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Early Maladaptive Schemas and Core Beliefs in Antisocial Personality Disorder

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According to cognitive theories of personality disorders, antisocial personality disorder (ASPD) is based upon a distinct set of cognitive-behavioral representations. The aim of this study is to examine this supposition by comparing the early maladaptive schemas (EMSs) and core beliefs of young antisocial men with those the SCS indicated that antisocial patients see themselves as unlovable, lonely, and rejected. Results of the SQ-SF indicated that antisocial patients had significantly elevated and clinically relevant scores in comparison to controls in the following areas: emotional deprivation, entitlement/grandiosity, mistrust/abuse, vulnerability to harm and illness, and social isolation. In general, the results of the present study tentatively indicate that while ASPD individuals demonstrate a common profile of core beliefs, these are not unique to individuals diagnosed with ASPD. The implications of these findings are discussed for cognitive behavioral theory, and treatment of ASPD.
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International Journal of Cognitive Therapy, 8(4), 306–317, 2015
© 2015 International Association for Cognitive Psychotherapy
306
Address correspondence to M. Hakan Türkçapar, M.D., Ph.D., Professor of Psychiatry, Department
of Psychology, Hasan Kalyoncu University, Havaalanı yolu, Istanbul 20710, Turkey. E-mail: mhakan.
turkcapar@hku.edu.tr
ÖZDEL ET AL.
CORE BELIEFS OF ANTISOCIAL PERSONALITY
Early Maladaptive Schemas
and Core Beliefs in Antisocial
Personality Disorder
Kadir Özdel
Department of Psychiatry, Diskapi Teaching and Research Hospital,
Ankara, Turkey
M. Hakan Türkçapar
Department of Psychology, Hasan Kalyoncu University, Istanbul, Turkey
S. Olga Guriz
Department of Psychiatry, Diskapi Teaching and Research Hospital,
Ankara, Turkey
Zeynep Hamamci
Department of Educational Sciences, University of Gaziantep, Gaziantep,
Turkey
Baki Duy
Department of Counseling and Guidance, Inonu University, Malatya, Turkey
Ibrahim Taymur
Department of Psychiatry, Sevket Yilmaz Teaching and Research Hospital,
Bursa, Turkey
John H. Riskind
Department of Psychology, George Mason University, Fairfax, Virginia, USA
According to cognitive theories of personality disorders, antisocial personality
disorder (ASPD) is based upon a distinct set of cognitive-behavioral representa-
tions. The aim of this study is to examine this supposition by comparing the early
maladaptive schemas (EMSs) and core beliefs of young antisocial men with those
of a set of socio-demographically matched, psychiatrically healthy individuals. We
used the Schema Questionnaire (SQ-SF) and the Social Comparison Scale (SCS)
to identify and evaluate subjects’ EMSs and core beliefs. Thirty-eight antisocial
individuals and 24 healthy control subjects participated in the study. Results of
CORE BELIEFS OF ANTISOCIAL PERSONALITY 307
the SCS indicated that antisocial patients see themselves as unlovable, lonely, and
rejected. Results of the SQ-SF indicated that antisocial patients had significantly
elevated and clinically relevant scores in comparison to controls in the following
areas: emotional deprivation, entitlement/grandiosity, mistrust/abuse, vulnerability
to harm and illness, and social isolation. In general, the results of the present study
tentatively indicate that while ASPD individuals demonstrate a common profile
of core beliefs, these are not unique to individuals diagnosed with ASPD. The
implications of these findings are discussed for cognitive behavioral theory, and
treatment of ASPD.
Keywords: antisocial, core beliefs, personality disorder, schemas
Theorists and researchers have been interested for some time in the role of the
basic cognitive structures called unconditional core beliefs (UCBs) and early
maladaptive schemas (EMSs) in personality disorders (Beck, Davis, & Freeman,
2015; DeRubeis, Tang, & Beck, 2001). According to Beck (1967), schemas are
cognitive structures for detecting, coding, and evaluating the data that affect an
individual. In general the term schema includes unconditional core beliefs like “I
am good,” “I am bad,” etc., along with rules and conditional beliefs. Although
some authors like Padesky have used the term schema exclusively to describe core
beliefs (Padesky, 1994). Young (1990) defined EMSs broadly as unconditional
and dysfunctional underlying beliefs about the self in relation to beliefs about the
environment. Psychopathology arises from the dominance of early maladaptive
schemas. Every person holds some EMSs but these cognitions are often more
resistant to change among people with severe psychological symptoms (Young &
Klosko, 1994).
