TYPE Original Research

PUBLISHED 10 May 2024

DOI 10.3389/fpsyt.2024.1360127

The importance of examining

OPEN ACCESS early maladaptive schemas in
EDITED BY
Massimiliano Beghi,
Azienda Unità Sanitaria Locale (AUSL)
the diagnosis and treatment of
della Romagna, Italy

REVIEWED BY
obsessive-compulsive disorder
Daniele Mastromo,
Cantonal Sociopsychiatric Katalin Csigó 1,2*, Ákos Münnich 3 and Judit Molnár 3
Organisation, Switzerland
Rosario Cambria, 1
Institute of Psychology, Pázmány Péter Catholic University, Budapest, Hungary, 2 Psychotherapy
Dipartimento di Salute Mentale, Italy Center, Nyírő Gyula National Institute of Psychiatry and Addictions, Budapest, Hungary, 3 Department
of Behavioural Sciences, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
*CORRESPONDENCE
Katalin Csigó
katacsigo@[Link]

RECEIVED 22 December 2023 Introduction: The aim of the study was twofolded: to identify the early
ACCEPTED 10 April 2024 maladaptive schemas characteristic of obsessive-compulsive disorder in a
PUBLISHED 10 May 2024
Hungarian sample and, to examine the presence and severity of comorbid
CITATION anxiety and depressive symptoms in the light of early maladaptive schemas.
Csigó K, Münnich Á and Molnár J (2024) The
importance of examining early maladaptive
schemas in the diagnosis and treatment of Methods: 112 participants (58 men and 54 women) diagnosed with OCD were
obsessive-compulsive disorder. involved in the study. The questionnaire package consisted of the Yale-Brown
Front. Psychiatry 15:1360127.
doi: 10.3389/fpsyt.2024.1360127
Obsessive Compulsive Scale (Y-BOCS), the State-Trait Anxiety Inventory (STAI),
the Beck Depression Inventory (BDI), the Penn State Worry Questionnaire
COPYRIGHT
© 2024 Csigó, Münnich and Molnár. This is an (PSWQ) and the Schema Questionnaire (SQ).
open-access article distributed under the terms
of the Creative Commons Attribution License Results: We identified five early maladaptive schemas with a direct effect on
(CC BY). The use, distribution or reproduction
in other forums is permitted, provided the the manifestation of obsessive-compulsive symptoms: Mistrust-Abuse,
original author(s) and the copyright owner(s) Inferiority/Shame, Dependence/Incompetence, Insufficient Self-Control/
are credited and that the original publication
in this journal is cited, in accordance with
Self-Discipline and Entitlement/Grandiosity (reversed effect). Based on the
accepted academic practice. No use, severity of the early maladaptive schemas, three significantly different groups
distribution or reproduction is permitted could be identified in our sample: patients with mild, moderate and high
which does not comply with these terms.
schema-values. Among the groups significant differences can be found in the
appearance and severity of compulsive symptoms, as well as in the presence of
anxiety and depressive symptoms. But contrary to our expectations, not the
severity, but the numberof the early maladaptive schemas showed a stronger
correlation with the symptom variables. An additional result of our study
derives from canonical correlation, addressing the relationship among early
maladaptive schemas, OCD symptoms, anxiety and depressive symptoms
from a new perspective. The results highlight that OCD is only one and not
the most serious consequence of personality damage, indicated by early
maladaptive schemas.

Discussion: The results of our study suggest that obsessive-compulsive

disorder can be divided into several subgroups, which can be separated in
terms of symptom severity, comorbid psychiatric symptoms and personality
impairment patterns. The relationship between OCD symptom severity and

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Csigó et al. 10.3389/fpsyt.2024.1360127

personality impairment seems to be not directly proportional. Our results

strengthen the new dimensional view of OCD, which can determine the
selection of the appropriate therapeutic treatment method beyond the
diagnostic process.

