A transdiagnostic perspective on unwanted intrusive thoughts in eating disorders and obsessive-compulsive disorder and their relationship with early maladaptive schemas: A path modeling analysis

Fatma Mahperi Uluyol

doi:10.18621/eurj.1688365

Araştırma Makalesi

BibTex

RIS

Kaynak Göster

Yıl 2025, EARLY ONLINE, 1 - 11

Fatma Mahperi Uluyol

https://doi.org/10.18621/eurj.1688365

Öz

Kaynakça

1. Rachman S. A cognitive theory of obsessions. Behav Res Ther. 1997;35(9):793-802. doi: 10.1016/s0005-7967(97)00040-5.
2. Purdon C, Clark DA. Obsessive intrusive thoughts in nonclinical subjects. Part I. Content and relation with depressive, anxious and obsessional symptoms. Behav Res Ther. 1993;31(8):713-720. doi: 10.1016/0005-7967(93)90001-b.
3. Audet JS, Bourguignon L, Aardema F. What makes an obsession? A systematic-review and meta-analysis on the specific characteristics of intrusive cognitions in OCD in comparison with other clinical and non-clinical populations. Clin Psychol Psychother. 2023;30(6):1446-1463. doi: 10.1002/cpp.2887.
4. Giraldo-O’Meara M, Belloch A. The appearance intrusions questionnaire: a self-report questionnaire to assess the universality and intrusiveness of preoccupations about appearance defects. Eur J Psychol Assess. 2017;35(3):423-435. doi: 10.1027/1015-5759/a000406.
5. Muse K, McManus F, Hackmann A, Williams M, Williams M. Intrusive imagery in severe health anxiety: Prevalence, nature and links with memories and maintenance cycles. Behav Res Ther. 2010;48(8):792-798. doi: 10.1016/j.brat.2010.05.008.
6. García-Soriano G, Roncero M, Perpiñá C, Belloch A. Intrusive thoughts in obsessive-compulsive disorder and eating disorder patients: a differential analysis. Eur Eat Disord Rev. 2014;22(3):191-199. doi: 10.1002/erv.2285.
7. Belloch A, Roncero M, Perpiñá C. Obsessional and Eating Disorder-related Intrusive Thoughts: Differences and Similarities Within and Between Individuals Vulnerable to OCD or to EDs. Eur Eat Disord Rev. 2016;24(6):446-454. doi: 10.1002/erv.2458.
8. Pascual-Vera B, Belloch A. Functional links of obsessive, dysmorphic, hypochondriac, and eating-disorders related mental intrusions. Int J Clin Health Psychol. 2018;18(1):43-51. doi: 10.1016/j.ijchp.2017.09.001.
9. Fusar‐Poli P, Solmi M, Brondino N, et al. Transdiagnostic psychiatry: a systematic review. World Psychiatry. 2019;18(2):192-207. doi: 10.1002/wps.20631.
10. Micali N, Hilton K, Natatani E, Heyman I, Turner C, Mataix-Cols D. Is childhood OCD a risk factor for eating disorders later in life? A longitudinal study. Psychol Med. 2011;41(12):2507-2513. doi:10.1017/S003329171100078X.
11. Bardone‐Cone AM, Thompson KA, Miller AJ. The self and eating disorders. J Pers. 2020;88(1):59-75. doi: 10.1111/jopy.12448.
12. Young JE, Klosko JS, Weishaar ME. Schema therapy: A practitioner’s guide. New York: The Guilford Pres, 2003.
13. Pugh M. The internal ‘anorexic voice’: a feature or fallacy of eating disorders? Adv Eat Disord. 2016;4(1):75-83. doi: 10.1080/21662630.2015.1116017.
14. Bär A, Bär HE, Rijkeboer MM, Lobbestael J. Early maladaptive schemas and schema modes in clinical disorders: A systematic review. Psychol Psychother. 2023;96(3):716-747. doi: 10.1111/papt.12465.
15. Maher A, Cason L, Huckstepp T, et al. Early maladaptive schemas in eating disorders: A systematic review. Eur Eat Disord Rev. 2022;30(1):3-22. doi.org/10.1002/erv.2866.
16. Jaeger T, Moulding R, Yang YH, David J, Knight T, Norberg MM. A systematic review of obsessive-compulsive disorder and self: Self-esteem, feared self, self-ambivalence, egodystonicity, early maladaptive schemas, and self concealment. J Obsessive Compuls Relat Disord. 2021;31:100665. doi.org/10.1016/j.jocrd.2021.100665.
17. Joshua PR, Lewis V, Kelty SF, Boer DP. Is schema therapy effective for adults with eating disorders? A systematic review into the evidence. Cogn Behav Ther. 2023;52(3):213-231. doi: 10.1080/16506073.2022.2158926.
18. Dostal AL, Pilkington PD. Early maladaptive schemas and obsessive-compulsive disorder: A systematic review and meta-analysis. J Affect Disord Rep. 2023;336:42-51. doi: 10.1016/j.jad.2023.05.053.
19. Perpiñá C, Roncero M, Belloch A, Sánchez-Reales S. Eating-related intrusive thoughts inventory: Exploring the dimensionality of eating disorder symptom. Psychol Rep. 2011;109(1):108-126. doi:10.2466/02.09.13.18.PR0.109.4.108-126.