EMSs have been assessed in personality disorders (Lawrence, Allen, &
Chanen, 2010; Mihaescu et al., 2005; Reeves & Taylor, 2007). Mihaescu et al.
(2005) found that YSQ scores were higher in patients with personality disorders.
Some of the typical core beliefs associated with each specific personality disorder
have been described (Beck, Rush, Shaw, & Emery, 1979; Young, 1990). Beck
argues that core beliefs such as “I need to look out for myself,” “I need to be the
aggressor or I will be the victim,” and “other people are patsies or wimps” are
specific to ASPD (Beck, Freeman, & Davis, 2004). Although Young proposed in
2003 that EMSs play a central role in understanding personality and personality
disorders, research devoted to the assessment of schemas, in particular personality
disorders, has been limited.
There has been some research aimed at identifying specific schemas for dis-
tinct personality disorders. Jovev and Jackson (2004) examined the specificity of
schema domains in three personality disorders—namely, obsessive compulsive
personality disorder (OCPD), avoidant personality disorder (APD), and bor-
derline personality disorder (BPD)—and suggested that there were different pat-
terns of EMS across different PDs and that the YSQ was potentially useful in
differentiating between them. On the other hand Nordahl, Holthe, and Haugum
(2005) found that narcissistic personality traits were associated with vulnerability
to harm, emotional inhibition, and insufficient self-control, whereas patients with
308 ÖZDEL ET AL.
antisocial, schizoid, and schizotypal personality traits did not show any significant
associations with any of the EMSs. Reeves and Taylor (2007) found among their
nonclinical sample that men endorsed more symptoms of ASPD and higher levels
of the core beliefs of emotional deprivation, social isolation, defectiveness/shame,
and emotional inhibition. In Reeves and Taylor’s study male gender was found to
be a unique predictor only for ASPD.
Antisocial personality disorder (ASPD) is characterized by a pervasive pat-
tern of disregard for and violation of the rights of others (American Psychiatric
Association [APA], 1994). According to the latest version of the Diagnostic and
Statistical Manual of Mental Disorders (DSM 5; APA, 2013), ASPD diagnosis is
conceptualized through a criteria set that includes criminal behavior, lying, reck-
less and impulsive behavior, aggression, and irresponsibility. The traditional view
of ASPD is that these individuals have failed to internalize the standards of the
society in which they live (Freeman, Pretzer, Fleming, & Simon, 1990). Beck and
Freeman’s (1990) discussion of ASPD suggests that there is evidence for develop-
mental delay in the moral maturity and cognitive functioning of antisocial indi-
viduals. People with antisocial personalities have a view of the world that is strictly
self-focused or personal rather than interpersonal. They usually are not able to
perceive other people’s points of view and have poor empathic ability (Beck et al.,
2015). They have learned to rely on themselves and to distrust others based upon
their fear of being exploited and humiliated by others (Millon & Everly, 1985). As
a possible expression of that kind of internal world, patients with ASPD tend to
be interpersonally aggressive, argumentative, abusive, and cruel.
A study conducted on college students found very strong associations be-
tween mistrust, emotional deprivation, social isolation, entitlement schemas, and
aggression. All schemas correlated with trait aggressiveness except the self-sacrifice
schema (Tremblay & Dozois, 2009). In addition Gilbert, Daffern, Talevski, and
Ogloff (2013) found, in their sample of offenders, that those schemas including
insufficient self-control, dependence, entitlement, social isolation, and failure-to-
achieve were all related to aggression. Some authors have suggested that ASPD
provides some individuals with a strong defense against feelings of helplessness
and dependency (Reid, 1985). Ball and Cecero (2001) found that ASPD was as-
sociated with schemas of mistrust/abuse and emotional inhibition, but not with
entitlement or insufficient self-control in their sample made up of addicted pa-
tients. A study conducted on an inmate population (incarcerated female offend-
ers) found that high scores on entitlement and insufficient self-control schemas
predicted higher levels of self-reported threats and assaults while in prison. These
EMSs were also predictive of hostility. On the other hand, disconnection or re-
jection EMSs (e.g., mistrust and abuse) were associated with hostility, paranoid
ideation, and interpersonal sensitivity (Loper, 2003). Gullhaugen and Nøttestad
(2012) found that the YSQ scores of offenders with possible and strong indica-
tions of psychopathy were different for 11 out of 15 possible EMSs—in other
words, all 15 EMSs except subjugation, self-sacrifice, unrelenting standards, and
insufficient self-control for offenders with possible indications of psychopathy;
CORE BELIEFS OF ANTISOCIAL PERSONALITY 309
then all 15 EMSs except abandonment/instability, failure, self-sacrifice, and unre-
lenting standards for offenders with strong indications of psychopathy.
