Early Maladaptive Schemas and Dissociation in Adolescent PTSD: Examining Indirect Pathways

Abstract

Responses to traumatic experiences and their relevance to psychopathology remain central topics in clinical research. This study examined the potential indirect effects of early maladaptive schemas (EMSs) and dissociative experiences in the association between trauma exposure and post-traumatic stress disorder (PTSD) symptom severity among adolescents. The sample comprised 70 Turkish adolescents aged 14–18 years (M = 16.3, SD = 1.2) with trauma histories meeting DSM-5 Criterion A for PTSD. Five EMS domains, assessed using the Young Schema Questionnaire, and four dissociative dimensions, measured by the Adolescent Dissociative Experiences Scale, were evaluated through a bootstrapped multiple indirect effects analysis. Current PTSD was identified in 60.0% of the sample; the most frequent index trauma was sexual abuse (47.1%), with 69.7% of these cases meeting PTSD criteria. The disconnection/rejection (β = 0.500, z = 2.400, p = 0.016) and other-directedness (β = 0.392, z = 2.290, p = 0.022) schema domains demonstrated significant indirect associations with PTSD symptom severity. Among dissociative dimensions, depersonalization/derealization (β = 0.430, z = 2.450, p = 0.014) also showed a significant indirect association. To the best of our knowledge, this is the first study to examine these indirect associations in an adolescent clinical sample. Although causal inferences cannot be drawn due to the cross-sectional design, findings highlight potential psychological pathways linking trauma to PTSD and may inform targeted early interventions for trauma-exposed youth.

Plain Language Summary

When young people experience traumatic events, such as abuse, violence, or witnessing serious harm, some go on to develop post-traumatic stress disorder (PTSD), while others do not. Understanding why this happens is important for developing better support and treatment for trauma-exposed youth. This study explored two possible reasons why trauma leads to PTSD in some teenagers but not others: the role of early maladaptive schemas and dissociative experiences. Early maladaptive schemas are deeply held negative beliefs about oneself and the world that develop during childhood. Dissociative experiences, particularly depersonalization and derealization, refer to feelings of being detached from oneself or from reality. We studied 70 teenagers aged 14 to 18 years receiving psychiatric care following a traumatic event. Each young person was assessed by a psychiatrist using structured clinical interviews and questionnaires. We found that 60% met the criteria for PTSD, with particularly high rates among those who had experienced sexual abuse. Two schema domains were linked to more severe PTSD symptoms. The first, disconnection/rejection, involves beliefs that one will be emotionally deprived, abandoned, mistreated, socially isolated, or is fundamentally flawed and unworthy of love. The second, other-directedness, involves prioritizing others' needs over one's own through self-sacrifice, subjugation, and approval-seeking, a pattern especially relevant during adolescence. Feelings of depersonalization and derealization were also associated with more severe PTSD symptoms. These findings may help clinicians identify at-risk teenagers and design targeted treatments addressing these belief patterns and dissociative experiences. Early intervention during adolescence may be particularly valuable.