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Early maladaptive schemas in adult patients with attention deficit hyperactivity disorder

Abstract

The main purpose of this study was to examine whether adult patients with attention deficit hyperactivity disorder (ADHD) demonstrate sets of dysfunctional cognitive beliefs and behavioural tendencies according to Jeffrey Young’s schema-focused therapy model. Sets of dysfunctional beliefs (maladaptive schemas) were assessed with the Young Schema Questionnaire (YSQ-S2) in 78 adult ADHD patients and 80 control subjects. Patients with ADHD scored significantly higher than the control group on almost all maladaptive schemas. The ‘Failure’, ‘Defectiveness/Shame’, ‘Subjugation’ and ‘Emotional Deprivation’ schemas were most pronounced in adult ADHD patients, while only ‘Vulnerability to Harm or Illness’ did not differ between the two groups. The schemas which were most pronounced in adult patients with ADHD correspond well with their learning histories and core symptoms. By demonstrating the existence of early maladaptive schemas in adults suffering from ADHD, this study suggests that schema theory may usefully be applied to adult ADHD therapy.

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References

  • Ak M, Lapsekili N, Haciomeroglu B, Sutcigil L, Turkcapar H (2012) Early maladaptive schemas in bipolar disorder. Psychol Psychother 85:260–267

    Article  PubMed  Google Scholar 

  • American Psychiatric Association (2013) Diagnostic and statistical manual of mental disorders, 5th edn. American Psychiatric Publishing, Arlington

    Book  Google Scholar 

  • Asherson P, Akehurst R, Kooij JJ, Huss M, Beusterien K, Sasane R, Gholizadeh S, Hodgkins P (2012) Under diagnosis of adult ADHD: cultural influences and societal burden. J Atten Disord 16:20S–38S

    Article  PubMed  Google Scholar 

  • Ball SA, Cecero JJ (2001) Addicted patients with personality disorders: traits, schemas, and presenting problems. J Pers Disord 15:72–83

    CAS  Article  PubMed  Google Scholar 

  • Barbaresi WJ, Katusic SK, Colligan RC, Weaver AL, Jacobsen SJ (2007) Long-term school outcomes for children with attention-deficit/hyperactivity disorder: a population-based perspective. J Dev Behav Pediatr 28:265–273

    Article  PubMed  Google Scholar 

  • Barkley RA, Murphy KR, Fischer M (2008) ADHD in adults. What science says. Guilford Press, New York

    Google Scholar 

  • Beck AT, Beamesderfer A (1974) Assessment of depression: the depression inventory. Mod Probl Pharmacopsychiatry 7:151–169

    CAS  Article  PubMed  Google Scholar 

  • Biederman J, Petty CR, Evans M, Small J, Faraone SV (2010) How persistent is ADHD? A controlled 10-year follow-up study of boys with ADHD. Psychiatry Res 177:299–304

    Article  PubMed  PubMed Central  Google Scholar 

  • Bowlby J (1988) A secure base: parent–child attachment and healthy human development. Basic Books, New York

    Google Scholar 

  • Bramham J, Young S, Bickerdike A, Spain D, McCartan D, Xenitidis K (2009) Evaluation of group cognitive behavioural therapy for adults with ADHD. J Attent Disord 12:434–441

    Article  Google Scholar 

  • Brook JS, Brook DW, Zhang C, Seltzer N, Finch SJ (2013) Adolescent ADHD and adult physical and mental health, work performance, and financial stress. Pediatrics 131:5–13

    Article  PubMed  PubMed Central  Google Scholar 

  • Cecero JJ, Beitel M, Prout T (2008) Exploring the relationships among early maladaptive schemas, psychological mindedness and self-reported college adjustment. Psychol Psychother 81:105–118

    Article  PubMed  Google Scholar 

  • Chang LR, Chiu YN, Wu YY, Gau SS (2013) Father’s parenting and father-child relationship among children and adolescents with attention-deficit/hyperactivity disorder. Compr Psychiatry 54:128–140

    Article  PubMed  Google Scholar 

  • Christiansen H, Kis B, Hirsch O, Philipsen A, Henneck M, Panczuk A, Pietrowsky R, Hebebrand J, Schimmelmann BG (2011) German validation of the Conners Adult ADHD Rating Scale-self-report (CAARS-S) I: factor structure and normative data. Eur Psychiatry J Assoc Eur Psychiatr 26:100–107