According to cognitive theorists (Beck et al., 2015), individuals with ASPD
see themselves as loners, autonomous and strong, while perceiving others as ex-
ploitative or vulnerable and deserving of exploitation. Based upon these thoughts,
antisocial individuals’ behavioral strategies of combativeness, exploitation, and
predation become overdeveloped while their strategies for empathy, reciprocity,
and social sensitivity remain underdeveloped. The purpose of this study was to
identify the core beliefs and early maladaptive schemas that characterize antisocial
personality disorder, as distinct from other personality disorders. Our hypothesis
was that individuals with ASPD view themselves not simply as autonomous and
strong, but also as dangerously vulnerable in social contexts. So their behavioral
problems, like attacking other people, are strategies they have developed to pre-
vent the activation of negative core beliefs.
METHODS
SUBJECTS
The subjects of this study were 38 patients diagnosed with antisocial personality
disorder, and 24 nonclinical volunteers. The members of the antisocial group were
selected from among young soldiers most of whom, 97.4%, were under treatment
for substance abuse during their mandatory military service. The subjects of the
control group were also selected from among young soldiers doing mandatory
military service. None of the controls had a history of or had been diagnosed with
a current major psychiatric disorder. The psychiatric histories of all of the subjects
in the control group were screened. Any subject who had a history of a psychiatric
disorder or who had received psychiatric or psychological treatment was excluded
from this study. The aims and scope of the study were explained to all participants
and all of them provided written informed consent. This study was approved by
the Ethics Committee of The Ankara Diskapi YB Research and Training Hospital.
All participants were screened using a clinical intake test battery. Diagnoses
were made through administering the Structured Clinical Interview for DSM-III-
R Personality Disorders (SCID-II). Prior to a clinical interview, each subject com-
pleted a personal and family medical history form. After a diagnostic interview,
subjects who had been diagnosed with ASPD participated in a detailed assessment
of their cognitive profile. This assessment was performed by a senior psychiatrist
(M.H.T) experienced in applying the SCID-II. Cognitive assessments were per-
formed by administering the Young Schema Questionnaire–Short Form (SQ-SF)
and the Social Comparison Scale (SCS). These assessment tests required a total of
approximately one hour.
310 ÖZDEL ET AL.
MEASURES
Schema Questionnaire–Short Form (SQ-SF). The Schema Questionnaire was
developed by Young (1990) and is a 205-item Likert scale that measures 16 hy-
pothesized early maladaptive schemas. Large sample size studies examining the
psychometric properties of the scale have supported 15 of these factors (one of
the proposed schemas was excluded; Schmidt, Joiner, Young, & Telch, 1995).
The SQ-SF (Young, 1998), a 75-item questionnaire, was then developed to as-
sess these 15 early maladaptive schemas. They include emotional deprivation,
abandonment, mistrust/abuse, social isolation, defectiveness, incompetence, de-
pendency, vulnerability to harm, enmeshment, subjugation of needs, self-sacrifice,
emotional inhibition, unrelenting standards, entitlement, and insufficient self-con-
trol. Each of the 75 items on the SQ-SF is rated on a 6-point scale (1 = completely
untrue of me; 2 = mostly untrue of me; 3 = slightly more true than untrue; 4 =
moderately true of me; 5 = mostly true of me; 6 = describes me perfectly) and
each schema consists of five items. Higher scores indicate a stronger presence of
that maladaptive schema in the thinking of the respondent (Young, 1998). Young
stated that there is no universally accepted scoring procedure for the YSQ (see
Young, Klosko, & Weishaar, 2003, p. 75), however, circling high scores like 5 or
6 for three or more items related to an individual schema implies clinical relevance
for that person. An approach grounded on that consideration has been used by
some researchers (Tremblay & Dozois, 2009; Waller, Shah, Ohanian, & Elliott,
2001). An alternative scoring system calculates a mean score for each schema and
considers a mean score equal to or greater than 4 to be clinically relevant (Gilbert
et al., 2013; Jovev & Jackson, 2004; Lee, Taylor, & Dunn, 1999; Reeves & Taylor,
2007).
The Turkish translation of the SQ-SF has been shown to be reliable for the
current sample (internal consistency, Chronbach’s α = .96). A later version of the
SQ, which adds an additional three schemas, was found valid and reliable in a
Turkish population (Young et al., 2003; Soygüt, Karaosmanoğlu, & Çakir, 2009).
