Schema Domains and Early Maladaptive Schemas

In our model, the 18 schemas are grouped into five broad categories of unmet emotional needs that we call “schema domains.” We review the empirical support for these 18 schemas later in the chapter. In this section we elaborate on the five domains and list the schemas they contain. In Figure 1.1, the five schema domains are centered, in italics, without numbers (e.g., “Disconnection and Rejection”); the 18 schemas are aligned to the left and numbered (e.g., “1. Abandonment/Instability”).

Domain I: Disconnection and Rejection

Patients with schemas in this domain are unable to form secure, satisfying attachments to others. They believe that their needs for stability, safety, nurturance, love, and belonging will not be met. Typical families of origin are unstable (Abandonment/Instability), abusive (Mistrust/Abuse), cold (Emotional Deprivation), rejecting (Defectiveness/Shame), or isolated from the outside world (Social Isolation/Alienation). Patients with schemas in the Disconnection and Rejection domain (especially the first four schemas) are often the most damaged. Many had traumatic childhoods, and as adults they tend to rush headlong from one self-destructive relationship to another or to avoid close relationships altogether. The therapy relationship is often central to the treatment of these patients.

The Abandonment/Instability schema is the perceived instability of one’s connection to significant others. Patients with this schema have the sense that important people in their life will not continue to be there because they are emotionally unpredictable, they are only present erratically, they will die, or they will leave the patient for someone better.

Patients who have the Mistrust/Abuse schema have the conviction that, given the opportunity, other people will use the patient for their own selfish ends. For example, they will abuse, hurt, humiliate, lie to, cheat, or manipulate the patient.

The Emotional Deprivation schema is the expectation that one’s desire for emotional connection will not be adequately fulfilled. We identify three forms: (1) deprivation of nurturance (the absence of affection or caring); (2) deprivation of empathy (the absence of listening or understanding); and (3) deprivation of protection (the absence of strength or guidance from others).

The Defectiveness/Shame schema is the feeling that one is flawed, bad, inferior, or worthless and that one would be unlovable to others if exposed. The schema usually involves a sense of shame regarding one’s perceived defects. Flaws may be private (e.g., selfishness, aggressive impulses, unacceptable sexual desires) or public (e.g., unattractive appearance, social awkwardness).

The Social Isolation/Alienation schema is the sense of being different from or not fitting into the larger social world outside the family. Typically, patients with this schema do not feel they belong to any group or community.

Domain II: Impaired Autonomy and Performance

Autonomy is the ability to separate from one’s family and to function independently comparable to people one’s own age. Patients with schemas in this domain have expectations about themselves and the world that interfere with their ability to differentiate themselves from parent figures and function independently. When these patients were children, typically their parents did everything for them and overprotected them; or, at the opposite (much more rare) extreme, hardly ever cared for or watched over them. (Both extremes lead to problems in the autonomy realm.) Often their parents undermined their self-confidence and failed to reinforce them for performing competently outside the home. Consequently, these patients are not able to forge their own identities and create their own lives. They are not able to set personal goals and master the requisite skills. With respect to competence, they remain children well into their adult lives.

Patients with the Dependence/Incompetence schema feel unable to handle their everyday responsibilities without substantial help from others. For example, they feel unable to manage money, solve practical problems, use good judgment, undertake new tasks, or make good decisions. The schema often presents as pervasive passivity or helplessness.

Vulnerability to Harm or Illness is the exaggerated fear that catastrophe will strike at any moment and that one will be unable to cope. Fears focus on the following types of catastrophes: (1) medical (e.g., heart attacks, diseases such as AIDS); (2) emotional (e.g., going crazy, losing control); and (3) external (e.g., accidents, crime, natural catastrophes).

Patients with the Enmeshment/Undeveloped Self schema are often overly involved with one or more significant others (often parents) to the detriment of their full individuation and social development. These patients frequently believe that at least one of the enmeshed individuals could not function without the other. The schema may include feelings of being smothered by or fused with others or lacking a clear sense of identity and direction.

The Failure schema is the belief that one will inevitably fail in areas of achievement (e.g., school, sports, career) and that, in terms of achievement, one is fundamentally inadequate relative to one’s peers. The schema often involves beliefs that one is unintelligent, inept, untalented, or unsuccessful.

Domain III: Impaired Limits

Patients with schemas in this domain have not developed adequate internal limits in regard to reciprocity or self-discipline. They may have difficulty respecting the rights of others, cooperating, keeping commitments, or meeting long-term goals. These patients often present as selfish, spoiled, irresponsible, or narcissistic. They typically grew up in families that were overly permissive and indulgent. (Entitlement can sometimes be a form of overcompensation for another schema, such as Emotional Deprivation; in these cases, overindulgence is usually not the primary origin, as we discuss in Chapter 10.) As children, these patients were not required to follow the rules that apply to everyone else, to consider others, or to develop self-control. As adults they lack the capacity to restrain their impulses and to delay gratification for the sake of future benefits.

