The Mediating Role of Schema Modes Between Early Maladaptive Schemas and Obsessive-Compulsive Disorder

Obsessive–Compulsive Disorder (OCD) is a debilitating anxiety condition. Schemas are not always active and their effects are not tangible; however, when activated, the individual engages in coping styles to reduce the associated unpleasant emotions and encounters a mindless state. Schema therapy assumes that Early Maladaptive Schemas (EMSs) are slightly correlated with psychopathology aspects. According to studies, EMSs can be used to explain the symptoms of psychopathology. Therefore, schema modes might play a mediating role between EMSs and disease symptoms. Early parent–child relationships and traumatic childhood events play a significant role in the development of Obsessive–Compulsive Disorder (OCD). Thus, this study aimed to explain the mediating role of schema modes between EMSs and OCD.

This descriptive–correlational research applied structural equation modeling. The statistical population included all individuals with OCD referring to the medical and counseling centers in Tehran City, Iran, in 2018. Initially, due to the possibility of sample loss caused by other psychiatric disorders, especially personality disorders and severe disorders such as bipolar disorder (except for comorbid disorders, e.g., anxiety, depression), unpreparedness, no satisfaction to participate in the study, or use of any psychotropic drugs and drug dependence, individuals were selected by non–random and purposive sampling methods. Eventually, 427 subjects provided completed questionnaires. The inclusion criteria of the study included men and women aged 18–60 years and a diagnosis of OCD at the discretion of a clinical psychologist and a psychiatrist. The exclusion criteria of the study were providing incomplete information and incomplete questionnaires. The Young Schema Questionnaire–Short Form (Young, 1998), the Short Schema Mode Inventory (Lobbestael et al., 2010), and The Revised Obsessive–Compulsive Inventory (Foa et al., 2002) were used. The obtained data were analyzed by Pearson correlation coefficient and structural equation modeling using SPSS and AMOS. The significance level of the tests was considered 0.05.

The obtained results suggested that the direct path coefficient between the first domain (abandonment) to the dysfunctional parent (β=0.46, p<0.001), the direct path coefficient between the fifth domain (over–vigilance and inhibition) to the dysfunctional parent (β=0.79, p<0.001), the direct path coefficient between the first domain to an inefficient coping (β=0.28, p<0.001), the direct path coefficient between the fifth domain to an inefficient coping (β=0.30, p=0.002), the direct path coefficient between dysfunctional parent to obsessive–compulsive disorder (β=0.54, p<0.001), and the direct path coefficient between dysfunctional coping with obsessive–compulsive disorder (β=0.33, p<0.001) were positive and significant. The results also signified that the indirect effect of the first domain with OCD mediated by the dysfunctional parent (β=0.18, p<0.001) and the indirect effect of the fifth domain with OCD mediated by the dysfunctional parent (β=0.13, p<0.001) were positive and significant. Additionally, the indirect effect of the first domain with OCD mediated by inefficient coping (β=0.14, p<0.001) and the indirect effect of the fifth domain with OCD mediated by inefficient coping (β=0.22, p<0.001) were positive and significant. Moreover, the effect of the whole of the first domain with OCD mediated by the dysfunctional parent (β=0.64, p<0.001) and the effect of the whole of the fifth domain with OCD mediated by the dysfunctional parent (β= 0.92, p<0.001) were positive. Besides, the effect of the whole of ​​the first domain with OCD mediated by inefficient coping (β=0.42, p<0.001) and the effect of the whole of ​​the fifth domain with OCD mediated by inefficient coping (β=0.52, p<0.001) were positive and significant. The goodness of fit indices also supported the optimal fit of the model with the collected data (X2/df=2.16, CFI=0.91, GFI=0.93, AGFI=0.94, RMSEA=0.045).

Based on the current study findings, schema mode (i.e., dysfunctional parents & inefficient coping) played a mediating role between EMSs (including the first domain, abandonment, & the fifth domain, over–vigilance & inhibition) and OCD.