The Social Comparison Scale (SCS). The Social Comparison Scale was devel-
oped by Allan and Gilbert (1995) to identify core beliefs. It is made up of 18 char-
acteristics that measure a person’s perceptions or beliefs about him- or herself in
comparison to others in relation to two opposed qualities. This test tries to identi-
fy judgments concerned with rank (inferior-superior) and determine how a person
judges him- or herself as fitting in with or being similar to others (same-different,
insider-outsider). The items are answered on a 6-point Likert scale (1–6). A score
approaching 1 indicates negative left-sided beliefs (e.g., negative beliefs like being
rejected, incompetent, unlikable) whereas a score approaching 6 indicates positive
right-sided beliefs (e.g., positive beliefs like being accepted, competent, likable).
The original form of the scale, developed by Allan and Gilbert (1995), had 11
items (Cronbach’s α = 0.91). In the original study, the total score on the SCS was
negatively correlated with depression, hostility, interpersonal sensitivity, and psy-
choticism. A Turkish version of this scale was created by Savaşir and Şahin (1997).
The internal consistency of the Turkish version of the scale is .89. The correlation
CORE BELIEFS OF ANTISOCIAL PERSONALITY 311
between the Turkish version of the scale and the Beck Depression Inventory (BDI)
is –.19. This scale differentiates people with low BDI scores and people with high
BDI scores (Erözkan, 2011).
All statistical analysis was performed using SPSS for Windows (SPSS Inc.).
T-tests were used to compare the means. Because we performed many t-tests, a
Bonferroni correction was made and the significance level was set at p < 0.0015.
RESULTS
The mean age of the antisocial subjects was 22.74 years old (SD = 1.88) and for
the control group 21.83 years old (SD = 2.41). The mean duration of education
for the antisocial group was 6.32 years (SD = 2.33) and for the control subjects it
was 8.83 (SD = 3.38) years. The difference between the ages of the antisocial and
control groups was not statistically significant (t = 1.65, p > .104). The subjects
in the antisocial group however, were significantly less educated than those in the
control group (t = 3.43, p < .001). There was no significant difference between
the groups with regard to their number of siblings (t = .247, p > .806). Most of
the subjects in the control group were high school graduates (41.7%), were cur-
rently working in a job (95.8%; c2 = 13.94, p = .003), did not have a history of
a psychiatric disorder (87.5%), smoked cigarettes (70.8%; c2 = 8.56, p = .003)
but were not using other substances (62.5%; c2 = 26.91, p = .000). Marital status
was not statistically different between the two groups (c2 = .057, p = .811). The
antisocial group showed a significantly more frequent history of psychiatric disor-
ders within their families (c2 = 5.19, p = .023). In the ASPD group 37 (97.4%)
were diagnosed with substance abuse/dependence problems, 14 (36.8%) were
diagnosed with depressive disorders, and 3 (7.8%) were diagnosed with anxiety
disorders in addition to their personality disorder.
A t-test for independent samples was employed to compare the mean SCS
scores of the two groups (their Bonferroni adjusted alpha level is 0.0015). The
results are shown in Table 1. There was a significant difference between the scores
of the groups favoring the control group on these items: unlovable-lovable (t =
3.80, p = 0.00), lonely-not lonely (t = 4.96, p = 0.00), rejected-accepted (t =
5.44, p = 0.00). In other words, the control group subjects scored higher on these
items (favoring the right-sided, more positive social comparison perception) than
subjects in the ASPD group. No significant difference was found between the two
groups in relation to these items: incompetent-competent (t = 2.29, p = .027),
inadequate-adequate (t = 1.94, p = .058), unsuccessful-successful (t = 2.00, p
= .057), extrovert-introvert (t = 3.09, p = 0.03), impatient-patient (t = 1.67,
p = .102), intolerant-tolerant (t = 2.30, p = .026), inconsistent-constant (t =
.08, p = .933), cowardly-brave (t = .33, p = .736), unconfident-confident (t =
.81, p = .81), unassertive-assertive (t = .75, p = 457), untidy-tidy (t = 1.08, p =
.283), passive-active (t = 1.22, p = .229), unstable-stable (t = 1.68, p = .099),
antipathetic-sympathetic (t = 2.52, p = .015), and not-obedient-obedient (t =
.32, p = .744).
312 ÖZDEL ET AL.