    CAS  Article  Google Scholar 

  • Christiansen H, Kis B, Hirsch O, Matthies S, Hebebrand J, Uekermann J, Abdel-Hamid M, Kraemer M, Wiltfang J, Graf E, Colla M, Sobanski E, Alm B, Rosler M, Jacob C, Jans T, Huss M, Schimmelmann BG, Philipsen A (2012) German validation of the Conners Adult ADHD Rating Scales (CAARS) II: reliability, validity, diagnostic sensitivity and specificity. Eur Psychiatry J Assoc Eur Psychiatr 27:321–328

    CAS  Article  Google Scholar 

  • Christiansen H, Hirsch O, Philipsen A, Oades RD, Matthies S, Hebebrand J, Ueckermann J, Abdel-Hamid M, Kraemer M, Wiltfang J, Graf E, Colla M, Sobanski E, Alm B, Rosler M, Jacob C, Jans T, Huss M, Schimmelmann BG, Kis B (2013) German validation of the Conners Adult ADHD Rating Scale-self-report: confirmation of factor structure in a large sample of participants with ADHD. J Attent Disord 17:690–698

    Article  Google Scholar 

  • Chronis-Tuscano M, Raggi VL, Clarke TL, Rooney ME, Diaz Y, Pian J (2008) Associations between maternal attention-deficit/hyperactivity disorder symptoms and parenting. J Abnorm Child Psychol 36:1237–1250

    Article  PubMed  PubMed Central  Google Scholar 

  • Conners CK, Erhardt D, Sparrow EP (1999). Conners‘ Adult ADHD Rating Scales (CAARS). North Tonawanda: Multi Health Systems

    Google Scholar 

  • Dan O, Raz S (2015) The relationships among ADHD, self-esteem, and test anxiety in young adults. J Attent Disord 19:231–239

    Article  Google Scholar 

  • Delattre V, Servant D, Rusinek S, Lorette C, Parquet PJ, Goudemand M, Hautekeete M (2004) The early maladaptive schemas: a study in adult patients with anxiety disorders. L’Encephale 30:255–258

    CAS  Article  PubMed  Google Scholar 

  • Derogatis LR (1992) Administration, scoring and procedures manual—II. Clinical Psychometric Research; SCL-90-R, Baltimore

    Google Scholar 

  • Ebert D, Krause J, Roth-Sackenheim C (2003) ADHD in adulthood—guidelines based on expert consensus with DGPPN support. Der Nervenarzt 74:939–946

    CAS  PubMed  Google Scholar 

  • Ek U, Westerlund J, Holmberg K, Fernell E (2011) Academic performance of adolescents with ADHD and other behavioural and learning problems—a population-based longitudinal study. Acta Paediatr 100:402–406

    CAS  Article  PubMed  Google Scholar 

  • Elkins IJ, Malone S, Keyes M, Iacono WG, McGue M (2011) The impact of attention-deficit/hyperactivity disorder on preadolescent adjustment may be greater for girls than for boys. J Clin Child Adolesc Psychol 53(40):532–545

    Article  Google Scholar 

  • Emilsson B, Gudjonsson G, Sigurdsson JF, Baldursson G, Einarsson E, Olafsdottir H, Young S (2011) Cognitive behaviour therapy in medication-treated adults with ADHD and persistent symptoms: a randomized controlled trial. BMC Psychiatry 11:116

    Article  PubMed  PubMed Central  Google Scholar 

  • Faraone SV, Biederman J, Mick E (2006) The age-dependent decline of attention deficit hyperactivity disorder: a meta-analysis of follow-up studies. Psychol Med 36:159–165

    Article  PubMed  Google Scholar 

  • Farrell JM, Shaw IA, Webber MA (2009) A schema-focused approach to group psychotherapy for outpatients with borderline personality disorder: a randomized controlled trial. J Behav Ther Exp Psychiatry 40:317–328

