Defectiveness

A brief introduction to schema therapy

Schema therapy is an integrative therapy initially developed for treating complex, longstanding, and diffuse psychological difficulties. It combines cognitive behavioral, attachment, gestalt, object relationships, constructivist, psychoanalytic, and neurobiological approaches within a unifying conceptual model (Young, 1990, 1999; Young et al., 2003). Additional interventions have since been outlined, such as EMDR (Young et al., 2002), mindfulness (van Vreeswijk et al., 2014), and body-focused methods (Briedis & Startup, 2020). Schema therapy expands on CBT by emphasizing the developmental origins of psychological problems, incorporating relational and experiential interventions, and targeting the maladaptive coping styles that perpetuate these difficulties (Young et al., 2003).

Early maladaptive schemas

Schemas are enduring and foundational mental structures that play an essential role in cognitive processing, enabling humans to represent the complexities of the world (Rafaeli et al., 2016). By simplifying reality, they make the vast array of information we encounter manageable, so that we can take quick and automatic action. Schemas also act as shortcuts that help us reach conclusions without unnecessary processing. However, while these shortcuts are efficient, they can produce distorted interpretations of reality. Research confirms that schemas can be adaptive or maladaptive, and positive or negative, depending on their output (Young et al., 2003). Adaptive schemas are associated with positive functions and adaptive behavioral dispositions (Louis et al., 2018).

In schema therapy, EMS are defined as negative, pervasive themes or patterns regarding oneself and one’s relationship with others that are dysfunctional and self-defeating. Structurally, EMS are believed to consist of thoughts, memories, emotions, bodily sensations, and the meanings ascribed to them (Van Genderen et al., 2012). Importantly, behavior is not a component of schemas, but a response to their activation. In other words, EMS activation results in schema-driven actions (Young et al., 2003).

Interactions between a child’s temperament, parenting, sociocultural context, and significant life experiences (e.g., traumatic events) can give rise to unmet emotional needs, which form the basis of EMS. EMS are usually accurate representations of these early environments and lead to responses that help the child survive and adapt to these contexts (Farrell et al., 2014; Young et al., 2003). EMS become dysfunctional when they are indiscriminately and repeatedly applied to later life experiences.

EMS are elaborated and strengthened throughout their lifespan, becoming the ‘filters’ through which individuals understand and make predictions about themselves, others, and the world (Young & Klosko, 1994). Accordingly, EMS developed in early life are superimposed on current events (even when not applicable), leading to dysfunctional patterns of thought, feeling, and behavior (Young et al., 2003).

[EMS] become dysfunctional because … they render all new situations, even ones that are profoundly different from the toxic early experiences, similarly toxic (even when in reality they are not), and … lead the person to maintain particular types of [toxic] environments or relationships, even when they can exert influence or choice and create other kinds of experiences.

Rafaeli et al., 2011.

Schema development

Core emotional needs

Satisfying core emotional needs during childhood leads to the development of healthy schemas, while unmet needs give rise to EMS. Young and colleagues (2003) originally outlined 5 core emotional needs based on Bowlby’s (1977) attachment theory and clinical observation (Bach et al., 2018). While they are believed to be universal, the strength of these needs can vary across individuals and potentially across cultures (e.g., Hahn & Oishi, 2006). They are:

• Secure attachments (e.g., safety, protection, acceptance, stability, and belonging).
• Autonomy, competence, and sense of identity.
• Freedom to express needs and emotions.
• Spontaneity and play.
• Realistic limits and self-control.

Given that core needs initially relate to the child’s primary attachments, difficulties within the nuclear family are often the principal source of EMS (Rafaeli et al., 2011). Young acknowledged that attachment needs were of primary importance for the developing child, laying the foundation for the satisfaction of other needs (Brockman et al., 2023). However, as children mature, needs arising other arenas such as school and the wider community become important (e.g., stable friendships, peer group acceptance, etc.). While unmet needs in these later contexts can lead to EMS, schemas emerging in adolescence are usually less pervasive than those developed during childhood (Young et al., 2003). EMS can also develop in later life (such as in response to deeply disturbing events), although this is much less common (Louis et al., 2018).

Other core needs have also been proposed, such as fairness, self-coherence (Arntz et al., 2021), novelty, self-comprehension (Flanagan, 2010), self-esteem (Loose et al., 2020), meaning (Meier, 2019), and connectedness to nature (O’Sheedy, 2021). However, these core needs have not yet been fully incorporated into the schema therapy model. Core needs are described in more detail in the Psychology Tools Unmet Emotional Needs information handout.

Early experiences

Interactions between a child’s early environment and innate temperament can frustrate their core emotional needs, leading to EMS development. Young and colleagues (2003) identify 4 childhood experiences that contribute to EMS:

1. Toxic withholding. The child is given too little of what they need (e.g., insufficient attention, affection, protection, etc.).
2. Toxic excess. The child is given too much of what they need (e.g., they are over-indulged, overprotected, granted excessive freedoms, etc.).
3. Traumatization. The child is harmed, victimized, or humiliated (e.g., parental abuse, bullying, discrimination, etc.).
4. Selective internalization. The child internalizes maladaptive attitudes that are modeled by a caregiver or family member (e.g., perfectionism, pessimism, etc.).

Emotional temperament

Temperament refers to enduring differences in children’s behavioral style and reactivity (Zentner & Bates, 2008). It can contribute to EMS formation by influencing parenting styles (Eisenberg et al., 1999; Kiff et al., 2011; Pekdoğan & Mehmet, 2022). For example:

• Irritable children tend to elicit punitive parenting, leading to increased anger.
• Fearful children tend to elicit protective parenting, leading to increased anxiety.
• Impulsive children tend to elicit controling parenting, increasing impulsivity.