T-tests were used to compare the mean scores of the two groups on the SQ-
SF (their Bonferroni adjusted alpha level is 0.0015). YSQ scores were assessed
in two ways. First, the mean raw scores of the groups were compared for each
schema. Second, if an item was marked at 5 or 6 for a schema (every schema is
made up of five items) this was assigned 1 point. If an item was marked between
1 and 4 that schema was assigned 0 points, then the means of the two groups were
compared. There was no significant difference between the two procedures for
detecting group differences. These results are shown in Table 1. According to these
results, there was a significant difference between the two groups on the following
subscales: dependence/incompetence (t = 5.25, p = 0.00), defectiveness/shame
(t = 6.04, p = 0.00), emotional deprivation (t = 4.87, p = .00), over-control/
emotional inhibition (t = 4.79, p = .000), entitlement/grandiosity (t = 4.61, p
= .000), failure to achieve (t = 5.08, p = .000), mistrust/abuse (t = 6.10, p =
.000), subjugation of needs (t = 4.66, p = .000), vulnerability to harm and ill-
ness (t = 6.77, p = .000), and social isolation (t = 7.96, p = .000). The subjects
in the ASPD group scored significantly higher on these dimensions than those
in the control group. No significant difference was found between the groups on
the dimensions of abandonment/instability (t = 2.56, p = .013), enmeshment/
undeveloped self (t = 1.19, p > .0238), insufficient self-control/self-discipline (t
= 3.09, p = .003), self-sacrifice (t = 1.20, p = .234), or unrelenting standards (t
= .93, p > .355). To indicate clinical importance, statistically significant schemas
with item score means greater than 4 are highlighted in Table 2.
TABLE 1. Social Comparison Scale Scores of the Antisocial Patients and Normal Controls
ITEM
ASPD Group (n = 38)
(Mean ± SDa)
Control Group (n = 24)
(Mean ± SD)t value
p
value
Incompetent-competent 3.47 ± 1.59 4.78 ± 1,20 2.29 .027
Inadequate-adequate 3.77 ± 1.6 4.89 ± 1.63 1.94 .058
Unsuccessful-successful 3.34 ± 1.69 4.55 ± 1.23 2.00 .057
Unlovable-lovable 2.97 ± 1.6 5.11 ± .65 3.80 .000*
Extrovert-introvert 2.51 ± 1.62 4.44 ± 1.88 3.09 .003
Lonely-not lonely 1.83 ± 1.32 4.55 ± 2.00 4.96 .000*
Rejected-accepted 2.42 ± 1.54 5.33 ± .87 5.44 .000*
Impatient-patient 2.19 ± 1.56 3.22 ± 1.98 1.67 .102
Intolerant-tolerant 3.97 ± 1.60 5.33 ± .86 2.30 .026
Inconsistent-constant 3.9 ± 2.0 3.88 ± 2.02 .08 .933
Cowardly-brave 4.91 ± 1.66 5.11 ± 1.16 .33 .736
Unconfident-confident 4.13 ± 1.80 4.66 ± 1.41 .81 .420
Unassertive-assertive 3.69 ± 1.98 4.22 ± 1.39 .75 .457
Untidy-tidy 3.19 ± 1.68 3.88 ± 1.83 1.08 .283
Passive-active 3.91 ± 1.66 4.66 ± 1.58 1.22 .229
Unstable-stable 3.36 ± 1.98 4.62 ± 1.50 1.68 .099
Antipathetic-sympathetic 3.60 ± 1.55 5.00 ± 1.11 2.52 .015
Not obedient-obedient 5.25 ± 1.24 5.11 ± .92 .32 .744
Note. SD = Standard Deviation; Student’s t-test α = 0,05; aα (with Bonferroni correction) = 0.0015. *Statistically significant.
CORE BELIEFS OF ANTISOCIAL PERSONALITY 313
DISCUSSION
The aim of the current study was to identify core beliefs specific to ASPD. Ac-
cording to comparisons with controls in terms of mean scores calculated for each
schema of the YSQ-SF, dependence/incompetence, defectiveness/shame, over-
control/emotional inhibition, entitlement/grandiosity, failure to achieve, mistrust/
abuse, subjugation of needs, vulnerability to harm and illness, and social isolation,
EMSs were statistically significantly higher in the ASPD group. These results are
similar to the findings in Gullhaugen and Nøttestad (2012). One of the shared
findings is that neither study found differences for the self-sacrifice and unrelent-
ing standards schemas.
