Attachment and symptoms of psychopathology: early maladaptive schemas as a cognitive link?

Analysis of clinical characteristics and prognosis of childhood functional neurological disorder: Identifying key factors of prognosis and optimizing clinical management

BACKGROUND

To explore and analyze the clinical characteristics of childhood functional neurological disorder (FND) and identify key factors influencing the prognosis to optimize clinical practice.

METHOD

In this retrospective study, clinical data of children with FND who visited the Department of Pediatric Neurology of West China Second Hospital of Sichuan University between March 2020 and March 2023 were collected to analyze their clinical characteristics and prognosis. And 173 patients completed follow-up one year after diagnosis. Logistic regression was used to analyze factors associated with clinical prognosis.

RESULTS

Among the 248 patients, with a median age of 10 years (IQR 9-12), 60.5 % were male and 39.5 % were female. The most common symptoms were weakness or paralysis and non-epileptic seizures. 11.2 % combined with psychiatric disorders. Half of the patients had experienced previous stressors, including personal (40.3 %), family (22.6 %), and school factors (21.0 %). The average follow-up time was 488.7 ± 295.5 days. The overall prognosis was good, with clinical symptom remission in 75.1 % of cases. Logistic regression revealed that both the duration of symptoms and comorbid psychiatric disorders were negatively associated with a good prognosis.

CONCLUSION

The clinical characteristics of children with FND may be associated with socio-cultural background factors and psychological factors. Symptom duration and comorbid psychiatric disorders are important factors influencing prognosis.

Late Adolescents' Early Maladaptive Schemas: Are They Longitudinally Linked with Middle Childhood Temperament Over and Above Attachment?

Temperament is thought to influence the development of early maladaptive schemas (EMSs). However, whether temperament is longitudinally related to EMSs beyond attachment, the best known predictor of EMSs, has been underexplored. Hence, this study investigated (1) Whether middle childhood temperament is longitudinally related to late adolescent EMSs, (2) To what extent temperament explains EMSs beyond middle childhood attachment, and (3) Whether attachment moderates this temperament-EMSs link. In total, 157 children (Mage = 10.91 in middle childhood, Mage = 16.71 in late adolescence) participated in this study. Adolescent EMSs were assessed along with middle childhood temperamental negative affect, affiliation, surgency, and effortful control, and attachment at both explicit and implicit levels. Results indicated that all temperamental features were longitudinally related to later EMSs; the majority of the temperament-EMSs links did not survive after controlling for attachment, except for some limited correlations between EMSs and negative affect and effortful control; and an inconsistent moderating effect for attachment on the temperament-EMSs link. This study provides further insight into the role of child factors (middle childhood temperament and late adolescent attachment) in understanding EMSs variability in late adolescence. It suggests that EMSs are informed more by past relational experiences (attachment) than children's inborn tendencies (temperament).

Studyholism and Attachment Style: A Study among Italian University Students

Studyholism (or obsession with studying) is a new potential clinical condition introduced in the literature in 2017. Since then, growing research has supported its conceptualization as a clinical disorder and highlighted some potential intervention targets, namely trait worry, social anxiety, negative interpretation bias, and defense mechanisms. The present study aims to extend the literature concerning psychodynamic-related constructs that might constitute targets for interventions aimed at reducing Studyholism by investigating the role of attachment in 1073 students (Mage = 23.48 ± 3.77), balanced concerning civil status (i.e., currently being single or involved in a relationship/non-single). Among the main findings, we found that insecure attachment-mainly preoccupied attachment-is a positive predictor of Studyholism in both non-single and single students. However, there are also some differences depending on the civil status. Finally, (single) disengaged studyholics have a statistically significant lower level of secure attachment than (single) engaged studyholics. In conclusion, this study showed the value of distinguishing between non-single and single students when investigating the role of attachment. Regarding problematic overstudying specifically, the study provided support for its definition as a clinical disorder, also with evidence of the appropriateness of its OCD-related conceptualization. Finally, it suggests preoccupied (insecure) attachment as a target to reduce Studyholism by fostering in students the feeling of being loved and deserving of being loved in their current adult relationships.

Sensitivity and Attachment in an Italian Sample of Hikikomori Adolescents and Young Adults

Hikikomori is a severe form of social withdrawal increasing among the young Italian population. Hikikomori has been connected to psychological problems and high environmental sensitivity. Nevertheless, only a few studies have been carried out in the Italian context, and they did not analyze several aspects strictly related to the hikikomori phenomenon, such as the role of attachment and sensitivity. We aimed to investigate the relationship between attachment, sensitivity, and psychological problems in a sample of Italian hikikomori. Our sample comprised 72 Italian adolescents and young adults (49 males and 23 females), meanly aged 22.5 years, recruited through online forums and clinical centers for the hikikomori phenomenon. Our participants fulfilled the Highly Sensitive Person Scale (HSPS), the Attachment Style Questionnaire (ASQ), and the Hopkins Symptom Checklist (SCL-90-R). The results showed high psychological issues (i.e., depression and anxiety), environmental sensitivity, and insecure attachment orientations. Moreover, we discovered a significant relationship between attachment dimensions, environmental sensitivity, and psychopathology. Our study sheds light on a novel research path and could help both the researchers and the clinicians who work with people suffering from social withdrawal.

The mediating role of early maladaptive schemas in the relationship between attachment styles and loneliness

BACKGROUND

As with the increasing prevalence of loneliness among college students, it seems necessary to investigate the early grounds of its formation. Therefore, the present study was conducted to examine the relationship between attachment styles and loneliness through the mediating role of early maladaptive schemas (EMS).

