One thousand and thirty-seven psychiatric patients and non-patients from six different sites completed the 205-item Young Schema Questionnaire or its shortended form, the 75-item Young Schema Questionnaire-S. Among 888 of the subjects, who all were patients, a confirmatory factor analysis (CFA) of the 75 items included in both forms of the questionnaire clearly yielded the 15 Early Maladaptive Schema (EMS) factors rationally developed by J. E. Young (1990). Confirmatory factor analyses, testing three models of the higher-order structure of the 15 EMSs, indicated that a fourfactor model was the best alternative. The results slightly favored a correlated four second-order factor model over one also including a third-order global factor. The four factors or schema domains were Disconnection, Impaired Autonomy, Exaggerated Standards, and Impaired Limits. Scales derived from the four higher-order factors had good internal and test-retest reliabilities and were related to DSM-IV Cluster C personality traits, agoraphobic avoidance behavior, and depressive symptoms.

Schema Therapy (ST) proposes that early maladaptive schemas (EMSs) are at the core of personality pathology and psychological distress, in particular personality disorder and chronic interpersonal difficulties. Therapeutic change in ST is based on the modification of early maladaptive schemas and associated coping behaviours. Some of these basic assumptions in the ST model were tested. It was hypothesized that EMSs are related to symptomatic distress but in particular personality pathology and personality disorder. Furthermore, schema modification should predict level of symptomatic distress by the end of treatment. Patients (N = 82) from a psychiatric outpatient clinic were assessed with SCID I and II and self-report inventories measuring a variety of psychiatric symptoms prior to and after treatment. The results were supportive of the ST model and showed that levels of early maladaptive schemas were related to personality pathology and that modification of early maladaptive schemas strongly predicted symptom relief by the end of treatment.