The main difference between the Gullhagen and Nøttestad study and the
present study is that Gullhagen and Nøttestad (2012) found higher scores in the
abandonment/instability and enmeshment/undeveloped self schemas. Further, al-
though their groups didn’t differ in terms of subjugation of needs schemas, we
found that the ASPD group had a higher score in this domain. The differences in
TABLE 2. Comparison of Early Maladaptive Schema Scores Between the Two Groups
ASPD Group Control
Group
ASPD Group Control
Group
(n = 38) (n = 24) (n = 38) (n = 24)
Schema Domain (Mean ± SD)a(Mean ± SD)at valuea(Mean ±
SD)b
(Mean ± SD)bt valueb
Abandonment/instability 16.67 ± 6.61 12.37 ± 6.04 2.56 1.97 ± 1.53 0.87 ± 1.42 2.80
Dependence/incom-
petence
17.9 ± 6.14 10.12 ± 4.51 5.25* 1.93 ± 1.51 0.62 ± 0.87 4.1*
Defectiveness/shame 17.05 ± 5.70 8.75 ± 4.43 6.04* 1.76 ± 1.50 0.38 ± 0.65 4.94*
Emotional deprivation 22.05 ± 4.82 14.78 ± 6.72 4.87* 2.97 ± 1.42 1.30 ± 1.52 4.23*
Over control/emotion-
al inhibition
19.16 ± 5.85 11.50 ± 6.45 4.79* 2.32 ± 1.52 0.75 ± 1.22 4.44*
Enmeshment/undevel-
oped self
16.17 ± 6.57 14.18 ± 5.28 1.19 1.62 ± 1.61 1.32 ± 1.36 0.72
Entitlement/grandi-
osity
21.10 ± 5.22 14.50 ± 5.47 4.61* 2.78 ± 1.33 1.18 ± 1.26 4.61*
Failure to achieve 18.2 ± 7.6 9.2 ± 5.1 5.08* 1.97 ± 1.86 0.33 ± 0.92 4.56*
Insufficient self-control/
self-discipline
21.00
±5.52**
16.37 ± 5.96 3.09 2.70 ± 1.41 1.70 ± 1.40 2.69
Mistrust/abuse 22.05 ± 5.96 12.82 ± 5.15 6.10* 3.11 ± 1.57 0.83 ± 0.94 7.14*
Subjugation 16.94 ± 6.46 9.62 ± 5.17 4.66* 1.86 ± 1.53 0.25 ± 0.68 5.62*
Self-sacrifice 18.00 ± 6.98 15.91 ± 5.98 1.20 2.05 ± 1.69 1.42 ± 1.47 1.49
Unrelenting standards/
hypercritical
17.50 ± 5.41 16.04 ± 6.48 .93 1.89 ± 1.24 1.65 ± 1.53 0.65
Vulnerability to harm
and illness
21.18 ± 5.91 10.91 ± 5.73 6.77* 2.81 ± 1.41 0.63 ± 1.10 6.78*
Social isolation 22.55 ± 6.06 10.20 ± 5.60 7.96* 3.14 ± 1.59 0.58 ± 0.78 8.28*
Note. aStandard scoring, bAlternative scoring. SD = Standard Deviation. Student’s t-test α (with Bonferroni correction) =
0.0015. *Statistically significant. **Clinically significant but not statistically significant.
314 ÖZDEL ET AL.
findings for these three schema domains may be due to the different characteris-
tics of these two study groups. For example, their group had strong psychopathy
indications: They showed elevations in schemas for enmeshment/undeveloped self
and insufficient self-control, whereas in our study, the ASPD group showed a high
score on the failure to achieve schema. When these results are taken together with
the results of another study by Chakhssi, Bernstein, and de Ruiter (2014), differ-
ent schemas can be related to different facets of psychopathy. It should be noted,
that high scores on insufficient self-control along with the entitlement schema in
those offenders with strong indications of psychopathy from a high security prison
(Gullhaugen & Nøttestad, 2012) would be consistent with schema theory of an-
tisocial personality disorder by Young et al. (2003) and some research findings on
aggression (Gilbert et al., 2013; Loper, 2003).
In another study of a nonclinical sample, all schemas of the antisocial patients
were significantly correlated with trait aggressiveness, which itself was strongly
correlated with schemas for mistrust, emotional deprivation, social isolation, and
entitlement (Tremblay & Dozois, 2009). Note that entitlement and insufficient
self-control are subsumed under the same schema domain of impaired limits. In
this domain, the deficiency is considered to be with internal limits, responsibility
to others, or long-term goal orientation leading to difficulty respecting the rights
of others (Young et al., 2003, p. 15). In Nordahl et al.’s (2005) study, it was found
that patients with any kind of personality disorder (n = 38) showed elevated
scores in all schemas with the exception of schemas for entitlement, insufficient
self-control and enmeshment. Nordahl also found that ASPD itself showed no
pattern of associations with specific EMSs. However, the small sample of Nor-
dahl’s study makes it difficult to interpret the lack of significant findings for spe-
cific schemas associated with ASPD.