KEYWORDS

OCD, maladaptive schemas, comorbid anxiety and depression, dimensional view of

OCD, schema theories

Introduction Empirical findings regarding the presence of early maladaptive

schemas in OCD are contradictory, so it is not clear which schema
Obsessive-compulsive disorder (OCD) is a clinical phenomenon modes could be used to describe the disorder (14).
consisting of compulsive thoughts and compulsive actions. The After reviewing research conducted with the Young Schema
symptoms of the disease are extremely diverse, with heterogeneous Questionnaire, the studies can be divided into four groups.
manifestations. The course of OCD is sometimes chronic, severe, and The first group of studies make efforts to identify the
often therapy-resistant (1–3). Obsessive-compulsive disorder is the characteristic schema profile of obsessive-compulsive disorder.
fourth most common psychiatric disease, with a prevalence of 1-3% Results suggest higher values on Social isolation/Alienation,
(4). The rate of subclinical forms is much higher, between 10 and 15% Vulnerability to Harm; Negativism-Pessimism (15); on Inferiority-
(5), but according to other studies, this proportion can reach 40% Shame and Social Isolation/Alienation (16); an increased value on the
among the adult population (6). The diagnostic and differential Vulnerability to Harm schema (17); and higher values on Emotional
diagnostic process of OCD is based on clinical exploration and self- Deprivation, Mistrust/Abuse and Defectiveness/Shame schemas (23).
completed questionnaires (e.g. Y-BOCS). Another group of studies aims to describe the schemas
The treatment protocol for OCD recommends a combination of characteristic in OCD by comparing obsessive-compulsive
CBT and pharmacotherapy as the leading method (7, 8), since, patients with normal controls. Kim et al. (18) compared schema
despite proper therapy choices, research data shows that nearly 25% modes of OCD patients with normal controls and found that OCD
of patients do not respond adequately to treatment (9). According patients show higher values on the Inferiority/Shame, Social
to other data, this number can be much higher, at around 50% (10). Isolation/Alienation and Failure to Achieve schemas. Another
In these cases symptoms persist, and the recommended treatment novel aspect of their study was that the activation of the schemas
does not cause remission. was compared with the OCD symptom dimensions, and they found
These findings raise important questions: is the diagnosis of OCD that the Vulnerability/Endangerment and Enmeshment/
defined in an appropriate way? Are comorbid diagnoses identified Undeveloped self schema showed a connection with the sexual/
adequately? Are the characteristic symptoms of the patient well religious compulsion symptom dimension. Compared to normal
understood, or should our approach be changed (see, for example, controls in another study, Enmeshment/Undeveloped self, Failure
the dimensional approach)? Overall, might it be necessary to look at to achieve, Negativism-pessimism, Vulnerability to harm,
obsessive-compulsive disorder from a new perspective (11)? Emotional deprivation, Social isolation, Defectiveness-shame,
Non-responder OCD patients are characterized by early onset Approval seeking, Insufficient self-control, Self-sacrifice and
of the disease, early childhood traumatization and emotional Punitiveness schemas were described as having high values (19).
deprivation, as well as comorbid personality disorder. In this The third group of studies attempted to determine the schema
context, Sookman (12) already proposed a complex approach to profile specific to OCD compared to other psychiatric diseases.
OCD, including the early attachment experiences of the patients, Comparing obsessive-compulsive patients with trichotillomaniac
developmental theory, the structural dimension, emotional focus patients it was found that Emotional deprivation, Social isolation/
and schemas. The complex examination of these factors can be Alienation, Mistrust-abuse, Defectiveness-shame, Subjugation and
conducted by using a new approach in the study of OCD, i.e. the Emotional inhibition schemas show significantly higher values in
empirical and theoretical frame of maladaptive schemas. obsessive-compulsive patients (20). In an Iranian sample, a high value
The concept of early maladaptive schemas was described by of the Mistrust/Abuse schema was found to be characteristic for
Jeffrey E. Young, who conceptualizes mental problems with the OCD, and it also proved to be related to a high risk of suicide (21).
presence and persistence of these schemas. Early maladaptive The last group of tests tries to measure and verify the
schemas can be defined as mental patterns consisting of pervasive effectiveness of the treatment in the light of maladaptive schemas.
memories, feelings, and cognitions related to ourselves and our In Wilhelm (22) study, as a result of CBT, a measurable change
relationships with others (13). appeared in the Dependency/Incompetence schema, preceding

