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

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.