20. Uluyol FM, Taşkale N, İnözü Mermerkaya M. [The Reliability and Validity Study of the Eating-related Intrusive Thoughts Inventory (INPIAS). Nesne Psikoloji Derg. 2022; 10(25):418-437. doi: 10.7816/nesne-10-25-04. [Article in Turkish]
21. Soygüt G, Karaosmanoğlu A, Cakir Z. [Assessment of early maladaptive schemas: a psychometric study of the Turkish young schema questionnaire-short form-3]. Turk Psikiyatri Derg. 2009;20(1):75-84. [Article in Turkish]
22. Obsessive Compulsive Cognitions Working Group. Development and initial validation of the obsessive beliefs questionnaire and the interpretation of intrusions inventory. Behav Res Ther. 2001;39(8):987-1006. doi: 10.1016/S0005-7967(00)00085-1
23. Yorulmaz O, Gençöz T. Examination of Interpretations of Intrusions Inventory, Obsessive Beliefs Questionnaire and Thought Control Questionnaire Used For Evaluation of Obsessive-Compulsive Disorder Symptoms in Turkish Sample. Turkish Psychological Articles. 2008;11(22):14-16. doi: 10.1016/j.jbtep.2010.11.007.
24. Fairburn CG, Cooper Z, O’Connor M. The eating disorder examination. Int J Eat Disord. 1993;6(1):1-8.
25. Yucel B, Polat A, Ikiz T, Dusgor BP, Elif Yavuz A, Sertel Berk O. The Turkish version of the eating disorder examination questionnaire: reliability and validity in adolescents. Eur Eat Disord Rev. 2011;19(6):509-511. doi: 10.1002/erv.1104.
26. Foa EB, Huppert JD, Leiberg S, et al. The Obsessive-Compulsive Inventory: development and validation of a short version. Psychol Assess. 2002;14(4):485-496. doi: 10.1037/1040-3590.14.4.485.
27. Yorulmaz O, Inozu M, Clark DA, Radomsky AS. Psychometric properties of the obsessive-compulsive inventory-revised in a Turkish analogue sample. Psychol Rep. 2015;117(3):781-793. doi: 10.2466/08.PR0.117c25z4.
28. Meydan CH, Şeşen H. Yapısal eşitlik modellemesi AMOS uygulamaları. Detay Yayıncılık; 2011.
29. Kinkel-Ram SS, Grunewald W, Ortiz SN, Magee JM, Smith AR. Examining weekly relationships between obsessive-compulsive and eating disorder symptoms. J Affect Disord. 2022;298(Pt A):9-16. doi: 10.1016/j.jad.2021.10.105.
30. Levinson CA, Brosof LC, Ram SS, Pruitt A, Russell S, Lenze EJ. Obsessions are strongly related to eating disorder symptoms in anorexia nervosa and atypical anorexia nervosa. Eat Behav. 2019;34:101298. doi: 10.1016/j.eatbeh.2019.05.001.
31. Atalay H, Atalay F, Karahan D, Caliskan M. Early maladaptive schemas activated in patients with obsessive compulsive disorder: A cross-sectional study. Int J Psychiatry Clin Pract. 2008;12(4),268-279. doi: 10.1080/13651500802095004.
32. Kizilagac F, Cerit C. Assessment of early maladaptive schemas in patients with obsessive-compulsive disorder. Dusunen Adam. 2019;32(1):14-32. doi: 10.14744/DAJPNS.2019.00003
33. Voderholzer U, Schwartz C, Thiel N, et al. A comparison of schemas, schema modes and childhood traumas in obsessive-compulsive disorder, chronic pain disorder and eating disorders. Psychopathology. 2013;47(1):24-31. doi: 10.1159/000348484.
34. Unoka Z, Tölgyes T, Czobor P, Simon L. Eating disorder behavior and early maladaptive schemas in subgroups of eating disorders. J Nerv Ment Dis. 2010;198(6)425-431. doi: 10.1097/NMD.0b013e3181e07d3d.
35. Legenbauer T, Radix AK, Augustat N, Schütt-Strömel S. Power of Cognition: How Dysfunctional Cognitions and Schemas Influence Eating Behavior in Daily Life Among Individuals With Eating Disorders. Front Psychol. 2018;9:2138. doi: 10.3389/fpsyg.2018.02138.
36. Thimm JC, Chang M. Early maladaptive schemas and mental disorders in adulthood: A systematic review and meta-analysis. International J Cogn Ther. 2022;15(4):371-413. doi: 10.1007/s41811-022-00149-7.
37. Simeone-DiFrancesco C, Roediger E, Stevens BA. Schema therapy with couples: a practitioner’s guide to healing relationships. John Wiley & Sons; 2015.
38. Haaland AT, Vogel PA, Launes G, et al. The role of early maladaptive schemas in predicting exposure and response prevention outcome for obsessive-compulsive disorder. Behav Res Ther. 2011;49(11):781-788. doi: 10.1016/j.brat.2011.08.007.
39. Pascual-Vera B, Akin B, Belloch A, et al. The cross-cultural and transdiagnostic nature of unwanted mental intrusions. Int J Clin Health Psychol. 2019;19(2),85-96. doi: 10.1016/j.ijchp.2019.02.005.
40. Pascual-Vera B, Akin B, Belloch, A. et al. Maladaptive consequences of mental intrusions with obsessive, dysmorphic, hypochondriac, and eating-disorders related contents: cross-cultural differences. Int J Clin Health Psychol. 2022;22(1):100275. doi: 10.1016/j.ijchp.2019.02.005.