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adaptive changes in behavior. Furthermore, Haaland et al (24) Hungarian sample. The second goal of the study was to examine
found that a high Abandonment/Instability schema value the presence and severity of comorbid anxiety and depressive
measured before treatment was associated with a worse treatment symptoms in the light of early maladaptive schemas.
outcome, while a high Self-Sacrifice schema indicated a good
treatment outcome. According to Gross et al. (25), obsessive-
compulsive disorder can be described as a special functioning of Method
the personality, where compulsive symptoms are the results of
overcompensation, manifesting themselves in the Perfectionist/ Participants and procedures
Overcontrolling mode or in the Alienated/Protective mode. In
this conceptual framework, these two characteristic schema The patients in the study participated in the OCD-specific
modes are related to the Vulnerable Child Mode and the psychotherapy treatment program of the OMIII (National
Demanding Parent Mode. Alienation makes the therapeutic Institute of Mental Health, Neurology and Neurosurgery,
relationship difficult, while overcontrolling hinders participation Budapest). The inclusion criterion was the diagnosis of obsessive-
in exposure-response prevention therapy (25). compulsive disorder based on the DSM-5 (DSM-5 28). The
Systematic reviews prove that schema therapy is a promising diagnosis was established by both a psychiatrist and a clinical
treatment approach in the therapy of OCD patients (26, 27), but at psychologist. Exclusion criteria included a diagnosis of psychosis,
the same time the case study data available is both sporadic and autism, and mental retardation. The patients participating in the
limited in number. The schema therapy approach can be study were informed about the anonymous handling of their
particularly useful for those who do not respond properly to CBT questionnaire data and their use as research data. The study was
techniques, are characterized by a chronic lifestyle, have a history of approved by the Medical Research Council.
trauma or suffer from a comorbid personality disorder (25). The entire sample consists of 112 people, 58 of whom are men,
Research related to schemas and schema modes in obsessive- and 54 women. The average age of the sample is 31.4 years. Table 1
compulsive disorder is quite contradictory, which can be caused
by several factors. On the one hand, the measurement of
compulsive symptoms in the studies is problematic – the Measures
symptoms are measured with a self-administered Y-BOCS test
and/or the Y-BOCS test filled out by the clinician, which can cause The Yale-Brown Obsessive Compulsive Scale (Y-BOCS) (29;
significant differences in the results. On the other hand, results can Hungarian adaptation Arató M.) is a self-administered symptom
vary, depending on whether the studies control for comorbid assessment scale most often used in obsessive-compulsive disorder.
psychiatric diseases. The methods used to analyze the Schema Test The scale consists of two parts. In the first part the patient indicates
also vary in different research, in terms of where the high schema whether the given symptom has occurred in the present or in the
value is defined, and which value is considered elevated. It is also past for each of the 70 listed symptoms. In the second part, the
an open question whether the schemas measured in the studies are clinician scores the severity of the obsessions and compulsions on a
OCD-specific, or their presence is rather caused by other factors 10-point scale. In the study, we used the patients’ self-
(e.g. comorbid personality disorder, OCD as a personality scoring questionnaire.
dysfunction, OCD as a chronic disease course). Examining The State-Trait Anxiety Inventory (STAI; 30; Hungarian
schemas in obsessive-compulsive disorder is therefore adaptation 31) is a widely used 40-item self-completion
particularly important both from a psychodiagnostics point of questionnaire developed to measure the intensity of anxiety. There
view and for treatment planning. are two versions, the current state anxiety (STAI-S) and the anxiety as
a personality trait (STAI-T) scales.
The Beck Depression Inventory (BDI, 32; Hungarian
The aim of the study adaptation 33) is one of the most frequently used questionnaires
to determine and monitor the severity of depression.
Our research was based on two goals. Our first aim was to The Penn State Worry Questionnaire (34, 35) is a 16-item self-
identify the early maladaptive schemas characteristic of obsessive- administered questionnaire most often used to measure
compulsive disorder, as they have not yet been assessed in a pathological worry.