    Article  PubMed  Google Scholar 

  • Fischer M, Barkley RA, Fletcher KE, Smallish L (1993) The adolescent outcome of hyperactive children: predictors of psychiatric, academic, social, and emotional adjustment. J Am Acad Child Adolesc Psychiatry 32:324–332

    CAS  Article  PubMed  Google Scholar 

  • Fydrich T, Renneberg B, Schmitz B, Wittchen H-U (1997) SKID-II. Strukturiertes Klinisches Interview für DSM-IV. Achse II: Persönlichkeitsstörungen. Interviewheft. Hogrefe, Göttingen

    Google Scholar 

  • Gau SS (2007) Parental and family factors for attention-deficit hyperactivity disorder in Taiwanese children. Aust N Z J Psychiatry 41:688–696

    Article  PubMed  Google Scholar 

  • Gau SS, Chang JP (2013) Maternal parenting styles and mother–child relationship among adolescents with and without persistent attention-deficit/hyperactivity disorder. Res Dev Disabil 34:1581–1594

    Article  PubMed  Google Scholar 

  • Giesen-Bloo J, van Dyck R, Spinhoven P, van Tilburg W, Dirksen C, van Asselt T, Kremers I, Nadort M, Arntz A (2006) Outpatient psychotherapy for borderline personality disorder: randomized trial of schema-focused therapy vs transference-focused psychotherapy. Arch Gen Psychiatry 63:649–658

    Article  PubMed  Google Scholar 

  • Griggs MS, Mikami AY (2011). Parental attention-deficit/hyperactivity disorder predicts child and parent outcomes of parental friendship coaching treatment. J Am Acad Child Adolesc Psychiatry 50(12):1236–1246

    Article  PubMed  PubMed Central  Google Scholar 

  • Grutschpalk J (2009) Diagnostik im Rahmen der Schematherapie unter besonderer Berücksichtigung der Persönlichkeitsakzentuierungen (Diagnosis in the context of schema therapy with special consideration of the personality traits) (Doctoral thesis, Hamburg University)

  • Haaland AT, Vogel PA, Launes G, Haaland VO, Hansen B, Solem S, Himle JA (2011) The role of early maladaptive schemas in predicting exposure and response prevention outcome for obsessive-compulsive disorder. Behav Res Ther 49:781–788

    Article  PubMed  Google Scholar 

  • Hautzinger M, Keller F, Kühner C (2006) Das Beck Depressions inventar II. Deutsche Bearbeitung und Handbuch zum BDI II. Harcourt Test Services, Frankfurt am Main

    Google Scholar 

  • Hawke LD, Provencher MD (2012) Early maladaptive schemas among patients diagnosed with bipolar disorder. J Affect Disord 136:803–811

    Article  PubMed  Google Scholar 

  • Henry E, Jones SH (2011) Experiences of older adult women diagnosed with attention deficit hyperactivity disorder. J Women Aging 23:246–262

    Article  PubMed  Google Scholar 

  • Hesslinger B, Tebartz van Elst L, Nyberg E, Dykierek P, Richter H, Berner M, Ebert D (2002) Psychotherapy of attention deficit hyperactivity disorder in adults—a pilot study using a structured skills training program. Eur Arch Psychiatry Clin Neurosci 252:177–184

    Article  PubMed  Google Scholar 

  • Kellogg SH, Young JE (2006) Schema therapy for borderline personality disorder. J Clin Psychol 62:445–458

    Article  PubMed  Google Scholar 

  • Kim DH, Yoo IY (2013) Relationship between attention deficit hyperactive disorder symptoms and perceived parenting practices of school-age children. J Clin Nurs 22:1133–1139

    Article  PubMed  Google Scholar 

  • Klassen AF, Miller A, Fine S (2004) Health-related quality of life in children and adolescents who have a diagnosis of attention-deficit/hyperactivity disorder. Pediatrics 114:e541–e547

    Article  PubMed  Google Scholar 

  • Kuhner C, Burger C, Keller F, Hautzinger M (2007) Reliability and validity of the Revised Beck Depression Inventory (BDI-II). Results from German samples. Der Nervenarzt 78:51–656

    Article  Google Scholar 

  • Loe IM, Feldman HM (2007) Academic and educational outcomes of children with ADHD. Ambul Pediatr 7:82–90