A transdiagnostic perspective on unwanted intrusive thoughts in eating disorders and obsessive-compulsive disorder and their relationship with early maladaptive schemas: A path modeling analysis

Yıl 2025, EARLY ONLINE, 1 - 11

Fatma Mahperi Uluyol

https://doi.org/10.18621/eurj.1688365

Öz

Objectives: Unwanted intrusive thoughts (UITs) are sudden, repetitive, ego-dystonic cognitions commonly observed across psychological disorders, including obsessive-compulsive disorder (OCD) and eating disorders (EDs). Despite disorder-specific content, their shared features - such as intrusiveness and suppression urges - suggest a transdiagnostic cognitive function. Early maladaptive schemas (EMSs), as deep cognitive structures, may shape how individuals interpret and respond to UITs, thereby influencing symptom severity. While some EMSs broadly relate to psychopathology, others appear disorder-specific. However, studies jointly examining UITs and EMSs across OCD and EDs within the same sample remain scarce. This study aims to explore the transdiagnostic and disorder-specific roles of UITs and EMSs in relation to OCD and ED symptoms by analyzing their shared and distinct associations in a non-clinical sample.

Methods: A total of 364 university students (270 females, 94 males) completed self-report measures assessing UITs related to EDs and OCD, EMSs, and ED/OCD symptomatology. Path analysis was conducted in Analysis of Moment Structures (AMOS) to test the theoretical model.