To overcome problems that come from simply comparing the means of YSQ
scores for specific schemas, we focused in the present analyses on specific schemas
that showed significant differences and that had raw schema scores of 20 or more
points. The precedent for this procedure is that it has been used in some prior
clinical research, as well as recommended by Young himself for use in clinical
practice (Gilbert et al., 2013; Jovev & Jackson, 2004; Lee et al., 1999; Reeves &
Taylor, 2007; Young et al., 2003). Using this procedure, significant findings were
obtained for the specific schemas for emotional deprivation, entitlement/grandi-
osity, mistrust/abuse, vulnerability to harm, and social isolation schemas. These
schemas, with the sole exception of vulnerability to harm, are consistent with
those found by Tremblay and Dozois (2009). Likewise, all five schemas emerged
as significant in the work of Gullhaugen and Nøttestad (2012) in groups both
with possible and with strong indications of psychopathy.
Three out of the above five schemas—namely, emotional deprivation, mis-
trust/abuse, and social isolation—fall into the disconnection and rejection domain.
In schema theory, personality disorders and characterological problems stem from
unmet needs originating in childhood. In this context, the disconnection and re-
jection domain is conceptualized as stemming from a person’s unmet needs for
love, security, stability, and nurturance. As a result, personality disordered indi-
CORE BELIEFS OF ANTISOCIAL PERSONALITY 315
viduals expect that their needs will not be met (Young et al., 2003). The present
findings indicated that the current sample diagnosed with ASPD see themselves as
more unlovable, lonelier, and more rejected than did the normal controls. Other
significant schemas were vulnerability to harm or illness and entitlement/grandios-
ity. In the present study, significant differences were also found for the vulnerabil-
ity to harm schema, which entails expectations of impending danger and not being
able to cope. A significant difference was also found for the entitlement/grandios-
ity schema, which is based on a belief that one has special rights and nobility and
reciprocity is not necessary in interpersonal relationships.
The results for the SQ-SF scores indicated that patients with ASPD expect
to be emotionally deprived, and that they mistrust others, fear being harmed or
hurt, perceive themselves as socially undesirable, and feel entitled to do anything
they wish. This finding is in line with the cognitive conceptualization that an-
tisocial personality disorder is characterized by the basic belief that “others are
to be taken” (Beck et al., 2004). The present results for the SCS scores indicate
that patients with antisocial personality disorder also tend to see themselves as
unlovable, lonely, and rejected. Beck et al. have suggested that maladaptive be-
liefs and strategies including those seen in ASPD may involve compensation for
a sense of victimization (Beck et al., 2004, p. 37). Thus, our results support the
notion that “antisocial people see themselves as victims.” Moreover, this set of
core beliefs is strongly related to vulnerability and feeling overwhelmed. Hence,
the findings suggest that a conditional belief such as “I should hurt him before he
hurts me” is behind the primary social strategies of attacking and exploiting used
by individuals with ASPD (Beck et al., 2004). This phenomenon fits well with
the notion of “schema overcompensation” proposed by Young et al. (2003), to
describe dysfunctional behavior patterns that would seem to contradict or indicate
the opposite of the schema they hold is true. Thus, if vulnerable core beliefs/sche-
mas are related to an entitlement schema, schema overcompensation may result in
assaultive, manipulative, or exploitive behavior. This possibility may have clinical
implications for therapy with ASPD patients.
Freeman et al. (1990) stressed that individuals diagnosed with ASPD are pri-
marily motivated to pursue their own interests—and these findings could be used
to inform strategies for increasing motivation for change. Given that assaultive,
manipulative, or exploitative strategies are most often problematic for the people
around antisocial individuals, not for antisocial people themselves, focusing on the
direct evaluation of those strategies with an ASP disordered patient may not be
useful in treatment.
Although some research has examined the core beliefs and schemas of antiso-
cial individuals, few studies have compared clinical samples with control groups
using the SQ-SF and SCS. Although the SCS has been primarily used in past re-
search for purposes of cross-validating early maladaptive schemas, it proved useful
in comparing the ASPD and control groups in the present study and produced the
expected results.