The Entitlement/Grandiosity schema is the assumption that one is superior to other people, and therefore entitled to special rights and privileges. Patients with this schema do not feel bound by the rules of reciprocity that guide normal social interaction. They often insist that they should be able to do whatever they want, regardless of the cost to others. They may maintain an exaggerated focus on superiority (e.g., being among the most successful, famous, wealthy) in order to achieve power. These patients are often overly demanding or dominating, and lack empathy.

Patients with the Insufficient Self-Control/Self-Discipline schema either cannot or will not exercise sufficient self-control and frustration tolerance to achieve their personal goals. These patients do not regulate the expression of their emotions and impulses. In the milder form of this schema, patients present with an exaggerated emphasis on discomfort avoidance. For example, they avoid most conflict or responsibility.

Domain IV: Other-Directedness

The patients in this domain place an excessive emphasis on meeting the needs of others rather than their own needs. They do this in order to gain approval, maintain emotional connection, or avoid retaliation. When interacting with others, they tend to focus almost exclusively on the responses of the other person rather than on their own needs, and often lack awareness of their own anger and preferences. As children, they were not free to follow their natural inclinations. As adults, rather than being directed internally, they are directed externally and follow the desires of others. The typical family origin is based on conditional acceptance: Children must restrain important aspects of themselves in order to obtain love or approval. In many such families, the parents value their own emotional needs or social “appearances” more than they value the unique needs of the child.

The Subjugation schema is an excessive surrendering of control to others because one feels coerced. The function of subjugation is usually to avoid anger, retaliation, or abandonment. The two major forms are: (1) subjugation of needs: suppressing one’s preferences or desires; and (2) subjugation of emotions: suppressing one’s emotional responses, especially anger. The schema usually involves the perception that one’s own needs and feelings are not valid or important. It frequently presents as excessive compliance and eagerness to please, combined with hypersensitivity to feeling trapped. Subjugation generally leads to a buildup of anger, manifested in maladaptive symptoms (e.g., passive-aggressive behavior, uncontrolled tempter outbursts, psychosomatic symptoms, or withdrawal of affection).

Patients with the Self-Sacrifice schema voluntarily meet the needs of others at the expense of their own gratification. They do this in order to spare others pain, avoid guilt, gain self-esteem, or maintain an emotional connection with someone they see as needy. The schema often results from an acute sensitivity to the suffering of others. It involves the sense that one’s own needs are not being adequately met and may lead to feelings of resentment. This schema overlaps with the 12-step concept of “co-dependency”

Patients with the Approval-Seeking/Recognition-Seeking schema value gaining approval or recognition from other people over developing a secure and genuine sense of self. Their self-esteem is dependent on the reactions of others rather than on their own reactions. The schema often includes an excessive preoccupation with social status, appearance, money, or success as a means of gaining approval or recognition. It frequently results in major life decisions that are inauthentic and unsatisfying.

Domain V: Overvigilance and Inhibition

Patients in this domain suppress their spontaneous feelings and impulses. They often strive to meet rigid, internalized rules about their own performance at the expense of happiness, self-expression, relaxation, close relationships, or good health. The typical origin is a childhood that was grim, repressed, and strict and in which self-control and self-denial predominated over spontaneity and pleasure. As children, these patients were not encouraged to play and pursue happiness. Rather, they learned to be hypervigilant to negative life events and to regard life as bleak. These patients usually convey a sense of pessimism and worry, fearing that their lives could fall apart if they fail to be alert and careful at all times.

The Negativity/Pessimism schema is a pervasive, lifelong focus on the negative aspects of life (e.g., pain, death, loss, disappointment, conflict, betrayal) while minimizing the positive aspects. The schema usually includes an exaggerated expectation that things will eventually go seriously wrong in a wide range of work, financial, or interpersonal situations. These patients have an inordinate fear of making mistakes that might lead to financial collapse, loss, humiliation, or being trapped in a bad situation. Because these patients exaggerate potential negative outcomes, they are frequently characterized by worry, apprehensiveness, hypervigilance, complaining, and indecision.

Patients with Emotional Inhibition constrain their spontaneous actions, feelings, and communication. They usually do this to prevent being criticized or losing control of their impulses. The most common areas of inhibition involve: (1) inhibition of anger; (2) inhibition of positive impulses (e.g., joy, affection, sexual excitement, playfulness); (3) difficulty expressing vulnerability; and (4) emphasis on rationality while disregarding emotions. These patients often present as flat, constricted, withdrawn, or cold.

The Unrelenting Standards/Hypercriticalness schema is the sense that one must strive to meet very high internalized standards, usually in order to avoid disapproval or shame. The schema typically results in feelings of constant pressure and hypercriticalness toward oneself and others. To be considered an Early Maladaptive Schema, there must be significant impairment in the patient’s health, self-esteem, relationships, or experience of pleasure. The schema typically presents as: (1) perfectionism (e.g., the need to do things “right,” inordinate attention to detail, or underestimating one’s level of performance); (2) rigid rules and “shoulds” in many areas of life, including unrealistically high moral, cultural, or religious standards; or (3) preoccupation with time and efficiency.