    Article  PubMed  Google Scholar 

  • Masley SA, Gillanders DT, Simpson SG, Taylor MA (2012) A systematic review of the evidence base for Schema Therapy. Cogn Behav Therapy 41:185–202

    Article  Google Scholar 

  • Miklosi M, Mate O, Somogyi K, Szabo M (2016) Adult attention deficit hyperactivity disorder symptoms, perceived stress, and well-being: the role of early maladaptive schemata. J Nerv Mental Disease 204(5):364–369

    Article  Google Scholar 

  • Modesto-Lowe V, Danforth JS, Brooks D (2008) ADHD: does parenting style matter? Clin Pediatr 47:865–872

    Article  Google Scholar 

  • Mongia M, Hechtman L (2012) Cognitive behaviour therapy for adults with attention-deficit/hyperactivity disorder: a review of recent randomized controlled trials. Curr Psychiatry Rep 14:561–567

    Article  PubMed  Google Scholar 

  • Mrug S, Molina BS, Hoza B, Gerdes AC, Hinshaw SP, Hechtman L, Arnold LE (2012) Peer rejection and friendships in children with attention-deficit/hyperactivity disorder: contributions to long-term outcomes. J Abnorm Child Psychol 40:1013–1026

    Article  PubMed  PubMed Central  Google Scholar 

  • Murray-Close D, Hoza B, Hinshaw SP, Arnold LE, Swanson J, Jensen PS, Hechtman L, Wells K (2010) Developmental processes in peer problems of children with attention-deficit/hyperactivity disorder in the multimodal treatment study of children with ADHD: developmental cascades and vicious cycles. Dev Psychopathol 22:785–802

    Article  PubMed  PubMed Central  Google Scholar 

  • National Institute for Health and Clinical Excellence (2008) Attention deficit hyperactivity disorder: diagnosis and management of ADHD in children young people and adults. London, NICE

  • Newark PE, Stieglitz RD (2010) Therapy-relevant factors in adult ADHD from a Cognitive behavioural perspective. Atten Deficit Hyperact Disorder 2(2):59–72

    Article  Google Scholar 

  • Nilsson KK (2012) Early maladaptive schemas and functional impairment in remitted bipolar disorder patients. J Behav Ther Exp Psychiatry 43:1104–1108

    Article  PubMed  Google Scholar 

  • Owens JS, Goldfine ME, Evangelista NM, Hoza B, Kaiser NM (2007) A critical review of self-perceptions and the positive illusory bias in children with ADHD. Clin Child Fam Psychol Rev 10:335–351

    Article  PubMed  Google Scholar 

  • Philipsen A (2012) Psychotherapy in adult attention deficit hyperactivity disorder: implications for treatment and research. Expert Rev Neurother 12:1217–1225

    CAS  Article  PubMed  Google Scholar 

  • Philipsen A, Richter H, Peters J, Alm B, Sobanski E, Colla M, Munzebrock M, Scheel C, Jacob C, Perlov E, Tebartz van Elst L, Hesslinger B (2007) Structured group psychotherapy in adults with attention deficit hyperactivity disorder: results of an open multicentre study. J Nerv Mental Disease 195:1013–1019

    Article  Google Scholar 

  • Pingault JB, Tremblay RE, Vitaro F, Carbonneau R, Genolini C, Falissard B, Cote SM (2011) Childhood trajectories of inattention and hyperactivity and prediction of educational attainment in early adulthood: a 16-year longitudinal population-based study. Am J Psychiatry 168:1164–1170

    Article  PubMed  Google Scholar 

  • Platts H, Mason O, Tyson M (2005) Early maladaptive schemas and adult attachment in a UK clinical population. Psychol Psychother 78:549–564

    Article  PubMed  Google Scholar 

  • Renner F, Lobbestael J, Peeters F, Arntz A, Huibers M (2012) Early maladaptive schemas in depressed patients: stability and relation with depressive symptoms over the course of treatment. J Affect Disord 136:581–590

    Article  PubMed  Google Scholar 

  • Retz-Junginger P, Retz W, Blocher D, Weijers HG, Trott GE, Wender PH, Rossler M (2002) Wender Utah rating scale. The short-version for the assessment of attention-deficit hyperactivity disorder in adults. Der Nervenarzt 73:830–838