METHODS

This research was correlational, of structural equations modeling (SEM) type. The statistical population included all the college students of the universities of Kermanshah in the academic year 2020-2021, of whom 338 were selected using convenience sampling. The measures used in this study included DiTomasso et al.'s social and emotional loneliness of adults, Hazan and Shaver's adult attachment, and Young's schema scales. For data analysis, Pearson's correlation coefficient and SEM were used in Lisrel 8.8 and SPSS-22 software.

RESULTS

The results illustrated that the hypothesized model of the study has a good fit in the studied sample. It was also found that both the avoidant and ambivalent attachment styles are related to loneliness through two EMS of disconnection-rejection and other-directedness.

CONCLUSIONS

Based on the findings, measures are recommended to increase information regarding the basic and underlying factors affecting loneliness for therapists and psychological specialists.

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.

Understanding interpersonal guilt: Associations with attachment, altruism, and personality pathology

The aim of this article is to empirically investigate the relationships among interpersonal guilt, as conceived within control-mastery theory (CMT), and attachment, altruism, and personality pathology in an English-speaking sample. An online sample of 393 participants was recruited to complete the Interpersonal Guilt Rating Scale self-report version-15 (IGRS-15s), together with other empirically validated measures for the assessment of attachment, altruism, and personality pathology. On the basis of previous studies conducted in Italian-speaking samples, we hypothesized that survivor guilt, separation/disloyalty guilt, and omnipotent responsibility guilt would be associated with attachment anxiety and avoidance, altruism, and personality pathology; self-hate was hypothesized to be associated only with attachment anxiety and avoidance and personality pathology. Analyses examined bivariate associations as well as the network of partial correlations among variables. The results largely confirmed hypothesized associations, with self-hate evincing the strongest unique association with personality dysfunction. Findings provide a basis for further research regarding interpersonal guilt and personality and relational functioning, with potential implications for clinical conceptualizations of the role of guilt in psychopathology.

Predictors of posttraumatic stress symptom severity and meaning made in treatment-seeking veterans

OBJECTIVE

Combat-exposed veterans risk encountering events that disrupt beliefs. To facilitate reduced discrepancy between prior beliefs and current trauma appraisals, veterans may engage in a process of meaning-making. Meaning-making can lead to positive outcomes, such as integrating the traumatic event into one's life narrative or adapting global meaning (meaning made) or elicit distress. Given these potentially different outcomes, this study examined potential correlates of posttraumatic stress symptom (PTSS) severity and meaning made, including relationship attachment dimensions of anxiety and avoidance, and difficulties with emotion regulation, while controlling for combat exposure.

METHOD

Veterans receiving mental health services at a Veterans Affairs (VA) Medical Center and a VA community-based outpatient clinic (N = 130) completed measures through a paper-and-pencil survey. Almost all participants (92%) were male, with a mean age of 55.92 years.

RESULTS

In terms of meaning made, lower levels of attachment anxiety and emotional clarity (an aspect of emotion regulation) predicted higher meaning made. In terms of PTSS severity, higher attachment avoidance, attachment anxiety, and difficulties engaging in goal-directed behavior (an aspect of emotion regulation) significantly predicted higher PTSS severity.

CONCLUSION

Aspects of both attachment style and emotion regulation difficulties affect meaning made and PTSS severity. These constructs may be especially relevant for clinicians working with veterans to help PTSS and support meaning made postcombat.

Understanding intergenerational transmission of early maladaptive schemas from a memory perspective: Moderating role of overgeneral memory on adverse experiences

BACKGROUND

Previous studies demonstrated that early maladaptive schemas (EMSs) are transmitted from mothers to children through adverse childhood experiences, such as maltreatment and unfulfilled core needs. The traumatic memory literature demonstrated that people with a history of trauma recall their traumatic and/or other negative experiences as categories of events-a phenomenon called overgeneral autobiographical memory (OGM)-to avoid the accompanying intense negative feelings. In the long run, OGM originating from an affect-regulation process after childhood traumatic experiences can facilitate the development of EMSs in children.

OBJECTIVE

This study expands the previous literature by studying whether OGM facilitates the transmission of EMSs by strengthening maladaptive thinking patterns after traumatic experiences.

PARTICIPANTS AND SETTINGS

A total of 120 mothers and late adolescents participated in this study. The mothers filled out the forms online through a link sent to their e-mail addresses, and the adolescents completed the forms online through a link posted on social media.

METHOD

Late adolescents completed the Autobiographical Memory Recall Task, Young Schema Questionnaire-Short Form-3 (YSQ-SF3), Childhood Trauma Questionnaire, and Beck Depression Inventory (BDI). Mothers filled out the YSQ-SF3 and BDI.

RESULTS

The results confirmed that adverse childhood experiences significantly mediated the relationship between mothers' and children's disconnection and rejection schemas. Furthermore, this relationship was stronger, especially for children with a higher tendency of overgeneral retrieval of negative experience (β = 0.26 (0.10), 95% CI [0.09, 0.49]).

CONCLUSIONS

The present study provides evidence that OGM facilitates the transmission of early maladaptive schemas.

