M., & Van Den Bergh, H. (2006). Multiple group confirmatory factor analysis of the young schema-questionnaire in a dutch clinical versus non-clinical population. Cognitive Therapy and Research. https://doi.org/10.1007/s10608-006-9051-8CrossRef

Schotte, C., & De Doncker, D. (1994). ADP-IV Questionnaire. University Hospital Antwerp.

Schotte, C., & De Doncker, D. (1996). ADP-IV Questionnaire: Manual and norms. University Hospital Antwerp.

Schotte, C. K. W., & De Doncker, D. (2000). De ADP-IV: Een vragenlijst voor een therapeutisch georiënteerde diagnostiek van persoonlijkheidsstoornissen. Psychopraxis, 2(6), 124–130. https://doi.org/10.1007/bf03071865CrossRef

Schotte, C. K. W., De Doncker, D., Dimitruk, D., Van Mulders, I., D’Haenen, H., & Cosyns, P. (2004). The ADP-IV questionnaire: Differential Validity and concordance with the semi-structured interview. Journal of Personality Disorders, 18(4), 405–419. https://doi.org/10.1521/pedi.18.4.405.40348CrossRefPubMed

Schotte, C. K. W., De Doncker, D., Vankerckhoven, C., Vertommen, H., & Cosyns, P. (1998). Self-report assessment of the DSM-IV personality disorders measurement of trait and distress characteristics: The ADP-IV. Psychological Medicine, 28(5), 1179–1188. https://doi.org/10.1017/S0033291798007041CrossRefPubMed

Stevenson, J., Datyner, A., Boyce, P., & Brodaty, H. (2011). The effect of age on prevalence, type and diagnosis of personality disorder in psychiatric inpatients. International Journal of Geriatric Psychiatry, 26(9), 981–987. https://doi.org/10.1002/gps.2645CrossRefPubMed

Stopa, L., Thorne, P., Waters, A., & Preston, J. (2001). Are the short and long forms of the young schema questionnaire comparable and how well does each version predict psychopathology scores? Journal of Cognitive Psychotherapy, 15(3), 253–272. https://doi.org/10.1891/0889-8391.15.3.253CrossRef

Swartz, H. A., Pilkonis, P. A., Frank, E., Proietti, J. M., & Scott, J. (2005). Acute treatment outcomes in patients with bipolar I disorder and co-morbid borderline personality disorder receiving medication and psychotherapy. Bipolar Disorders, 7(2), 192–197. https://doi.org/10.1111/j.1399-5618.2005.00179.xCrossRefPubMed

Waller, G., Meyer, C., & Ohanian, V. (2001). Psychometric properties of the long and short versions of the young schema questionnaire: Core beliefs among bulimic and comparison women. Cognitive Therapy and Research, 25(2), 137–147.CrossRef

Wang, J., Chen, Z., Sun, W., Zheng, Y., Hui, L., Liu, X., Wang, J., Wu, H., Qiao, Y., & Zhang, T. (2019). a strategy to address high comorbidity of personality disorders in a chinese population: A principal and subordinate diagnostic model. Psychiatry, 82(3), 272–282. https://doi.org/10.1080/00332747.2019.1600218CrossRefPubMed

Welburn, K., Coristine, M., Dagg, P., Pontefract, A., & Jordan, S. (2002). The schema questionnaire—short form: Factor analysis and relationship between schemas and symptoms. Cognitive Therapy and Research, 26(4), 519–530. https://doi.org/10.1023/A:1016231902020CrossRef

Young, J. E. (1990). Cognitive therapy for personality disorders: A schema-focused approach. Sarasota professional Resource Exchange.

Young, J., & Behary, W. T. (1999). Schema-focused Therapy for Personality Disorders. In N. Tarrier, A. Wells, & G. Haddock (Eds.), Treating Complex Cases: The Cognitive Behavioural Therapy Approach (pp. 340–376). Wiley.

Young, J. E., & Brown, G. (1994). Young Schema-Questionnaire (2nd ed). In J. E. Young (Ed.), Cognitive therapy for personality disorders: A schema-focused approach Sarasota: Professional Resource Press.

Young, J. E., Klosko, J. S., & Weishaar, M. E. (2003). Schematherapy: A practitioner’s guide. The Guilford Press.

Young, J. E., & Pijnaker, H. (1999). Cognitieve therapie persoonlijkheidsstoornissen: Een schemagerichte benadering. Bohn Stafleu Van Loghum.CrossRef

Zanarini, M. C., Frankenburg, F. R., Dubo, E. D., Sickel, A. E., Trikha, A., Levin, A., & Reynolds, V. (1998a). Axis I comorbidity of borderline personality disorder. American Journal of Psychiatry, 155(12), 1733–1739. https://doi.org/10.1176/ajp.155.12.1733CrossRefPubMed

Zanarini, M. C., Frankenburg, F. R., Dubo, E. D., Sickel, A. E., Trikha, A., Levin, A., & Reynolds, V. (1998b). Axis II comorbidity of borderline personality disorder. Comprehensive Psychiatry, 39(5), 296–302. https://doi.org/10.1016/S0010-440X(98)90038-4CrossRefPubMed

Zeigler-Hill, V., Green, B. A., Arnau, R. C., Sisemore, T. B., & Myers, E. M. (2011). Trouble ahead, trouble behind: Narcissism and early maladaptive schemas. Journal of Behavior Therapy and Experimental Psychiatry, 42(1), 96–103. https://doi.org/10.1016/j.jbtep.2010.07.004CrossRefPubMed

Zimmerman, M., Rothschild, L., & Chelminski, I. (2005). The prevalence of DSM-IV personality disorders in psychiatric outpatients. The American Journal of Psychiatry, 162(10), 1911–1918. https://doi.org/10.1176/appi.ajp.162.10.1911CrossRefPubMed

Titel: Relationships Between DSM-5 Personality Disorders and Early Maladaptive Schemas from the Perspective of Dimensional and Categorical Comorbidity
Auteurs: Bettina Steylaerts
Eva Dierckx
Chris Schotte
Publicatiedatum: 21-02-2023
Uitgeverij: Springer US
Gepubliceerd in: Cognitive Therapy and Research / Uitgave 3/2023
Print ISSN: 0147-5916
Elektronisch ISSN: 1573-2819
DOI: https://doi.org/10.1007/s10608-023-10349-w

Bohn Stafleu van Loghum

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Abstract

Background

Methods

Results

Conclusions

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