TABLE 1 Demographic data of the sample.

Education
grade school university high school college vocational school Total
Gender Male 1 26 22 4 1 54

Female 0 16 34 7 1 58

Total 1 42 56 11 2 112

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The Schema Questionnaire (13; Hungarian adaptation 36) is a The cluster profiles characterized by low, medium and high
tool for measuring early maladaptive schemas responsible for the maladaptive schema values can be seen in Figure 1.
development and persistence of pathological personality traits. The Linear regression analysis showed a significant effect on the Y-
Hungarian version of the questionnaire contains 19 maladaptive BOCS value in the case of the following early maladaptive schemas:
schemas, which can be classified into five higher schema ranges. The Mistrust-Abuse, Inferiority/Shame, Dependence/Incompetence,
internal consistency of the Hungarian version of the questionnaire Entitlement/Grandiosity and Insufficient Self-Control/Self-
is very high (Cronbach’s alpha=0.86-0.95). Its factor structure is Discipline. In the case of the specific early maladaptive schemas
consistent with the results obtained on international samples, and of Mistrust-Abuse, Inferiority/Shame, Dependence/Incompetence
its validity has been confirmed too (36). and Insufficient Self-Control/Self-Discipline the effect is direct,
while in the case of the Entitlement/Grandiosity schema it
is reversed.
Statistical analysis The early maladaptive schemas above belong to three major
schema domains: Disconnection and Rejection (Ma, Ds), Impaired
As the first step of the statistical analysis, we filtered the data. Autonomy and Performance (Di), and Impaired Limits (Et,
Due to improper filling out of the questionnaires or missing answers Is) (Table 4).
we had 97 participants who completed both the Y-BOCS and the According to the results of Pearson’s correlation, all variables
Schema Questionnaire. So in analyzing data relevant for the first (STAI-S, STAI-T, BDI, PSWQ, Y_BOCS) correlate significantly.
objective of the study we worked on a sample of 97 participants. In But in the light of our research goals, we focused only on the
the examination of our second goal we analyzed answers from those variables correlating with Y-BOCS. A moderately strong, significant
who filled out all questionnaires properly, i.e. the responses of 78 relationship was found between YBOCS and STAI-T, while there
people. Table 2 were significant but weaker relationships between YBOCS and
In order to calculate the schema values, the answers indicated by 3, STAI-S, Y-BOCS and BDI, and PSWQ and Y-BOCS. Table 5
4, 5 or 6 per person and schema were taken into account. We divided In the next step we examined the relationship between
the number obtained in this way by the number of possible choices and obsessive-compulsive symptoms, comorbid anxiety and depressive
multiplied it by 100, thus obtaining a percentage value. The value is symptoms and the severity of maladaptive schemas (Cluster 1, 2
100% if the examinee gave all questions a value of 3 or more. and 3). According to the results of the variance analysis, significant
Based on the values of the 19 early maladaptive schemas, we differences can be found in the groups characterized by low,
classified the respondents into three clusters (characterized by low, medium and high schema values along with the total values of
medium and high schema values) using K-means cluster analysis. the STAI-S, PSWQ and BDI scales. For all variables examined, the
In the next step we examined the effect of specific early highest mean scores were found not in group 3, as we had expected,
maladaptive schemas on the value of Y-BOCS using multiple but in group 2. Group 2 can be characterized by moderately severe
linear regression analysis, where the target variable was Y-BOCS schemas, but with the largest number of schemas (sum of
and the predictors were schema variables; then we checked the schemes) Table 6.
deviation of the Y-BOCS according to the clusters using In the final step we examined structural relationships among all
variance analysis. variables by canonical correlation.
Finally, Pearson’s correlations between the Y-BOCS and the When the variables of an observation are partitioned into two
STAI-S, STAI-T, BDI and PSWQ variables were calculated. psychological contexts, canonical-correlation analysis (CCA) can be
used to explore possible structural relationships between the
contexts. In our case context1 contains the variables of the
Results comorbid symptoms of OCD (YBOCS, STAI-S, STAI-T, BDI,
PSWQ), while context2 consists of the early maladaptive schemas
The mean values (percentages) of Y-BOCS and early (Ed, Ab, Ma, Si, Ds, Su, Fa, Di, Vh, Em, Et, Is, Sb, Ss, As, Np, Ei,
maladaptive schemas in the sample can be seen on Table 3. Us, Pu).

