Early Maladaptive Schemas and Dissociative Symptoms: A Systematic Review and Meta-Analysis

Dissociation is an underresearched and important clinical construct associated with impaired functioning and poor quality of life. Improved understanding of the modifiable correlates of dissociation can inform early detection and effective treatments. The aim of this systematic review and meta-analysis was to synthesise the evidence on the associations between dissociative symptoms and early maladaptive schemas (EMSs).

The reviewed studies reported unadjusted association/s between dissociative symptoms and EMS/s and were published in English in peer-reviewed journals. PsycINFO, PubMed and CINAHL Complete databases were searched on 17 April 2024, and citation searches were completed on 27 April 2024. Random-effects meta-analyses were completed to evaluate the magnitude of the associations between dissociative symptoms and each of the 18 EMSs. Methodological quality was assessed using the AXIS tool.

A total of nine cross-sectional studies published between 2001 and 2023 were included (pooled N = 2300). Dissociative symptoms were positively correlated with 14 of the 18 EMSs. The largest associations were with the defectiveness/shame (r[7] = 0.45, 95% CI [0.34, 0.56]), vulnerability to harm (r[5] = 0.45, 95% CI [0.30, 0.58]) and social isolation schemas (r[8] = 0.39, 95% CI [0.25, 0.51]). Moderate to considerable heterogeneity was present in 14 of the meta-analyses.

The emerging findings suggest EMSs are important cognitive correlates of dissociation that warrant increased empirical attention. In particular, longitudinal research is needed to explore temporal causality. Additional research could examine whether targeting EMSs relating to feeling unlovable, isolated and vulnerable to harm can help ameliorate dissociative symptoms.