    CAS  Article  PubMed  Google Scholar 

  • Retz-Junginger P, Retz W, Blocher D, Stieglitz RD, Georg T, Supprian T, Wender PH, Rosler M (2003) Reliability and validity of the Wender-Utah-Rating-Scale short form. Retrospective assessment of symptoms for attention deficit/hyperactivity disorder. Der Nervenarzt 74:987–993

    CAS  Article  PubMed  Google Scholar 

  • Riso LP (2007) Cognitive schemas and core beliefs in psychological problems. American Psychological Association, Washington

    Google Scholar 

  • Rosler M, Retz W, Retz-Junginger P, Thome J, Supprian T, Nissen T, Stieglitz RD, Blocher D, Hengesch G, Trott GE (2004) Tools for the diagnosis of attention-deficit/hyperactivity disorder in adults. Self-rating behaviour questionnaire and diagnostic checklist. Der Nervenarzt 75:888–895

    CAS  Article  PubMed  Google Scholar 

  • Rösler M, Retz-Junginger P, Retz W, Stieglitz R-D (2008) Homburger ADHS-Skalen für Erwachsene (HASE). Manual. Hogrefe, Göttingen

    Google Scholar 

  • Rostain AL, Ramsay JR (2006) A combined treatment approach for adults with ADHD—results of an open study of 43 patients. J Attent Disord 10:150–159

    Article  Google Scholar 

  • Rucklidge JJ, Brown DL, Crawford S, Kaplan BJ (2006) Retrospective reports of childhood trauma in adults with ADHD. J Attent Disord 9:631–641

    Article  Google Scholar 

  • Safren SA (2006) Cognitive-behavioural approaches to ADHD treatment in adulthood. J Clin Psychiatry 67(Suppl 8):46–50

    PubMed  Google Scholar 

  • Safren SA, Sprich S, Chulvick S, Otto MW (2004) Psychosocial treatments for adults with attention-deficit/hyperactivity disorder. Psychiatr Clin N Am 27:349–360

    Article  Google Scholar 

  • Safren SA, Otto MW, Sprich S, Winett CL, Wilens TE, Biederman J (2005) Cognitive-behavioural therapy for ADHD in medication-treated adults with continued symptoms. Behav Res Ther 43:831–842

    Article  PubMed  Google Scholar 

  • Safren SA, Sprich S, Mimiaga MJ, Surman C, Knouse L, Groves M, Otto MW (2010) Cognitive behavioural therapy vs relaxation with educational support for medication-treated adults with ADHD and persistent symptoms: a randomized controlled trial. J Am Med Assoc 304:875–880

    CAS  Article  Google Scholar 

  • Schmitz N, Hartkamp N, Kiuse J, Franke GH, Reister G, Tress W (2000) The symptom check-list-90-R (SCL-90-R): a german validation study. Qual Life Res Int J Qual Life Asp Treatment Care Rehabil 9:185–193

    CAS  Article  Google Scholar 

  • Sibley MH, Mitchell JT, Becker SP (2016) Method of adult diagnosis influences estimated persistence of childhood ADHD: a systematic review of longitudinal studies. Lancet Psychiatry 3(12):1157–1165

    Article  PubMed  Google Scholar 

  • Sigre-Leiros VL, Carvalho J, Nobre P (2013) Early maladaptive schemas and aggressive sexual behaviour: a preliminary study with male college students. J Sex Med 10:1764–1772

    Article  PubMed  Google Scholar 

  • Sobanski E (2006) Psychiatric comorbidity in adults with attention-deficit/hyperactivity disorder (ADHD). Eur Arch Psychiatry Clin Neurosci 256(Suppl 1):26–31

    Article  Google Scholar 

  • Solanto MV, Marks DJ, Wasserstein J, Mitchell K, Abikoff H, Alvir JM, Kofman MD (2010) Efficacy of meta-cognitive therapy for adult ADHD. Am J Psychiatry 167:958–968

    Article  PubMed  PubMed Central  Google Scholar 

  • Stevenson CS, Whitmont S, Bornholt L, Livesey D, Stevenson RJ (2002) A cognitive remediation programme for adults with attention deficit hyperactivity disorder. Aust N Z J Psychiatry 36:610–616