TABLE 2 Descriptive statistics of Y-BOCS, STAI-S, STAI-T, BDI and PSWQ questionnaires.

N Minimum Maximum Mean Std. Deviation

Y-BOCS 97 3 98 32.67 21.637

STAI-S 110 23 78 51.30 12.877

STAI-T 108 29 78 55.38 11.122

BDI 90 0 40 16.06 9.208

PSWQ 110 30 80 61.45 10.998

Valid N (listwise) 78

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TABLE 3 Mean values and standard deviation of Y-BOCS and specific canonical correlation is 0.804 (sig < 0.001, F = 2.008, df1 = 95, df2 =
early maladaptive schemas (percentage) for the entire sample.
267.352, calculated by SPSS 29.0).
From Figure 2 we may conclude that the two groups of variables
Std.
Mean N (context1 and context2) correlate highly significantly, and these
Deviation
relationships are dominated by the highest values.
Y-BOCS 32.67 21.63 97

Ed 38.83 36.78 97

Ab 43.52 29.22 97 Discussion

Ma 41.96 26.12 97
In our study we examined the effect of the presence and severity
Si 48.76 32.34 97
of early maladaptive schemas on OCD symptoms and on comorbid
Ds 33.26 29.03 97 anxiety and depressive symptoms in a Hungarian sample. We
Su 31.04 29.56 97
identified five early maladaptive schemas which have a direct
effect on the manifestation of obsessive-compulsive symptoms:
Fa 39.17 35.06 97
Mistrust-Abuse, Defectiveness/Shame, Dependence/Incompetence,
Di 45.77 30.45 97 Entitlement/Grandiosity and Insufficient Self-Control/Self-
Vh 48.82 28.03 97
Discipline. In the case of the Entitlement/Grandiosity schema the
effect is reversed. The five identified schemas can be organized into
Em 37.95 29.92 97
three schema domains: Disconnection and Rejection, Impaired
Et 44.14 26.11 97 Autonomy and Performance and Impaired Limits.
Is 50.44 26.57 97
These schema domains can help the understanding of the
pathomechanism of OCD. Our results indicate that problems with
Sb 45.05 32.56 97
attachment stability and security play a significant role in the
Ss 57.36 27.23 97 development of obsessive-compulsive disorder. It seems very likely
As 55.74 29.31 97 that OCD patients did not experience attachment security and stability;
moreover, they might lack the experience of sharing emotions and
Np 64.76 25.85 97
receiving valid reflections. The unfavorable early attachment
Ei 43.75 27.81 97 experiences resulted in imperfect, inadequate, or unacceptable self-
Us 60.88 25.5 97 representations, dominating their self-image. Their basic experiences
might also be inhibited and limited fulfilment of their autonomy needs,
Pu 54.41 25.28 97
the feeling of incompetence in relation to their own decisions, and the
resulting constant need to seek external confirmation. Additional
CCA will find linear combinations of context1 and of context2 problems might be the insufficiency of setting up and maintaining
variables in such a way that the correlation between the two linear boundaries, inadequate regulation and expression of their feelings and
combinations is maximized. The first (most important) impulses, and the active presence of omnipotent fantasies.
unstandardized canonical-correlation coefficients are shown in a In our study, based on the severity of the early maladaptive
helio-map (Figure 2); the higher the column the higher the actual schemas, we were able to identify three significantly different
value, and the positive values are denoted by solid black. The first groups. Among these groups there are significant differences, not

FIGURE 1
Clusters of early maladaptive schemas characterized by low, medium and high values.

