The relationship between Early Maladaptive Schemas and the development of Obsessive-Compulsive Disorder and

the associated subtypes

Mary McGinley1, Karen Kirby1
1. Psychology, School of Psychology, Ulster University.
Introduction
Early Maladaptive Schemas (EMS’s) refer to the early development of self-defeating cognitive and emotional patterns which remain throughout life (Young et al., 2003). Whilst there is a
scarcity of literature considering the relationship between schemas and specific psychopathologies, when reviewing the literature pertaining to Obsessive Compulsive Disorder (OCD) and
EMS’s, an association between OCD and specific EMS activation was found (Figure 1). There remains a paucity of literature concerning the relationship between EMS’s, schema focused
therapies and the development of psychological disorders (Delattre et al., 2004). Considering this, the present study explored the relationship between specific schema activation and OCD,
and distinguished whether a dominant schema could be identified. It was hypothesised that: i) Young Schema Questionnaire (YSQ) scores would be positively correlated with OCD scores; ii)
specific schemas would be significantly correlated with OCD scores, and iii) there would be significant correlation between specific EMS’s and specific OCD subtypes. Identification of specific
schemas associated with OCD may allow for more bespoke treatments. Furthermore, determination and reduction of EMS’s associated with OCD may contribute to positive clinical
outcomes.
Method
High OCD scores A quantitative cross-sectional survey was used for data collection. 103 participants
completed the Obsessive-Compulsive Inventory – Revised, and the Young Schema
The association
between OCD and Specific Schema Questionnaire – Short Form (YSQ-S3) online. Relationships between the EMS’s: emotional
EMS activation Activation deprivation, mistrust/abuse, social isolation, defectiveness/shame, failure, and
High Scores in YSQ vulnerability to harm; and OCD (across subscales: checking, ordering, washing, hoarding,
obsessing and neutralizing), were tested using multiple regression analysis.

Vulnerability /
Social Isolation Defectiveness / Shame
Factors for success of Schema Therapy in the treatment of OCD
Pessimism

Emotional Deprivation Mistrust / Abuse Failure

Consider strength of Consider the underlying
Consider linear Consider effects of OCD
associations between causes for schema
Figure 1: Specific Schema Activation in patients with OCD (Atalay et al., (2008); Kim, Lee & Lee relationships between symptoms on EMS
EMSs, and the impact on activation, and
(2016); Yoosefi et al., (2016)). EMS’s formation
the development of OCD development of OCD

No previous research has yielded similar findings. The results suggest that the analysis of
The Relationship between EMS’s & OCD Subtypes
OCD subtypes with regards to EMS’s, may highlight OCD specific schemas; and offer
Significantly predicted
Strong strength of association insight into differential schema-related characteristics of each OCD subtype.
Did not significantly predict

Mistrust/Abuse Vulnerability to Harm

What does this research mean for Schema Therapists?

Offers clinicians a better

Encourages clinicians to
insight to their own Allows for collaboration,
Therapists can extend consider how
schemas/behaviours, knowledge expansion,
their offerings to a relationships between
which improves clinical psychoeducation, and
diverse client group EMS’s and OCD subtypes
practice and allows for innovation transfer.
Failure Defectiveness/Shame affects symptom
OCD better treatment of
presentation.
clients with OCD.
Table 1: Future Research and Clinical Implications

Discussion and research implications

Social Isolation Emotional Deprivation The research highlighted significant relationships between EMS’s and OCD. This supports the research
on which the hypotheses for the study were based (Figure 1). The findings also highlight a significant
correlation between EMS’s and OCD subtypes, which could influence clinical practice and be
implemented in the diagnosis and treatment of OCD (Figure 2).
Figure 2: The findings of the current research demonstrating the relationship between EMS’s and However, one of the main limitations associated with assessing EMS’s, is that they are believed to be
OCD. unconscious/underlying structures; whereas the self-report measures used within this study rely on
the participants’ self-perception and conscious awareness. Although literature suggests that EMSs
The Relationship between EMS’s and OCD Sub-types operate outside the bounds of conscious awareness, it could be inferred that participants have some
awareness of schemas – particularly when they contribute to negative outcomes/experiences.

Whilst non-self-report measures may offset any bias caused by self-reporting; the administration of
Washing such measures requires training and may be time consuming in clinical settings. This highlights the
need for valid and reliable self-report measures which can measure EMSs.
Vulnerability to Harm
Hoarding The use of a self-report questionnaire to collect data pertaining to OCD may also resulted in
participants falsely reporting or omitting accurate answers. Many sufferers of OCD refuse to disclose
the true nature of intrusions, due to the belief that there is something inherently “wrong” with them.
Mistrust / Abuse Therefore, the reliability of the data collected is questionable. The author did not control for
Ordering confounding factors/co-morbidities of OCD. Therefore, it remains unclear whether the activation of
schemas within this study was specific to OCD and OCD subtypes, or whether non-specific factors
OCD such as disability, co-morbidity, or functional impairment due to chronic illness contributed to EMS
Checking Failure scores. Further research is required to determine the power of the relationship between EMS’s and
OCD subtypes; and explore long term benefits of treatments that consider this finding.
Acknowledgements
Neutralising This work was supervised by Dr Karen Kirby PhD, MSc, BSc, C.Psychol, AFBPsS, SFHEA; and supported by Ulster
Social Isolation University.

Obsessing References
Atalay, H., Atalay, F., Karahan, D., & Caliskan, M. (2008). Early maladaptive schemas activated in patients with obsessive
compulsive disorder: A cross-sectional study. International journal of psychiatry in clinical practice, 12(4), 268–279
Delattre, V., Servant, D., Rusinek, S., Lorette, C., Parquet, P. J., Goudemand, M., & Hautekeete, M. (2004). The early
maladaptive schemas: a study in adult patients with anxiety disorders. L'Encephale, 30(3), 255–258.
Significantly predicted
Kim, J.E., Lee, S.W., & Lee, S.J. (2014). Relationship between early maladaptive schemas and symptom dimensions in
patients with obsessive-compulsive disorder. Psychiatry Research, 215, 134-140.
Figure 3: Findings from the current study which demonstrate the relationship between specific EMS’s young, J., Klosko, J., & Weishaar, M. (2003). Schema Therapy: A Practitioner's Guide. Guilford Press.
and OCD sub-types Yoosefi, N., Etemadi, O., Bahrami, F., Fatehizade, M., & Ahmadi, S.A. (2010). An Investigation on Early Maladaptive
Schema in Marital Relationship as Predictors of Divorce. Journal of Divorce & Remarriage, 51, 269 - 292.