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
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.
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.

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- Article Type Research Article
- Submitted February 21, 2026
- Published April 1, 2026
- Issue Volume 12 - Issue 4 (April 2026)
- Section Research Article