Early Maladaptive Schemas as Core Therapeutic Targets in Eating Disorders and Obesity: A Schema Therapy–Informed Network Analysis

Abstract

Early maladaptive schemas (EMSs) are stable cognitive-emotional patterns central to the psychopathology of eating disorders (EDs) and obesity. This study used a schema therapy–informed network analysis to explore the structure and significance of EMSs in people with anorexia nervosa (AN, n = 129), bulimia nervosa (BN, n = 124), binge-eating disorder (BED, n = 166), and obesity (n = 152). Networks were modelled using the Young Schema Questionnaire (YSQ-S3), with expected influence as the main centrality, in a final sample of 571 patients. In AN, the most central schemas were Defectiveness/Shame, Negativity/Pessimism, and Subjugation, reflecting self-criticism, hopelessness, and submission. BN showed a similar pattern with high centrality for Subjugation, Defectiveness/Shame, and Negativity/Pessimism. In BED, central EMSs included Subjugation, Social Isolation, Negativity/Pessimism, and Abandonment, emphasizing loneliness and emotional vulnerability. The obesity group showed dominant roles for Negativity/Pessimism, Social Isolation, Subjugation, and Mistrust/Abuse, indicating patterns of mistrust, hopelessness, and relational avoidance. Negativity/Pessimism and Subjugation were central across all groups, highlighting their transdiagnostic relevance. Interestingly, Social Isolation appeared prominently in BED and obesity, possibly associated with earlier experiences of bullying and rejection. These findings underscore the clinical value of targeting central EMSs in schema therapy, offering a network-based framework to guide individualized interventions across EDs and obesity.