Exploring everyday state attachment dynamics in middle childhood

The current study explored dynamics of secure state attachment expectations in everyday life in middle childhood, specifically state attachment carry-over and reactivity to experiences of caregiver support in the context of stress. In two independent samples (one community sample, N = 123; one adoption sample, N = 69), children (8–12 years) daily reported on their state attachment for respectively 14 and 7 consecutive days. Additionally, they reported daily on their experiences of distress and subsequent experiences of caregiver support. Results in both samples indicated that secure state attachment on a day-to-day basis is characterized by a significant positive carry-over effect, suggesting that state attachment fluctuations are (partially) self-predictive. In Study 1, experiencing no support following distress significantly related to intraindividual decreases in secure state attachment; in Study 2, experiencing effective support during distress related to intra-individual increases in secure state attachment. Taken together, the current studies provide novel and important insights into how state attachment temporally evolves on a day-to-day basis in middle childhood.

A Multi-Faceted Evaluation of Impulsivity Traits and Early Maladaptive Schemas in Patients with Anorexia Nervosa

(1) Background: patients with Anorexia Nervosa (AN) are classified either as restrictive (ANr) or binge/purge (ANbp) according to the absence or presence of impulsive eating and compensatory behaviors. The aim of the present study was to assess the levels of impulsivity in both AN subtypes and to explore whether individual differences in impulsivity may be explained by differences in the presence of early maladaptive schemas. (2) Methods: the sample group included 122 patients with ANr, 112 patients with ANbp, and 131 healthy women (HW). All of these participants completed the UPPS-P scale for an assessment of impulsive behaviors and the Young Schema Questionnaire (YSQ-S3) for an assessment of early maladaptive schemas. (3) Results: the patients with ANbp displayed higher levels of impulsivity compared with the patients with ANr and HW. Patients with AN, especially the restrictive subtype, also reported higher levels of early maladaptive schemas than HW, and regression analyses revealed that specific maladaptive schemas partially explain the variability in impulsivity in both patients and HW. (4) Conclusions: it appears that maladaptive beliefs developed during childhood or adolescence may predict the development of impulsivity, a personality trait usually associated with maladaptive behaviors, and appears to be prevalent among ANbp patients. The clinical effects of this, as well as directions for future study, are also discussed in this paper.

Negative emotions in siblings of individuals with developmental disabilities: The roles of early maladaptive schemas and system justification

BACKGROUND

Developmental disabilities (DD) in close family members have profound effects on psychological adjustment of siblings of individuals with DD. One factor that influences the psychological adjustment of siblings is emotions. However, little is known about emotions among siblings of individuals with DD.

AIMS

This study sought to examine negative emotions of adolescent siblings of individuals with DD and focus on the roles of individual- and system-related factors, namely early maladaptive schemas (EMS) and system justification.

METHODS AND PROCEDURES

A cross-sectional study including adolescent 72 siblings of individuals with DD and 109 adolescent siblings of individuals without DD was conducted.

OUTCOMES AND RESULTS

The siblings of individuals with DD had higher scores on the Other-Directedness schema domain and system justification than the siblings of individuals without DD. However, the frequency of negative emotions did not differ between groups. Lower scores on EMS and higher scores on system justification were associated with less frequent negative emotions.

CONCLUSIONS AND IMPLICATIONS

Negative emotions seem to be common in adolescents regardless of having a sibling with DD or not. Nevertheless, EMS and system justification tendencies in siblings of individuals with DD may act as vulnerability factors for negative emotions.

State Attachment Variability: Between- and within-Person Level Associations with Trait Attachment and Psychological Problems

Research suggests that inter-individual differences in the degree of state attachment variability are related to differences in trait attachment and psychological problems between children. In this study, we tested whether such associations are also relevant at a within-person level, and if so, whether intra-individual fluctuations in the degree of variability were predictive of or predicted by intra-individual fluctuations in trait attachment and psychological problems. Children (N = 152; M_age = 10.41 years, SD_age = 0.60 at time 1) were tested three times over a period of one year. At each timepoint, children reported on their expectations of maternal support in different distressing situations. Additionally, we administered measures of trait attachment to children and psychological problems to children and their mothers. We used Random-Intercept Cross-Lagged Panel Models to distinguish between-person from within-person associations between these constructs over time. The results revealed that the degree of state attachment variability was mainly relevant to understand differences between children in trait attachment and psychological problems: children who overall showed more state attachment variability were overall less securely attached at a trait-level and reported more psychological problems. Although evidence for within-person associations was less robust, there was some indication that the degree of state attachment variability might be related to the development of trust and psychological problems at a within-person level.

The Relation Between Attachment and Depression in Children and Adolescents: A Multilevel Meta-Analysis

Insecure attachment to primary caregivers is associated with the development of depression symptoms in children and youth. This association has been shown by individual studies testing the relation between attachment and depression and by meta-analyses focusing on broad internalizing problems instead of depression or adult samples only. We therefore meta-analytically examined the associations between attachment security and depression in children and adolescents, using a multilevel approach. In total, 643 effect sizes were extracted from 123 independent samples. A significant moderate overall effect size was found (r = .31), indicating that insecure attachment to primary caregivers is associated with depression. Multivariate analysis of the significant moderators that impacted on the strength of the association between attachment security and depression showed that country of the study, study design, gender, the type of attachment, and the type of instrument to assess attachment uniquely contributed to the explanation of variance. This study suggests that insecure attachment may be a predictor of the development of depression in children and adolescents. When treating depression in children, attachment should therefore be addressed.

Mediating Role of Narcissism, Vulnerable Narcissism, and Self-Compassion in the Relationship Between Attachment Dimensions and Psychopathology

OBJECTIVE

This study aimed to test the mediation effect of narcissism, vulnerable narcissism, and self-compassion in the relationship between attachment dimensions and psychopathology.