The Punitiveness schema is the conviction that people should be harshly punished for making mistakes. The schema involves the tendency to be angry and intolerant with those people (including oneself) who do not meet one’s standards. It usually includes difficulty forgiving mistakes because one is reluctant to consider extenuating circumstances, to allow for human imperfection, or to take a person’s intentions into account.

Case Illustration

Let us consider a brief case vignette that illustrates the schema concept. A young woman named Natalie comes for treatment. Natalie has an Emotional Deprivation schema: Her predominant experience of intimate relationships is that her emotional needs are not met. This has been true since early childhood. Natalie was an only child with emotionally cold parents. Although they met all of her physical needs, they did not nurture her or give her sufficient attention or affection. They did not try to understand who she was. In her family, Natalie felt alone.

Natalie’s presenting problem is chronic depression. She tells her therapist that she has been depressed her whole life. Although she has been in and out of therapy for years, her depression persists. Natalie has generally been attracted to emotionally depriving men. Her husband, Paul, fits this pattern. When Natalie goes to Paul for holding or sympathy, he becomes irritated and pushes her away. This triggers her Emotional Deprivation schema, and she becomes angry. Her anger is partially justified but also partially an overreaction to a husband who loves her but does not know how to show it.

Natalie’s anger further alienates her husband, and he distances himself from her even more, thus perpetuating her schema of deprivation. The marriage is caught in a vicious cycle, driven by her schema. In her marriage, Natalie continues to live out her childhood deprivation. Before marrying, Natalie had dated a more emotionally demonstrative man, but she was not sexually attracted to him and felt “suffocated” by normal expressions of tenderness. This tendency to be most attracted to partners who trigger a core schema is one we commonly observe in our patients (“schema chemistry”).

This example illustrates how early childhood deprivation leads to the development of a schema, which is then unwittingly played out and perpetuated in later life, leading to dysfunctional relationships and chronic Axis I symptoms.

Conditional versus Unconditional Schemas

We originally believed that the main difference between Early Maladaptive Schemas and Beck’s underlying assumptions (Beck, Rush, Shaw, & Emery, 1979) was that schemas are unconditional, whereas underlying assumptions are conditional. We now view some schemas as conditional and others as unconditional. Generally, the schemas that are developed earliest and are most at the core are unconditional beliefs about the self and others, whereas the schemas that are developed later are conditional.

Unconditional schemas hold out no hope to the patient. No matter what the individual does, the outcome will be the same. The individual will be incompetent, fused, unlovable, a misfit, endangered, bad—and nothing can change it. The schema encapsulates what was done to the child, without the child having had any choice in the matter. The schema simply is. In contrast, conditional schemas hold out the possibility of hope. The individual might change the outcome. The individual can subjugate, self-sacrifice, seek approval, inhibit emotions, or strive to meet high standards and, in so doing, perhaps avert the negative outcome, at least temporarily.

Conditional schemas often develop as attempts to get relief from the unconditional schemas. In this sense, conditional schemas are “secondary.” Here are some examples:

It is usually impossible to meet the demands of conditional schemas all of the time. For example, it is hard to subjugate oneself totally and never get angry. It is hard to be demanding enough to get all of one’s needs met or self-sacrificing enough to meet all of the other individual’s needs. At most the conditional schemas can forestall the core schemas. The individual is bound to fall short and thus have to face the truth of the core schema once again. (Not all conditional schemas can be linked to earlier ones. These schemas are conditional only in the sense that, if the child does what is expected, feared consequences can often be avoided.)

How Schemas Interfere with Traditional Cognitive-Behavioral Therapy

Many Early Maladaptive Schemas have the potential to sabotage traditional cognitive-behavioral therapy. Schemas make it difficult for patients to meet many of the assumptions of traditional cognitive-behavioral therapy noted previously in this chapter. For example, in regard to the assumption that patients can form a positive therapeutic alliance fairly quickly, patients who have schemas in the Disconnection and Rejection domain (Abandonment, Mistrust/Abuse, Emotional Deprivation, Defectiveness/Shame) may not be able to establish this kind of uncomplicated positive bond in a short period of time. Similarly, in terms of the presumption that patients have a strong sense of identity and clear life goals to guide the selection of treatment objectives, patients with schemas in the Impaired Autonomy and Performance domain (Dependence, Vulnerability, Enmeshment/Undeveloped Self, Failure) may not know who they are and what they want and thus may be unable to set specific treatment goals.

Cognitive-behavioral therapy assumes that patients can access cognitions and emotions and verbalize them in therapy. Patients with schemas in the Other-Directedness domain (Subjugation, Self-Sacrifice, Approval-Seeking) may be too focused on ascertaining what the therapist wants to look within themselves or to speak about their own thoughts and feelings. Finally, cognitive-behavior therapy assumes that patients can comply with treatment procedures. Patients with schemas in the Impaired Limits domain (Entitlement, Insufficient Self-Control/Self-Discipline) may be too unmotivated or undisciplined to do so.