Table 1 Early maladaptive schemas and core domains

Abandonment

 Perceived instability or unreliability of those available for support and connection. Involves the sense that significant others will not be able to continue providing emotional support, connection, strength, or practical protection because they are emotionally unstable and unpredictable, unreliable, or erratically present; because they will die imminently; or because they will abandon the patient in favour of someone better.

Disconnection / Rejection

Mistrust / Abuse

 Expectation that others will hurt, abuse, humiliate, cheat, lie, manipulate, or take advantage. Usually involves the perception that the harm is intentional or the result of unjustified and extreme negligence. May include the sense that one always ends up being cheated relative to others or “getting the short end of the stick.”

Emotional Deprivation

 Expectation that one’s desire for a normal degree of emotional support will not be adequately met by others. The three major forms of deprivation are: (A) Deprivation of Nurturance: Absence of attention, affection, warmth, or companionship; (B) Deprivation of Empathy: Absence of understanding, listening, self-disclosure, or mutual sharing of feelings from others; (C) Deprivation of Protection.

Defectiveness / Shame

 Feeling that one is defective, bad, unwanted, inferior, or invalid in important respects; or that one would be unlovable to significant others if exposed. May involve hypersensitivity to criticism, rejection, and blame; self-consciousness, comparisons, and insecurity around others; or a sense of shame regarding one’s perceived flaws. These flaws may be private Or public.

Social isolation / Alienation

 Feeling that one is isolated from the rest of the world, different from other people, and/or not part of any group or community.

Dependence / Incompetence

 Belief that one is unable to handle one’s everyday responsibilities in a competent manner, without considerable help from others (e.g., take care of oneself, solve daily problems, exercise good judgment, tackle new tasks, make good decisions). Often presents as helplessness.

Impaired Autonomy

Vulnerability to harm / Illness

 Exaggerated fear that imminent catastrophe will strike at any time and that one will be unable to prevent it. Fears focus on one or more of the following: (A) Medical Catastrophes; (B) Emotional Catastrophes; (C) External Catastrophes.

Enmeshment/Undeveloped self

 Excessive emotional involvement and closeness with one or more significant others (often parents), at the expense of full individuation or normal social development. Often involves the belief that at least one of the enmeshed individuals cannot survive or be happy without the constant support of the other.

Failure to achieve

 The belief that one has failed, will inevitably fail, or is fundamentally inadequate relative to one’s peers, in areas of achievement. Often involves beliefs that one is stupid, inept, untalented, ignorant, lower in status, less successful than others.

Entitlement / Grandiosity

 The belief that one is superior to other people; entitled to special rights and privileges; or not bound by the rules of reciprocity that guide normal social interaction. Often involves insistence that one should be able to do or have whatever one wants, regardless of what is realistic, what others consider reasonable, or the cost to others; or an exaggerated focus on superiority - in order to achieve power or control (not primarily for attention or approval).

Impaired Limits

Insufficient self-control / Self-discipline

 Pervasive difficulty or refusal to exercise sufficient self-control and frustration tolerance to achieve one’s personal goals, or to restrain the excessive expression of one’s emotions and impulses. In its milder form, patient presents with an exaggerated emphasis on discomfort-avoidance: avoiding pain, conflict, confrontation, responsibility, or overexertion---at the expense of personal fulfilment, commitment, or integrity.

Subjugation

 Excessive surrendering of control to others because one feels coerced - - usually to avoid anger, retaliation, or abandonment. The two major forms of subjugation are: (A) Subjugation of Needs: Suppression of one’s preferences, decisions, and desires; (B) Subjugation of Emotions: Suppression of emotional expression, especially anger. Usually involves the perception that one’s own desires, opinions, and feelings are not valid or important to others.

Other Directedness

Self-sacrifice

 Excessive focus on voluntarily meeting the needs of others in daily situations, at the expense of one’s own gratification. The most common reasons are: to prevent causing pain to others; to avoid guilt from feeling selfish; or to maintain the connection with others perceived as needy. Often results from an acute sensitivity to the pain of others. Sometimes leads to a sense that one’s own needs are not being adequately met and to resentment of those who are taken care of.

Approval-seeking / Recognition-seeking

 Excessive emphasis on gaining approval, recognition, or attention from other people, or fitting in, at the expense of developing a secure and true sense of self. One’s sense of esteem is dependent primarily on the reactions of others rather than on one’s own natural inclinations. Sometimes includes an overemphasis on status, appearance, social acceptance, money, or achievement -- as means of gaining approval, admiration, or attention (not primarily for power or control).

Negativity / Pessimism

 A pervasive, lifelong focus on the negative aspects of life while minimizing or neglecting the positive or optimistic aspects. Usually includes an exaggerated expectation-- in a wide range of work, financial, or interpersonal situations -- that things will eventually go seriously wrong.

Overvigilance / Inhibition

Emotional inhibition

 The excessive inhibition of spontaneous action, feeling, or communication -- usually to avoid disapproval by others, feelings of shame, or losing control of one’s impulses. The most common areas of inhibition involve: (a) inhibition of anger & aggression; (b) inhibition of positive impulses; (c) difficulty expressing vulnerability or communicating freely about one’s feelings, needs; (d) excessive emphasis on rationality while disregarding emotions.

Unrelenting standards / Hypercriticalness

 The underlying belief that one must strive to meet very high internalized standards of behaviour and performance, usually to avoid criticism. Typically results in feelings of pressure or difficulty slowing down; and in hypercriticalness toward oneself and others.

Punitiveness

 The belief that people should be harshly punished for making mistakes. Involves the tendency to be angry, intolerant, punitive, and impatient with those people (including oneself) who do not meet one’s expectations or standards. Usually includes difficulty forgiving mistakes in oneself or others, because of a reluctance to consider extenuating circumstances, allow for human imperfection, or empathize with feelings.