METHODS

The sample included 203 students, of whom 134 (66%) were women and 69 (34%) men with ages between 18 and 36 years [(mean: 20.73 (SD = 2.86)]. In this study, inventory of experiences in close relationships, Beck depression scale, Beck anxiety scale, narcissistic personality inventory, vulnerable narcissism scale, and self-compassion scale were used.

RESULTS

Anxious attachment was positively correlated with vulnerable narcissism and narcissistic personality traits, negatively with self-compassion, and positively with depression and anxiety. However, avoidant attachment was negatively correlated with vulnerable narcissism and narcissistic personality traits. Self-compassion was negatively associated with vulnerable narcissism, depression, and anxiety. When mediating effects were tested, it was found that narcissistic personality traits and vulnerable narcissism had mediating effects both in the relationship between anxious attachment and anxiety and in the relationship between anxious attachment and depression.

CONCLUSION

As it is known that insecure attachment is associated with the development of many psychopathologies in terms of preventive mental health, it is thought that it will be important to consider the dimensions of self-compassion and narcissism in the prevention programs to be carried out. Considering the mediating effect of self-compassion, targeting the development of an individual's non-judgmental attitude toward himself or herself can prevent possible psychological problems and create a buffering effect.

Emotional dysregulation in adults: The influence of rumination and negative secondary appraisals of emotion

BACKGROUND

Emotional dysregulation is commonly discussed as a transdiagnostic factor in clinical populations. The present study aims to investigate cognitive factors (rumination and negative appraisals of emotion) in the maintenance of emotional dysregulation in a normative sample in order to partially validate a cognitive model of emotional dysregulation and to examine the potential clinical relevance of addressing cognitive factors in the treatment of emotional dysregulation.

METHODS

People who were 18 or older were asked to participate via a university research system and social media. Participants (N = 216) were asked to fill out online surveys regarding emotional dysregulation, rumination and negative secondary appraisals of emotion.

RESULTS

People who had higher emotional dysregulation levels displayed a greater tendency to ruminate and were more prone to negative secondary appraisals of emotion. There was a positive association between rumination and negative secondary appraisals of emotion, and this association was mediated by emotional dysregulation.

LIMITATIONS

The present study was solely based on self-report measurements and the collected data were cross-sectional.

CONCLUSIONS

The present study showed that a wide spectrum of experiences of emotional dysregulation occurred in a normative sample. The significant mediation highlighted the maintaining role of rumination and negative appraisals in emotional dysregulation. These data highlight the importance of addressing cognitive factors in emotional dysregulation.

Attachment Insecurity in Rats Subjected to Maternal Separation and Early Weaning: Sex Differences

Attachment insecurity in the forms of attachment anxiety and avoidance is associated with mental disorders in humans. In this research field, rodents, especially mice and rats, are commonly used to study social behaviors and underlying biological mechanisms due to their pronounced sociability. However, quantitative assessment of attachment security/insecurity in rodents has been a major challenge. The present study identified attachment insecurity behaviors in rats subjected to maternal separation (MS) during postnatal days (PD) 2-16 and early weaning (EW) during PD 17-21. This MSEW procedure has been used to mimic early life neglect in humans. After MSEW, rats continued to survive until early adulthood when they were subjected to open-field, social interaction, and elevated-plus maze tests. Compared to CNT rats in either gender, MSEW rats moved longer distances at higher velocities in the open-field. The MSEW rats also showed lower ratios of travel distance at central zone over that on whole arena of the open-field compared to CNT rats. In social interaction test, male CNT rats preferred to investigate an empty cage than females; whereas female CNT rats spent more time with a partner-containing cage as compared to males. This gender-specific difference was reversed in MSEW rats. On elevated-plus maze female CNT rats exhibited more risk-taking behaviors as compared to male counterparts. Moreover, female MSEW rats experienced a greater difficulty in making a decision on whether approaching to or averting from which arms of elevated-plus maze. Taken together, male MSEW rats behaved like attachment anxiety while females' phenotype is alike to attachment avoidance described in humans. These results shall prompt further application of MSEW rat in abnormal psychology and biological psychiatry research.

The Relationship between Problematic Facebook Use and Early Maladaptive Schemas

Facebook is an increasingly popular online social media platform for communication, entertainment, and information exchange. Previous studies have shown the relationship between problematic Facebook use (PFU) and mental health problems. Additionally, previous studies have reported associations between maladaptive cognitive schemas and mental health problems. However, little is known about their impact on problematic behavior associated with Facebook use. Consequently, the present study investigated the relationship between PFU and early maladaptive schemas (EMSs) among Facebook users. The study comprised 619 Facebook users (568 females; age range from 18 to 30 years; M = 21.34, SD = 2.41 years). The severity of PFU was assessed using the Facebook Intrusion Scale, and EMS dimensions were assessed using the 90-item Young Schema Questionnaire (YSQ–S3). The findings showed a positive relationship between PFU and EMSs, such as insufficient self-control/self-discipline and approval seeking. PFU was negatively associated with EMSs, such as social isolation/alienation and self-sacrifice schemas. Additionally, the findings showed that EMSs, as well as Facebook use characteristics, such as the time spent using Facebook per week, using Facebook apps, and number of friends on Facebook contributed to explaining the variance in PFU scores. These findings may contribute to a better understanding of mechanisms related to the development of PFU, which are associated with cognitive schemas. Additionally, the results may be useful in developing more effective methods of prevention and treatment of this problematic behavior.

