Early maladaptive schemas in patients with somatoform disorders and somatization

Abstract

Maladaptive schemas are stable relational patterns that develop through harmful childhood experiences with primary caregivers. Schemas within somatoform disorders are rarely explored even though these disorders are clinically important due to high prevalence, co-morbidity, and cost for the health care system. This study investigates schemas according to Young's schema theory in patients with somatoform disorders in comparison with healthy controls and patients with depressive or anxiety disorders. Further associations between schemas and somatization were explored. We included 134 patients with a somatoform disorder and 39 age-matched healthy controls, 83 patients with a unipolar depression, and 34 patients with an anxiety disorder. The clinical sample consists of day care patients, diagnosed with the Structured Clinical Interview for Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, but without a personality disorder. Primary measures were the Young Schema Questionnaire (YSQ-S2), the Screening for Somatoform Disorders (SOMS-7T), the Beck Depression Inventory, Second Edition, and the Childhood Trauma Questionnaire. Analyses of variance indicated that somatoform patients scored higher onalmost all schemas than do healthy controls (p < 0.001, η 2 = 0.148). The highest mean scores were reached for the schemas "self-sacrifice" and "unrelenting standards," with significant higher values in the patient sample. However, when compared with patients with depressive or anxiety disorders, somatoform patients scored equally or even lower. High somatization was associated with generally higher schema activation. This effect was to a great extent mediated by depressive symptoms. Only the schema "vulnerability to harm or illness" was exclusively related to somatization.These findings suggest that schemas should be systematically assessed within psychotherapy of somatoform patients.

Interpersonal dynamics and therapeutic relationship in patients with functional somatic syndromes: A metasynthesis of case studies.

“…Despite the limited generalizability of case study evidence in the traditional sense, such comparative metasyntheses would allow for additional valuable clinical inferences and theory building. Samples of more homogenous case studies (e.g., stemming from mixed-methods randomized controlled trials) could provide further insight into the interpersonal dynamics of different clinical populations and allow for testing of more specific hypotheses on interpersonal dynamics-for example, from psychodynamic (Cornelis et al, 2017) or schema therapy domains (Henker et al, 2019).…”

Evaluation of Early Maladaptive Schemes in Female Fibromyalgia Patients

“…Our regression analysis results indicate that the emotional deprivation and vulnerability to harm schemas predict FIQ scores. In a recent study, overall higher scores were found on the schemas in somatization disorder, but the vulnerability to harm schema was reported to be related to somatization when depressive symptoms were controlled (16).…”

“…Previous studies draw attention to the relationships between schemas and pain disorders (14,15), somatization disorders (16), and migraine (17). However, as far as we know, there is only one study evaluating the relationship of EMS in fibromyalgia patients.…”

Early maladaptive schemas and mental disorders in adulthood: A systematic review and meta-analysis

“…A total of eight studies (Ahmadpanah et al, 2017;Atalay, Atalay, & Bagdacicek, 2011;Chen, Tam, & Chang, 2019;Halvorsen et al, 2009;Henker et al, 2019;Wesley & Manjula, 2015) examined EMSs in depressed patients. The results of the meta-analyses showed the largest ESs for social isolation (g = 3.13, 95% CI [0.88, 5.38]), abandonment (g = 2.14, 95% CI [0.97, 3.31]), emotional deprivation (g = 2.12, 95% CI [1.00, 3.23]), defectiveness/shame (g = 2.11, 95% CI [0.49, 3.73]), and negativity/pessimism (g = 2.10, 95% CI [1.08, 3.12]) (Table 5).…”