Results: EMS domains were differentially associated with UITs and symptom severity in OCD and EDs. Other-Directedness predicted OBQ (β=0.32) and indirectly OCI-R (β=0.06). Impaired Autonomy was linked to both OBQ (β=0.23) and EDITs (β=0.48), while Impaired Limits was associated only with OCI-R (β=0.18). OBQ predicted OCI-R (β=0.20) and EDITs predicted both EDE-Q (β=0.65) and OBQ (β=0.17).

Conclusions: UITs and specific schema domains may jointly contribute to EDs and OCD symptoms, suggesting targets for early intervention in subclinical populations.

Anahtar Kelimeler

Unwanted intrusive thoughts, early maladaptive schemas, transdiagnostic, obsessive-compulsive disorder, eating disorders

Etik Beyan

This study was approved by the Akdeniz University Faculty of Medicine Clinical Research Ethics Committee (Decision no. 2019-243, date: 06.03.2019). All subjects gave written informed consent in accordance with the Declaration of Helsinki (2013).

Destekleyen Kurum

The Scientific Research Projects Coordination Unit of Akdeniz University

Kaynakça

1. Rachman S. A cognitive theory of obsessions. Behav Res Ther. 1997;35(9):793-802. doi: 10.1016/s0005-7967(97)00040-5.
2. Purdon C, Clark DA. Obsessive intrusive thoughts in nonclinical subjects. Part I. Content and relation with depressive, anxious and obsessional symptoms. Behav Res Ther. 1993;31(8):713-720. doi: 10.1016/0005-7967(93)90001-b.
3. Audet JS, Bourguignon L, Aardema F. What makes an obsession? A systematic-review and meta-analysis on the specific characteristics of intrusive cognitions in OCD in comparison with other clinical and non-clinical populations. Clin Psychol Psychother. 2023;30(6):1446-1463. doi: 10.1002/cpp.2887.
4. Giraldo-O’Meara M, Belloch A. The appearance intrusions questionnaire: a self-report questionnaire to assess the universality and intrusiveness of preoccupations about appearance defects. Eur J Psychol Assess. 2017;35(3):423-435. doi: 10.1027/1015-5759/a000406.
5. Muse K, McManus F, Hackmann A, Williams M, Williams M. Intrusive imagery in severe health anxiety: Prevalence, nature and links with memories and maintenance cycles. Behav Res Ther. 2010;48(8):792-798. doi: 10.1016/j.brat.2010.05.008.
6. García-Soriano G, Roncero M, Perpiñá C, Belloch A. Intrusive thoughts in obsessive-compulsive disorder and eating disorder patients: a differential analysis. Eur Eat Disord Rev. 2014;22(3):191-199. doi: 10.1002/erv.2285.
7. Belloch A, Roncero M, Perpiñá C. Obsessional and Eating Disorder-related Intrusive Thoughts: Differences and Similarities Within and Between Individuals Vulnerable to OCD or to EDs. Eur Eat Disord Rev. 2016;24(6):446-454. doi: 10.1002/erv.2458.
8. Pascual-Vera B, Belloch A. Functional links of obsessive, dysmorphic, hypochondriac, and eating-disorders related mental intrusions. Int J Clin Health Psychol. 2018;18(1):43-51. doi: 10.1016/j.ijchp.2017.09.001.
9. Fusar‐Poli P, Solmi M, Brondino N, et al. Transdiagnostic psychiatry: a systematic review. World Psychiatry. 2019;18(2):192-207. doi: 10.1002/wps.20631.
10. Micali N, Hilton K, Natatani E, Heyman I, Turner C, Mataix-Cols D. Is childhood OCD a risk factor for eating disorders later in life? A longitudinal study. Psychol Med. 2011;41(12):2507-2513. doi:10.1017/S003329171100078X.
11. Bardone‐Cone AM, Thompson KA, Miller AJ. The self and eating disorders. J Pers. 2020;88(1):59-75. doi: 10.1111/jopy.12448.
12. Young JE, Klosko JS, Weishaar ME. Schema therapy: A practitioner’s guide. New York: The Guilford Pres, 2003.