A learning theory of attachment: Unraveling the black box of attachment development

Attachment is an inborn behavioral system that is biologically driven and essential for survival. During child development, individual differences in (in)secure attachment emerge. The development of different attachment behaviors has been traditionally explained as a process during which experiences with (lack of) responsive and supportive care are internalized into working models of attachment. However, this idea has been criticized for being vague and even untestable. With the aim of unraveling this black box, we propose to integrate evidence from conditioning research with attachment theory to formulate a Learning Theory of Attachment. In this review, we explain how the development of individual differences in attachment security at least partly follows the principles of classical and operant conditioning. We combine observed associations between attachment and neurocognitive and endocrinological (cortisol, oxytocin, and dopamine) processes with insights in conditioning dynamics to explain the development of attachment. This may contribute to the explanation of empirical observations in attachment research that are insufficiently accounted for by traditional attachment theory.

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.

Personality Structure and Attachment in Bipolar Disorder

BACKGROUND

An impairment of self and interpersonal functioning has an impact on coping strategies, regulation of affect and stress. Little is known so far about the impairment of personality functioning in patients with bipolar disorder (BD). The aim of this study is to assess the effects of personality structure and attachment in BD patients on the symptom burden.

METHODS

Forty-six patients with the diagnosis of BD were assessed by the 12-item Operationalized Psychodynamic Diagnosis Structure Questionnaire (OPD-SQS), the short version of Experience in Close Relationship-revised (ECR-R-D), and the Brief Symptom Inventory-18 (BSI 18) to determine the level of personality functioning, attachment patterns, and symptom load.

RESULTS

We observed positive correlations between personality difficulties, insecure attachment, and symptom load in patients with BD. A low level of structural integration and an insecure attachment style in patients with BD were accompanied by a significantly higher symptom load (r = 0.66, p ≤ 0.01). Interestingly, there were no significant differences in the structural integration (T(1.44) = -0.93, p = 0.357) and in the attachment style attachment related avoidance: (T(1,44) = 1.50, p = 0.140); attachment related anxiety (T(1,44) = -0.781, p = 0.439) of study participants with BD when compared to the normative value of the general population.

LIMITATIONS

Our limitations are the small sample size of our group and the lack of a control group.

CONCLUSION

In general, our results suggest that there is a link between personality structure and affective dynamics including depressive, anxiety, and somatization symptoms in BD. These findings underline the increasing importance of assessing personality structure and attachment for diagnosis and treatment planning of BD.

The role of self-compassion in the relationship between attachment, depression, and quality of life

BACKGROUND

Self-compassion may be shaped by early attachment experiences, and has been linked to mental health and well-being. This study examined the role of two distinct features of self-compassion, self-warmth and self-coldness, in the relationship between attachment insecurity and depression as well as quality of life in a general population sample in Germany.

METHODS

Participants (N = 2,253; 53.4% female, M_age 50 years) completed the Self-Compassion Scale (SCS), Adult Attachment Scale (AAS), Beck Depression Inventory-Fast Screen (BDI-FS), and European Organization for Research and Treatment of Cancer Quality of Life Questionnaire (EORTC QLQ-C30). Mediation analysis was used to examine whether insecure attachment predicted increased symptoms of depression and decreased quality of life through decreased self-warmth and increased self-coldness.

RESULTS

Attachment-related anxiety and avoidance had a significant direct effect on depressive symptoms and significant indirect effect via self-warmth and self-coldness. The indirect effect via self-warmth appears to be of negligible magnitude. Attachment-related anxiety and avoidance had a significant direct effect on quality of life, and significant indirect effect via self-coldness. The indirect effect via self-warmth was not statistically significant, speaking against self-warmth as a relevant mediator.

LIMITATIONS

Causal conclusions cannot be drawn based on cross-sectional research design. All measures were based on participant self-report.

CONCLUSIONS

This study contributes to a more differentiated understanding of how attachment insecurity and self-compassion may contribute to affective disorders. Findings suggest that self-coldness may be particularly relevant in affective disorders and when addressing relational struggles, with both theoretical and clinical implications for psychotherapy and future research.

Adverse childhood experiences lead to trans-generational transmission of early maladaptive schemas

BACKGROUND

According to schema theory, early maladaptive schemas (EMSs) are formed due to unsatisfied core emotional needs in childhood. However, there is limited research about the association between parent's EMS and the child's EMS.

OBJECTIVE

The current study investigated the mechanisms underlying the relationship between the parent's disconnection and rejection schemas and the child's disconnection and rejection schemas.

PARTICIPANTS AND SETTING

One hundred seventy-nine mother-late adolescent dyads participated in the study. Mothers filled out the forms at home, and adolescents completed the forms in the classroom.

METHODS

The adolescents completed the Young Schema Questionnaire-Short Form-3 (YSQ-SF3), Childhood Trauma Questionnaire, Father Involvement Scale, and Resilience Scale. The mothers completed only the YSQ-SF3.

RESULTS

Mothers' EMSs related to the disconnection and rejection domain predicted their children's EMS in the same domain. Adverse childhood experiences also significantly mediated this relationship only when father involvement was low (β = .08, SE = .04, 95% CI [.01, .18]).

CONCLUSIONS

The current study provides evidence that EMSs are passed on from one generation to the next through adverse childhood experiences especially when fathers do not provide enough support in childrearing.

An integrative perspective on the interplay between early maladaptive schemas and mental health: The role of self-compassion and emotion regulation

OBJECTIVES

We aimed to test whether negative emotion regulation difficulties and self-compassion mediate the relationship between early maladaptive schemas (EMSs) and symptoms of psychopathology and life satisfaction.

METHODS

Data were collected from 296 adults (179 females, 117 males), whose age ranged from 17 to 52 years. The mediating roles of self-compassion and negative emotion regulation were examined via Hayes' procedure (PROCESS) for multiple mediation.