It is generally difficult to find large samples of participants in studies of per-
sonality disorders. A limitation of the small number of subjects in this current
316 ÖZDEL ET AL.
study is that it may limit the generalizability of the findings and they clearly re-
quire replication. Another potential limitation is that there was a significant differ-
ence between our control group and the ASPD groups in their educational levels.
Yet here, too, it is difficult to find ASPD samples of well-educated individuals. A
further potential limitation is that the patients in the present sample were drawn
from the general population serving in the military and may have milder forms of
ASPD because individuals with more severe forms of ASPD are exempted from
military service. One could argue, however, that a significant strength of this study
was that the study sample was recruited from the same environment for both
the control and the antisocial groups. Thus, caution is necessary in interpreting
the present findings and further studies are needed to address these limitations.
In general, the results of the present study tentatively indicate that while ASPD
individuals demonstrate a common profile of core beliefs, these are not unique to
individuals diagnosed with ASPD.
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... [14][15][16] Moreover, some studies were conducted with control groups included in the clinical studies. 8,13,16,17,21 When the aforementioned studies were examined, it was found that PDs were associated with at least one schema and that the schemas between the clinical sample and the control group differed. On the other hand, in the single study conducted in Turkey examining the relationship between PDs and early maladaptive schemas, 21 it was found that the early maladaptive schema scores of the sample group diagnosed with antisocial PD were significantly higher than the scores of the healthy sample group. ...
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As practical and insightful as its predecessor, the second edition of this acclaimed text gives students of cognitive and cognitive-behavioral therapy a solid grounding in principles while modeling an integrative approach to the problems they will encounter most. The same quartet of knowledgeable clinicians who authored the original have updated and restructured their work to take readers through the best of contemporary cognitive practice, from intake interview and case conceptualization to the crucial final meetings. Their goal is to offer empirically valid interventions that truly address the complex problems of today’s clients, and this straightforward volume presents these strategies with maximum utility for trainee and clinician alike. • Clinical vignettes and verbatim transcripts illustrating interventions in action. • Guidelines for assessing clients throughout the course of therapy. • Effective ways to strengthen the therapeutic relationship. • Equal coverage on treatment of Axis I and personality disorders. • New chapters on treatment of children, adolescents, couples, and groups. • Techniques for getting past roadblocks, dealing with non-compliance, and avoiding relapses. Uncovering new clinical possibilities, debunking common misconceptions, and encouraging readers to sharpen their skills, the authors show why, decades after its inception, cognitive therapy continues to get results. The second edition of Clinical Applications of Cognitive Therapy is an invaluable source of knowledge for researchers and advanced students of behavior therapy, clinical and counseling psychology, psychiatry, and psychiatric social work, and for clinicians at all levels of practice.
Chapter
In the last several years, there has been a growing interest in the study and understanding of personality disorders. Patients with personality disorders have been part of the clinician’s case load since the beginning of the recorded history of psychotherapy; the general psycho­therapeutic literature on the treatment of personality disorders, however, has emerged more recently and is growing quickly. The main theoretical orientation in the present literature is psychoanalytic (Abend, Porder, & Willick, 1983; Chatham, 1985; Goldstein, 1985; Gunder­son, 1984; Horowitz, 1977; Kernberg, 1975, 1984; Lion, 1981; Masterson, 1978, 1980, 1985; Reid, 1981; Saul & Warner, 1982). Millon (1981) is one of the few volumes in the area of personality disorders that offers a behavioral focus, and the volume by Beck, Freeman and associates (1989) will be the first to offer a specific cognitive-behavioral focus. This is of interest, in that leading cognitive therapists have been, and remain, interested in “personality disorder” and “personality change” (Hartman & Blankenstein, 1986). When Beck (1963a,b) and Ellis (1957a, 1958) first introduced cognitive approaches, they drew upon the ideas of “ego analysts,” derived from Adler’s critiques of early Freudian psychoanalysis. Though their therapeutic innovations were seen as radical, their earliest cognitive therapies were, in many ways, “insight therapies” in that the therapy was assumed to change a patient’s overt “personality,” whether or not the therapy changed some hypothesized underlying personality. Although Beck and Ellis were among the first to use a wide array of behavioral treatment techniques, including structured in vivo homework, they have consistently emphasized the therapeutic impact of these techniques on cognitive schemata and have argued in favor of the integration of behavioral techniques into therapy within a broad framework that has some roots in prior analytic practice (Beck, 1976; Ellis & Bernard, 1985); they and their associates have emphasized the impact of treatment for particular types, or styles, of cognitive errors on dysfunctional self-concepts, as well as on presenting focal problems (Beck & Freeman, 1989; Ellis, 1985; Freeman, 1987).