13. Pugh M. The internal ‘anorexic voice’: a feature or fallacy of eating disorders? Adv Eat Disord. 2016;4(1):75-83. doi: 10.1080/21662630.2015.1116017.
14. Bär A, Bär HE, Rijkeboer MM, Lobbestael J. Early maladaptive schemas and schema modes in clinical disorders: A systematic review. Psychol Psychother. 2023;96(3):716-747. doi: 10.1111/papt.12465.
15. Maher A, Cason L, Huckstepp T, et al. Early maladaptive schemas in eating disorders: A systematic review. Eur Eat Disord Rev. 2022;30(1):3-22. doi.org/10.1002/erv.2866.
16. Jaeger T, Moulding R, Yang YH, David J, Knight T, Norberg MM. A systematic review of obsessive-compulsive disorder and self: Self-esteem, feared self, self-ambivalence, egodystonicity, early maladaptive schemas, and self concealment. J Obsessive Compuls Relat Disord. 2021;31:100665. doi.org/10.1016/j.jocrd.2021.100665.
17. Joshua PR, Lewis V, Kelty SF, Boer DP. Is schema therapy effective for adults with eating disorders? A systematic review into the evidence. Cogn Behav Ther. 2023;52(3):213-231. doi: 10.1080/16506073.2022.2158926.
18. Dostal AL, Pilkington PD. Early maladaptive schemas and obsessive-compulsive disorder: A systematic review and meta-analysis. J Affect Disord Rep. 2023;336:42-51. doi: 10.1016/j.jad.2023.05.053.
19. Perpiñá C, Roncero M, Belloch A, Sánchez-Reales S. Eating-related intrusive thoughts inventory: Exploring the dimensionality of eating disorder symptom. Psychol Rep. 2011;109(1):108-126. doi:10.2466/02.09.13.18.PR0.109.4.108-126.
20. Uluyol FM, Taşkale N, İnözü Mermerkaya M. [The Reliability and Validity Study of the Eating-related Intrusive Thoughts Inventory (INPIAS). Nesne Psikoloji Derg. 2022; 10(25):418-437. doi: 10.7816/nesne-10-25-04. [Article in Turkish]
21. Soygüt G, Karaosmanoğlu A, Cakir Z. [Assessment of early maladaptive schemas: a psychometric study of the Turkish young schema questionnaire-short form-3]. Turk Psikiyatri Derg. 2009;20(1):75-84. [Article in Turkish]
22. Obsessive Compulsive Cognitions Working Group. Development and initial validation of the obsessive beliefs questionnaire and the interpretation of intrusions inventory. Behav Res Ther. 2001;39(8):987-1006. doi: 10.1016/S0005-7967(00)00085-1
23. Yorulmaz O, Gençöz T. Examination of Interpretations of Intrusions Inventory, Obsessive Beliefs Questionnaire and Thought Control Questionnaire Used For Evaluation of Obsessive-Compulsive Disorder Symptoms in Turkish Sample. Turkish Psychological Articles. 2008;11(22):14-16. doi: 10.1016/j.jbtep.2010.11.007.
24. Fairburn CG, Cooper Z, O’Connor M. The eating disorder examination. Int J Eat Disord. 1993;6(1):1-8.
25. Yucel B, Polat A, Ikiz T, Dusgor BP, Elif Yavuz A, Sertel Berk O. The Turkish version of the eating disorder examination questionnaire: reliability and validity in adolescents. Eur Eat Disord Rev. 2011;19(6):509-511. doi: 10.1002/erv.1104.
26. Foa EB, Huppert JD, Leiberg S, et al. The Obsessive-Compulsive Inventory: development and validation of a short version. Psychol Assess. 2002;14(4):485-496. doi: 10.1037/1040-3590.14.4.485.
27. Yorulmaz O, Inozu M, Clark DA, Radomsky AS. Psychometric properties of the obsessive-compulsive inventory-revised in a Turkish analogue sample. Psychol Rep. 2015;117(3):781-793. doi: 10.2466/08.PR0.117c25z4.
28. Meydan CH, Şeşen H. Yapısal eşitlik modellemesi AMOS uygulamaları. Detay Yayıncılık; 2011.