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TABLE 4 Results of linear regression, where the target variable is the value of Y-BOCS and the predictors are the values of early maladaptive schemas.

Unstandardized Coefficients Standardized Coefficients

Model B Std. Error Beta t Sig.
1 (Constant) 16.030 6.660 2.407 .018

Ed .001 .074 .002 .015 .988

Ab -.081 .119 -.110 -.680 .499

Ma .288 .116 .347 2.479 .015

Si -.151 .107 -.226 -1.412 .162

Ds .249 .114 .334 2.180 .032

Su -.044 .116 -.060 -.381 .704

Fa -.138 .092 -.223 -1.502 .137

Di .235 .117 .330 2.009 .048

Vh .125 .098 .162 1.279 .205

Em .029 .090 .041 .327 .745

Et -.313 .120 -.378 -2.603 .011

Is .248 .108 .304 2.287 .025

Sb -.131 .094 -.196 -1.389 .169

Ss -.104 .108 -.131 -.968 .336

As -.123 .100 -.166 -1.233 .221

Np .059 .113 .071 .522 .603

Ei .128 .098 .164 1.310 .194

Us .058 .101 .068 .572 .569

Pu .056 .102 .065 .546 .586

TABLE 5 The results of the Pearson correlation.

Y-BOCS STAI-S STAI-T BDI PSWQ

Y-BOCS Pearson Correlation 1 .282** .411** .296** .311**

Sig. (2-tailed) .005 <.001 .009 .002

N 97 97 96 78 97

STAI-S Pearson Correlation .282** 1 .582** .517** .444**

Sig. (2-tailed) .005 <.001 <.001 <.001

N 97 110 108 90 110

STAI-T Pearson Correlation .411** .582** 1 .690** .637**

Sig. (2-tailed) <.001 <.001 <.001 <.001

N 96 108 108 89 108

BDI Pearson Correlation .296** .517** .690** 1 .438**

Sig. (2-tailed) .009 <.001 <.001 <.001

N 78 90 89 90 90

PSWQ Pearson Correlation .311** .444** .637** .438** 1

Sig. (2-tailed) .002 <.001 <.001 <.001

N 97 110 108 90 110

** = strong correlation.

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TABLE 6 The results of the variance analysis.

Std.
N Mean Deviation Std. Error Minimum Maximum
Y-BOCS 1 46 29.11 18.703 2.758 4 78