RESULTS

Negative emotion regulation was the only mediator to psychopathological symptoms, with no additional role for self-compassion, whereas self-compassion mediated only to life satisfaction, with no additional role for negative emotion regulation.

CONCLUSIONS

The results provide evidence for unique mediating roles of negative emotion regulation and self-compassion, depending on the outcome variable. That helps to understand how problems that may be identified in terms of positive and negative domains are related to EMSs, and allows to put forward potential strategies within the frame of schema therapy.

Burnout amongst clinical and counselling psychologist: The role of early maladaptive schemas and coping modes as vulnerability factors

Psychologists are subject to multiple competing emotional demands that increase the risk of burnout. Research has demonstrated that burnout arises from both organizational and personal factors, including psychologists' personal beliefs and coping. Preliminary research indicates that early maladaptive schemas (EMS) are associated with high burnout, yet, to date, the role of EMS and associated coping responses (maladaptive coping modes [MCM]) in predicting high burnout amongst psychologists has not been investigated. Four hundred forty-three psychologists completed a self-report online questionnaire comprising the Maslach Burnout Inventory-emotional exhaustion scale (EE), Young Schema Questionnaire, and Schema Mode Inventory. The two most common EMS amongst psychologists were unrelenting standards and self-sacrifice. There was substantial indication of burnout, with 18.3% in the high range and 29.6% in the moderate range of EE. The most common MCM were detached protector and detached self-soother. Controlling for demographics and job demands, EMS accounted for an additional 18% variance in EE. MCM accounted for an additional 6% beyond the variance explained by demographics, job demands, and EMS. Practical recommendations are suggested to reduce psychologist burnout.

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.

Examining the role of attachment in the relationship between childhood adversity, psychological distress and subjective well-being

Childhood adversity is associated with a wide range of detrimental psychological consequences. This study examined the mediating role of relationship-specific attachment (avoidance and anxiety) in the associations between childhood adversity and both psychological distress and subjective well-being. University students (N=190) across the Republic of Ireland completed self-report measures including the Adverse Childhood Experiences scale, Experiences in Close Relationships - Relationship Structures scale, Depression Anxiety and Stress scales and measures of subjective well-being. One hundred and twenty-eight participants (67.4%) reported experiencing at least one adverse childhood experience. Childhood adversity was associated with symptoms of psychological distress and subjective well-being. All such associations were mediated by certain relationship-specific attachment dimensions. Of these, attachment anxiety in general relationships was the most prominent mediator for both psychological distress and subjective well-being. Attachment to one's father and to one's romantic partner did not mediate any association. These findings indicate that attachment, in particular relationships, is an important factor in the associations between childhood adversity and both psychological distress and subjective well-being as an adult. One's attachment anxiety in general relationships is particularly important in these associations. Therapeutic interventions addressing these attachment domains may offset the detrimental effects of childhood adversity. Future research is required using a longitudinal design.

The Relationships Between Self-Compassion, Attachment and Interpersonal Problems in Clinical Patients with Mixed Anxiety and Depression and Emotional Distress

Self-compassion has been consistently linked to psychological well-being. The ability to be self-compassionate may be shaped by early attachment experiences and associated with interpersonal difficulties. However, evidence has yet to be extended to clinical populations. This study examined the role of self-compassion and its relationship with attachment and interpersonal problems in clinical patients with anxiety and depression. Participants (N = 74; 60% female, mean age 40 years) were recruited from a primary care psychological therapies service in Scotland, UK. Participants completed four self-report questionnaires assessing self-compassion, attachment, interpersonal problems and emotional distress (including depression and anxiety). Low self-compassion, attachment-related avoidance (but not attachment-related anxiety) and high interpersonal problems were all associated with higher levels of emotional distress and anxiety. Low self-compassion and high interpersonal problems were predicted by attachment-related avoidance. Self-compassion mediated the relationship between attachment-related avoidance and emotional distress and anxiety. This was a cross-sectional design and therefore a definitive conclusion cannot be drawn regarding causal relationships between these variables. Self-reported questionnaires were subject to response bias. This study has extended the evidence base regarding the role of self-compassion in patients with clinical levels of depression and anxiety. Notably, our findings indicated that self-compassion may be a particularly important construct, both theoretically and clinically, in understanding psychological distress amongst those with higher levels of attachment avoidance. This study supports the development and practice of psychotherapeutic approaches, such as compassion-focused therapy for which there is a growing evidence base.

The Suicide Narrative Interview: adolescents' attachment expectancies and symptom severity in a clinical sample

Insecure attachment styles have consistently been identified as risk factors for adolescent psychopathology and, more specifically, suicidal ideation. However, much less is known about the mechanisms that account for the relationship between attachment styles and severity of suicidal ideation within clinical samples. In the current study, adolescents' expectancies for caregiver availability and responsiveness were coded from transcripts of the Suicide Narrative Interview in a clinical sample of 129 depressed and suicidal adolescents. Results indicated that negative expectancies for caregiver availability in the Suicide Narrative Interview were associated both with attachment insecurity and with the intensity of adolescents' suicidal ideation. The implications of adolescents' expectancies for caregiver availability as targets for clinical intervention are discussed.

Maladaptive schemas mediate poor parental attachment and suicidality in college students

In college-aged adults (n = 766), the transition to adulthood may aggravate risk factors for suicidal behavior such as poor parental attachment and maladaptive self-schemas. Because poor parental attachment may facilitate developing maladaptive self-related schemas, this study was designed to determine whether specific maladaptive schemas mediate the relation between poor parental attachment and college students' suicide proneness and ideation. Findings supported this hypothesis. Defectiveness and emotional deprivation schemas, which are consistent with "perceived burdensomeness" and "thwarted belonging," may be important intervention targets for suicide prevention programs. The ongoing role of parental attachment during early adult development is highlighted.