    Article  PubMed  Google Scholar 

  • Thimm JC (2010) Relationships between early maladaptive schemas and psychosocial developmental task resolution. Clin Psychol Psychother 17:219–230

    PubMed  Google Scholar 

  • Torrente F, López P, Alvarez Prado D, Kichic R, Cetkovich-Bakmas M, Lischinsky A, Manes F (2014) Dysfunctional cognitions and their emotional, behavioural, and functional correlates in adults with attention deficit hyperactivity disorder (ADHD): is the cognitive-behavioural model valid? J Attent Disord 18(5):412–424

    Article  Google Scholar 

  • Van Asselt AD, Dirksen CD, Arntz A, Giesen-Bloo JH, van Dyck R, Spinhoven P, van Tilburg W, Kremers IP, Nadort M, Severens JL (2008) Out-patient psychotherapy for borderline personality disorder: cost-effectiveness of schema-focused therapy vs. transference-focused psychotherapy. Br J Psychiatry J Mental Sci 192:450–457

    Article  Google Scholar 

  • Vitola ES, Bau CH, Salum GA, Horta BL, Quevedo L, Barros FC, Pinheiro RT, Kieling C, Rohde LA, Grevet EH (2016) Exploring DSM-5 ADHD criteria beyond young adulthood: phenomenology, psychometric properties and prevalence in a large three-decade birth cohort. Psychol Med 21:1–11

    Google Scholar 

  • Weinstein CS (1994) Cognitive remediation strategies: an adjunct to the psychotherapy of adults with attention-deficit hyperactivity disorder. J Psychother Pract Res 3:44–57

    CAS  PubMed  PubMed Central  Google Scholar 

  • Wittchen HU, Wunderlich U, Gruschwitz S, Zaudig M (1997) SKID-I: Strukturiertes Klinisches Interview für DSM-IV, Achse I: Psychische Störungen: Interviewheft. Hogrefe, Göttingen

    Google Scholar 

  • Young S, Amarasinghe JM (2010) Practitioner review: non-pharmacological treatments for ADHD: a lifespan approach. J Child Psychol Psychiatry 51:116–133

    Article  PubMed  Google Scholar 

  • Young JE, Brown G, Berbalk H, Grutschpalk J (2003a) Deutsche Kurzfassung des YSQ-L und Übersetzung der neu ergänzten Items (Unpublished translation)

  • Young JE, Klosko JS, Weishaar ME (2003b) Schema Therapy: a practitioner’s guide. The Guilford Press, New York

    Google Scholar 

  • Young JE, Klosko JS, Weishaar ME (2005) Schematherapie. Ein praxisorientiertes Handbuch. Junfermann Verlag, Paderborn

    Google Scholar 

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Correspondence to Alexandra Philipsen.

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Conflict of interest

Alexandra Philipsen has received advisory board fees, lecture fees and congress support from Medice; advisory board fees and lecture fees from Lilly, Novartis and Shire, congress support from Servier and Medice, travel grant and lecture fees from Lundbeck within the last 5 years. She has authored books and articles on adult ADHD published by Elsevier, Hogrefe, Schattauer, MWV, Springer, Kohlhammer and Karger. Alexandra P. Lam declares that she received travel grants within the last year from MEDICE Arzneimittel Pütter GmbH and Co KG. Swantje Matthies received a speakers’ fee from Jansen-Cilag and was involved in clinical trials conducted by Janssen-Cilag and Lilly in the years 2007–2009. Caroline Lücke, Helge H. Müller and Sigrid Breit report no conflict of interest.

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Written informed consent was obtained from all participants, and the study was approved by the ethics committee of the University Medical Centre Freiburg. The study was conducted in line with the Declaration of Helsinki.

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Philipsen, A., Lam, A.P., Breit, S. et al. Early maladaptive schemas in adult patients with attention deficit hyperactivity disorder. ADHD Atten Def Hyp Disord 9, 101–111 (2017). https://doi.org/10.1007/s12402-016-0211-8

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Keywords

  • Adult ADHD
  • Attention deficit hyperactivity disorder
  • Early maladaptive schemas
  • Young Schema Questionnaire