2 28 43.11 22.872 4.322 12 90

3 23 27.09 22.080 4.604 3 98

Total 97 32.67 21.637 2.197 3 98

STAI-S 1 51 50.78 11.903 1.667 26 74

2 35 56.69 13.139 2.221 23 78

3 24 44.54 11.413 2.330 25 63

Total 110 51.30 12.877 1.228 23 78

STAI-T 1 51 54.39 9.743 1.364 35 74

2 33 63.73 8.921 1.553 45 78

3 24 46.00 8.027 1.639 29 58

Total 108 55.38 11.122 1.070 29 78

BDI 1 43 15.16 9.108 1.389 0 35

2 27 21.19 9.195 1.770 7 40

3 20 11.05 5.708 1.276 0 23

Total 90 16.06 9.208 .971 0 40

PSWQ 1 51 59.80 11.128 1.558 30 80

2 35 67.89 9.132 1.544 48 80

3 24 55.58 8.707 1.777 35 75

Total 110 61.45 10.998 1.049 30 80

Schema_total 1 52 112.92 15.856 2.199 83 143

2 36 170.39 20.533 3.422 129 215

3 24 53.38 18.812 3.840 24 83

Total 112 118.63 46.115 4.357 24 215

only in the appearance and severity of compulsive symptoms, but Using canonical correlation we intended to examine the
also in the presence of anxiety and depressive symptoms. relationship among early maladaptive schemas, OCD symptoms,
However, contrary to our expectations, the severity of the early anxiety and depressive symptoms from a new perspective.
maladaptive schemas did not show a linear relationship with the The results highlight that OCD is only one consequence of early
examined symptom variables. According to our results, compulsive, maladaptive schemas and not the most serious one.
anxiety and depressive symptoms show a stronger correlation with In other words, our data indicate that the appearance of
the numberof early maladaptive schemas even when these are less compulsive symptoms is only one, and not even the most
severe. It seems that the more early maladaptive schemas a person significant consequence of personality damage.
has, the more of his/her basic needs remain unfulfilled, and the Based on the results of our study, it can be suggested that
more areas of his/her life feature consequential undesirable effects. obsessive-compulsive disorder is a psychiatric disease that can be
On the other hand, in the case of fewer maladaptive schemas (even described with a complex pathomechanism, where several triggering
if they are more severe), the person is presumably able to function factors can be identified. Compulsive patients can be classified into
adaptively in more areas or life situations. subgroups with different symptoms and different patterns of
The second goal of the study was to examine the presence and personality impairment. One group of patients is characterized by a
severity of comorbid anxiety and depressive symptoms in OCD severe range of compulsive symptoms in addition to the functional
patients in the light of early maladaptive schemas. presence of intact personality parts, while another group is
Our results indicate that OCD symptoms show a significant characterized by the presence of few compulsive symptoms (which
correlation with anxiety and depressive symptoms. The strongest may cause severe subjective discomfort for the patient) and numerous
relationship was found in the case of trait anxiety and OCD. personality dysfunctions. Thus, a well-defined set of maladaptive

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FIGURE 2
Canonical correlation. Early maladaptive schemas are on the left side, while the symptomatic consequences (anxiety, depression, worry,
compulsions) are on the right side. The black columns strengthen the relationship, the white ones indicate the weakening factors.

schemas can even be predictive of the development/severity of of the schemes we have chosen a new methodology, due to the
compulsive symptoms. inconsistencies found in the international literature. Our novel result
The group of obsessive-compulsive patients with different is the comparison of the presence and severity of early maladaptive
symptoms and functional characteristics also provides an schemas and other psychiatric symptoms. At the same time, further
opportunity for the further development of different treatment studies are necessary to determine the additional characteristics of the
and psychotherapy treatment techniques. It is necessary to use compulsive patient subgroups identified in our study. Further
different psychotherapeutic techniques to treat patients belonging investigation is required to determine the symptomatic,
to different subgroups. endophenotype and biological markers of the subgroups.
The results of our study suggest that obsessive-compulsive
disorder can be divided into several subgroups, which can be
separated in terms of symptom severity, comorbid psychiatric Data availability statement
symptoms, and personality impairment patterns, and that the
relationship between OCD symptom severity and personality The original contributions presented in the study are included
impairment is not directly proportional. in the article/supplementary material. Further inquiries can be
directed to the corresponding author.

Strengths and limitations

Ethics statement
To the best of our knowledge, our study was the first to examine
early maladaptive schemas and schema domains specific to obsessive- The studies involving humans were approved by Medical
compulsive disorder in a Hungarian, clinical sample. In the analysis Research Council Budapest, Hungary. The studies were

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conducted in accordance with the local legislation and institutional Conflict of interest
requirements. The participants provided their written informed
consent to participate in this study. The authors declare that the research was conducted in the
absence of any commercial or financial relationships that could be
construed as a potential conflict of interest.
Author contributions
KC: Writing – original draft. Á M: Writing – review & editing. Publisher’s note
JM: Writing – original draft.
All claims expressed in this article are solely those of the
authors and do not necessarily represent those of their affiliated
Funding organizations, or those of the publisher, the editors and the
reviewers. Any product that may be evaluated in this article, or
The author(s) declare that no financial support was received for claim that may be made by its manufacturer, is not guaranteed or
the research, authorship, and/or publication of this article. endorsed by the publisher.

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