Insecure attachment and maladaptive schema in disordered eating: The mediating role of rejection sensitivity

AIM

The current study aimed to assess insecure attachment and the disconnection and rejection domain of maladaptive schema in the context of disordered eating. Rejection sensitivity (RS) was proposed as a mediator between maladaptive schema and disordered eating.

METHOD

The sample consisted of 108 female participants with a lifetime eating disorder diagnosis and 508 female control participants. Participants were asked to complete a number of self-report measures related to insecure attachment (anxious and avoidant), maladaptive schema (emotional deprivation, abandonment, mistrust, social isolation, and defectiveness), RS (interpersonal and appearance-based), and disordered eating.

RESULTS

Path analysis indicated that anxious attachment was associated with disordered eating through multiple pathways involving emotional deprivation, abandonment, interpersonal RS, and appearance-based RS. Avoidant attachment was not related to disordered eating behaviours.

CONCLUSION

The results indicate that both interpersonal and appearance-based RS are important mediators for the relationships between insecure attachment, maladaptive schema, and disordered eating.

KEY PRACTITIONER MESSAGE

The results from the current study suggest that insecure attachment leads to maladaptive schema, which in turn leads to sensitivity to rejection and subsequent disordered eating behaviour. Attachment anxiety, but not attachment avoidance, was related to greater endorsement of all five schemas in the disconnection and rejection domain. Path analysis revealed that, of the schema in the disconnection and rejection domain, only emotional deprivation and abandonment were related to disordered eating. Interpersonal and appearance-based rejection sensitivity were significant mediators of the relationship between emotional deprivation and disordered eating as well as the relationship between abandonment and disordered eating. Differentiating between schemas within schema domains has clinical value in further understanding the pathway to disordered eating. The schemas of emotional deprivation and abandonment are implicated in disordered eating, suggesting the need to target these schemas in schema therapy.

Predictors and mediators of trait anger across the psychosis continuum: The role of attachment style, paranoia and social cognition

Anger in the context of psychosis has a significant impact on treatment outcomes and serious implications for risk management. Understanding mechanisms underlying anger will improve interventions and inform strategies for prevention. This study is the first to examine the relationships between anger and key theoretical drivers across different phases of the psychosis continuum. A battery including measures of theory of mind, attachment, hostile attribution bias, paranoia and anger was administered to 174 participants (14 ultra-high risk, 20 first-episode, 20 established psychosis, 120 non-clinical participants). We tested the model that insecure attachment, paranoia, impaired theory of mind and hostile attribution bias would predict trait anger using multiple regression. Attachment avoidance, paranoia and hostile attribution bias were significantly associated with anger but attachment anxiety and theory of mind were not. Mediation analysis showed that paranoia partially mediated the relationship between avoidant attachment and anger but hostile attribution bias did not. Findings emphasise the importance of interventions targeting paranoia to reduce anger and the potential of preventive strategies focused on attachment relationships in early life or adulthood to reduce adult paranoia and anger.

SECURE BASE SCRIPT CONTENT EXPLAINS THE ASSOCIATION BETWEEN ATTACHMENT AVOIDANCE AND EMOTION-RELATED CONSTRUCTS IN PARENTS OF YOUNG CHILDREN

The secure base script (SBS) framework is one method of assessing implicit internal working models of attachment; recently, researchers have applied this method to analyze narratives regarding relationship experiences. This study examines the associations between attachment avoidance and SBS content when parents recall a positive moment of connection between themselves and their children (relational savoring) as well as their association with parental emotion and reflective functioning (RF). Using a sample of parents (N = 155, 92% female) of young children (53% boys, M_age = 12.76 months), we found that parental attachment avoidance is inversely associated with SBS content during relational savoring, and that SBS content is an indirect effect explaining the association between attachment avoidance and postsavoring (positive and negative) emotion as well as avoidance and poststressor RF. Findings have implications for understanding attachment and parenting.

The influence of parenting on maladaptive cognitive schema: a cross-sectional research on a group of adults

BACKGROUND

The literature emphasizes the role of early interpersonal experiences in the development of cognitive vulnerability; in particular, interruptions in early family relationships, parental unavailability and dysfunctional parenting are potential evolutionary precursors to negative cognitive style and emotional disorders.

MATERIALS AND METHODS

This study measured the relationship of retrospective ratings on parental bonding with cognitive patterns in a group of Italian adults. The objectives of this study were as follows: to analyze the influence of age and education level on cognitive domains; to verify whether being parents and living at home with parents affect both parenting style and cognitive domains; to investigate how the type of the maternal and paternal parenting independently affects cognitive styles; to measure the predictive variables for the use of cognitive dysfunctional patterns and to investigate age as a moderating variable of the relation between parenting styles and cognitive domains in a group of adult men and women. The research involved 209 adults (118 males and 91 females) living in Sicily (Italy) aged between 20 and 60 years (M = 37.52; SD = 11.42). The research lasted for 1 year. The instruments used were the Parental Bonding Instrument to measure the perception of parenting during childhood and the Young Schema Questionnaire-3 to investigate cognitive patterns.

RESULTS

Data show that being a younger adult male with mother's parenting style characterized by a lower level of nurturance is predictive of the disconnection and rejection domain, whereas, being a younger adult woman, with a higher level of maternal control is predictive of the impaired limits domain.