29. Kinkel-Ram SS, Grunewald W, Ortiz SN, Magee JM, Smith AR. Examining weekly relationships between obsessive-compulsive and eating disorder symptoms. J Affect Disord. 2022;298(Pt A):9-16. doi: 10.1016/j.jad.2021.10.105.
30. Levinson CA, Brosof LC, Ram SS, Pruitt A, Russell S, Lenze EJ. Obsessions are strongly related to eating disorder symptoms in anorexia nervosa and atypical anorexia nervosa. Eat Behav. 2019;34:101298. doi: 10.1016/j.eatbeh.2019.05.001.
31. Atalay H, Atalay F, Karahan D, Caliskan M. Early maladaptive schemas activated in patients with obsessive compulsive disorder: A cross-sectional study. Int J Psychiatry Clin Pract. 2008;12(4),268-279. doi: 10.1080/13651500802095004.
32. Kizilagac F, Cerit C. Assessment of early maladaptive schemas in patients with obsessive-compulsive disorder. Dusunen Adam. 2019;32(1):14-32. doi: 10.14744/DAJPNS.2019.00003
33. Voderholzer U, Schwartz C, Thiel N, et al. A comparison of schemas, schema modes and childhood traumas in obsessive-compulsive disorder, chronic pain disorder and eating disorders. Psychopathology. 2013;47(1):24-31. doi: 10.1159/000348484.
34. Unoka Z, Tölgyes T, Czobor P, Simon L. Eating disorder behavior and early maladaptive schemas in subgroups of eating disorders. J Nerv Ment Dis. 2010;198(6)425-431. doi: 10.1097/NMD.0b013e3181e07d3d.
35. Legenbauer T, Radix AK, Augustat N, Schütt-Strömel S. Power of Cognition: How Dysfunctional Cognitions and Schemas Influence Eating Behavior in Daily Life Among Individuals With Eating Disorders. Front Psychol. 2018;9:2138. doi: 10.3389/fpsyg.2018.02138.
36. Thimm JC, Chang M. Early maladaptive schemas and mental disorders in adulthood: A systematic review and meta-analysis. International J Cogn Ther. 2022;15(4):371-413. doi: 10.1007/s41811-022-00149-7.
37. Simeone-DiFrancesco C, Roediger E, Stevens BA. Schema therapy with couples: a practitioner’s guide to healing relationships. John Wiley & Sons; 2015.
38. Haaland AT, Vogel PA, Launes G, et al. The role of early maladaptive schemas in predicting exposure and response prevention outcome for obsessive-compulsive disorder. Behav Res Ther. 2011;49(11):781-788. doi: 10.1016/j.brat.2011.08.007.
39. Pascual-Vera B, Akin B, Belloch A, et al. The cross-cultural and transdiagnostic nature of unwanted mental intrusions. Int J Clin Health Psychol. 2019;19(2),85-96. doi: 10.1016/j.ijchp.2019.02.005.
40. Pascual-Vera B, Akin B, Belloch, A. et al. Maladaptive consequences of mental intrusions with obsessive, dysmorphic, hypochondriac, and eating-disorders related contents: cross-cultural differences. Int J Clin Health Psychol. 2022;22(1):100275. doi: 10.1016/j.ijchp.2019.02.005.

Toplam 40 adet kaynakça vardır.

Ayrıntılar

Birincil Dil	İngilizce
Konular	Psikiyatri
Bölüm	Original Article
Yazarlar	Fatma Mahperi Uluyol 0000-0002-7879-9807
Erken Görünüm Tarihi	31 Temmuz 2025
Yayımlanma Tarihi
Gönderilme Tarihi	1 Mayıs 2025
Kabul Tarihi	28 Temmuz 2025
Yayımlandığı Sayı	Yıl 2025 EARLY ONLINE

Kaynak Göster

AMA	Uluyol FM. A transdiagnostic perspective on unwanted intrusive thoughts in eating disorders and obsessive-compulsive disorder and their relationship with early maladaptive schemas: A path modeling analysis. Eur Res J. Published online 01 Temmuz 2025:1-11. doi:10.18621/eurj.1688365

Makale Dosyaları

Tam Metin

e-ISSN: 2149-3189

Facebook - Twitter - Linkedin - Instagram

The European Research Journal, hosted by Turkish JournalPark ACADEMIC, is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.

2025