CONCLUSION

This study underlines that because mothers and fathers establish different bonds with their children, care and control by both parents might impact different domains of development.

An investigation of the mediating role of personality and family functioning in the association between attachment styles and eating disorder status

Background

This study examined relationships between attachment style, eating disorders (EDs), personality variables and family functioning.

Methods

In our study, 253 women (M = 25.72 years, SD = 8.73) were grouped into one of four categories either according to self-reported ED diagnosis or by exceeding cut-offs for a clinical diagnosis on the Eating Disorder Examination Questionnaire (EDE-Q) or Short Evaluation of Eating Disorders (SEED): anorexia nervosa (AN), bulimia nervosa (BN), other eating disorder (O-ED), no eating disorder (Non-ED). The ED group (AN, BN, O-ED) included 106 women (M = 24.74 years, SD = 7.71), and the Non-ED group 147 women (M = 26.42 years, SD = 9.37). Approximately half of the ED group had a comorbid disorder (59.4 %), while the majority of the Non-ED group had no psychological disorder (89.1 %).

Results

Participants with an ED were significantly more often insecurely attached (Adult Attachment Scale; AAS), emotionally unstable, less extraverted (Big-Five-Test of Personality; B5T) and showed less positive family functioning (Experiences in Personal Social Systems Questionnaire; EXIS.pers). Results showed partial mediation for attachment and EDs through neuroticism, extraversion and family functioning.

Discussion

The study found further evidence for elevated problems with attachment, personality, and family experiences in individuals with EDs, while suggesting mechanisms that may link these constructs. Implications for research and practice were discussed.

Conclusion

This study supports findings that acknowledge the mediating role played by personality factors and family functioning in the relationship between attachment and EDs.

Predicting Early Maladaptive Schemas Using Baumrind's Parenting Styles

BACKGROUND

Families play an essential role in maintaining children's mental, social, and physical health. The family provides the first and the most important social context for human development.

OBJECTIVES

The present study aimed to predict early maladaptive schemas using Baumrind's parenting styles (root development).

PATIENTS AND METHODS

A total of 357 undergraduate students of Islamic Azad University, Urmia Branch, Iran, were selected through random cluster sampling during 2013 and 2014. The students were assessed using the Schema Questionnaire-Short Form (SQ-SF) and the Baumrind's parenting styles inventories.

RESULTS

The result of regression analysis showed that Baumrind's parenting styles are significant predictors of early maladaptive schemas (P < 0.001).

CONCLUSIONS

The authoritative parenting style has some features such as showing high levels of warmth or encouraging kids to express their own possibly divergent opinions. The authoritarian parenting style, however, possesses traits such as heartlessness, impassiveness, strictness, and lack of attention to the children's developmental needs, which is not acceptable.

The secure base script: associated with early maladaptive schemas related to attachment

OBJECTIVES

To examine the relations between traditionally assessed early maladaptive schemas and the attachment-specific secure base script (a script-like representation of what individuals expect to happen when they face distress), to inform our understanding of beliefs about the self in relation to others. The present study took an ecologically driven approach, assessing knowledge of the secure base script from descriptions of current relationships.

DESIGN

A cross-sectional design was used.

METHODS

One hundred forty-six undergraduate students, recruited as part of a larger study on adversity and self-concept, provided narrative descriptions of their current relationships. Narratives were coded for attachment-related 'secure base' content using a secure base script scale for relationship narratives. Early maladaptive schemas were assessed with the Young Schema Questionnaire, and attachment was additionally evaluated using the Experiences in Close Relationships questionnaire.

RESULTS

Self-reported attachment avoidance and anxiety were related to secure base script content in theory-consistent ways. The extent to which participants described secure base script content was inversely associated with four out of five maladaptive schemas characterized most centrally by disconnection from others. Furthermore, these associations remained significant when controlling for self-reported attachment style. Self-reported attachment avoidance and anxiety also were related to maladaptive schemas in a predictable pattern.

CONCLUSIONS

Results bridge cognitive and attachment theories, supporting the interrelatedness of secure base script knowledge assessed in current relationships, and schema-related content regarding connectedness with others. Better integration of theories regarding internal representations may serve to enrich psychotherapeutic formulation from a variety of clinical perspectives.

PRACTITIONER POINTS

Schema Therapy's (Young, Klosko, & Weishaar, 2003 , Schema therapy: A practitioner's guide. New York: Guilford Press) early maladaptive schemas, with themes of disconnection from others/in relationships, are related to the attachment construct of knowledge of a secure base script. Applying secure base script coding procedure to a relationship speech task provides a potentially valuable performance-based tool for evaluating important attachment related constructs in a brief, non-obtrusive format. Better understanding of how self-schema and attachment constructs are associated may be of benefit to case formulation for psychotherapeutic intervention.

(In)variability of Attachment in Middle Childhood: Secure Base Script Evidence in Diary Data

Secure attachment is characterised by a secure base script regarding the attachment figure as a source for support. Having such a cognitive script should affect the stability of state attachment. Specifically, incongruent attachment-related information should get assimilated to this secure base script, leading to state attachment scores that hardly fluctuate. For children without a script, state attachment should vary depending on the quality of attachment-related interactions. Two diary studies were carried out in 9- to 13-year-old children. Results suggested that with assimilation: (1) securely attached children fluctuated less in their daily attachment-related appraisals; (2) fluctuations were related to conflicts with mother; (3) this relation was stronger for less securely attached children. Consequently, these studies further support the secure base script hypothesis and provide insight into the interplay of trait and state components of attachment-related appraisals.