Moreover, children have a ‘differential susceptibility’ to their childhood environments and experiences (Belsky, 2013). For example, reactive children are more likely to flounder in response to poor parenting. This partly explains why some individuals develop EMS in the absence of severe trauma (Lockwood & Perris, 2012).

Schema perpetuation

EMS are remarkably obstinate: they “fight for survival”. Young and colleagues (2003) suggest the durability of EMS partly stems the need for ‘cognitive consistency’: people strive to maintain a stable view of themselves and the world, even if it is inaccurate and distressing. Moreover, EMS are often central to an individual’s sense of self, making the idea of a schematic “paradigm shift” extremely threatening (Beck et al., 2004; Young & Klokso, 1994):

Although [the client’s] schematic structure may be unrewarding and lonely, change means that [they] are in new territory... They are being asked not just to change a single chain of behaviors, or reframe a simple perception, but rather to give up who they are and how they have defined themselves for many years, and across many contexts.

Beck et al., 2004.

Several other factors account for why EMS persist and are strengthened over time.

• Cognitive factors. EMS act as cognitive filters, distorting information and generating unhelpful thinking styles (Young et al., 2003). For example, schema-consistent information is exaggerated, while schema-inconsistent information is filtered out (i.e., magnification and minimization). Other cognitive distortions linked to EMS perpetuation include selective abstraction, overgeneralization, and labeling (Da Luz et al., 2017; Young, 1999). Research indicates schema activation not only generates negative automatic thoughts, but that these appraisals in turn reinforce EMS (Calvete et al., 2013).
• Affective factors. Individuals often block painful emotions linked to their EMS. Consequently, EMS do not reach conscious awareness which prevents their disconfirmation (Young et al., 2003). Affect can also make schema-congruent perceptions feel true. Finally, schema maintenance processes and their centrality to the individual’s sense of self can engender hopelessness about change (Young, 1999).
• Behavioral factors. EMS lead to self-defeating behaviors, referred to as ‘coping responses’. For example, individuals might remain in toxic situations, provoke negative responses from others, or select partners that reinforce their EMS (Rafaeli et al., 2011).

Maladaptive coping styles

Coping styles refer to the characteristic ways individuals manage their EMS. Coping styles develop in childhood and operate outside of awareness, helping individuals adapt to their EMS, the intense affect accompanying them, and the environments in which they were formed (Rafaeli et al., 2011; Young et al., 2003). Much like EMS, factors that may influence the emergence of coping styles include temperament, modeling, conditioning, and culture (Loose et al., 2020; Nia & Sovani, 2014). While they are apparent in all individuals, coping styles tend to be more rigid, extreme, and ‘overlearned’ in clinical groups (Beck et al., 2004). Most importantly, coping styles play a central role in EMS perpetuation.

Coping styles, in turn, give rise to idiographic ‘coping responses’ – the situation-specific manifestations of the client’s coping style. While coping styles are repetitious, coping responses are more variable and can take the form of behavioral, cognitive, or emotional reactions to EMS activation (Simeone-DiFrancesco et al., 2015).

Young and colleagues (Young & Klosko, 1994; Young et al., 2003) identify three coping styles, recently reformulated by an international working group (Arntz et al., 2021). While most individuals use a mix of coping styles, some disorders are characterized by the predominance of one coping style (e.g., overcompensatory control in narcissistic personality disorder; Rafaeli et al., 2011):

• ‘Surrender’ (Young et al., 2003) or ‘Resignation’ (Arntz et al., 2021). Corresponding to the evolutionary ‘freeze’ or ‘fawn’ response, the individual responds to their EMS by accepting its core message and behaving as if it were true. Consequently, they experience the pain of the EMS directly.
• ‘Avoidance’ (Young et al., 2003) or ‘Escape’ (Young & Klosko, 1994). Corresponding to the evolutionary ‘flight’ response, the individual arranges their life such that their EMS is not triggered. The pain of their EMS is avoided or suppressed. Avoidant coping may be overt (e.g., escaping from schema activating situations or individuals) or covert (e.g., using substances or dissociation to dull schema-related distress).
• ‘Overcompensation’ (Young et al., 2003) or ‘Inversion’ (Arntz et al., 2021). Corresponding to the ‘fight’ response, the individual responds to schema activation by attacking, overcorrecting, or externalizing their EMS (Greenwald & Young, 1998). The pain of the EMS is masked with other thoughts, emotions, and actions (e.g., the individual replaces feelings of inferiority with superiority).

Three additional coping styles (indolence, mockery, and gaucherie) have also been proposed (Askari, 2021).

Young (1990) originally described 15 EMS, which were later increased to 18 schemas (Young et al., 2003). Additional schemas have since been proposed (e.g., Arntz et al., 2021; Brockman et al., 2023; Yalcin et al., 2023). The 18 EMS described by Young and colleagues (2003) were subsequently clustered into ‘schema domains’ which correspond to specific unmet emotional needs. Defectiveness is grouped with EMS in the ‘disconnection and rejection’ domain (Bach et al., 2018; Young et al., 2003), which is characterized by difficulties forming secure attachments and the expectation that acceptance, connection, and compassion will not be forthcoming in these relationships (Young, 2014).

Defectiveness

Individuals with defectiveness experience a pervasive sense of inadequacy and inferiority. They see themselves as fundamentally flawed and defective, leading to deep-seated shame and unworthiness. Research suggests that it is one of the most pronounced EMS across psychological disorders (Thimm & Chang, 2022) and readily transmitted between parents and their children (Mącik et al., 2016).

You feel that your defectiveness is inside you. It is not immediately observable. Rather, it is in the essence of your being – you feel completely unworthy of love.

Young & Klosko, 1994.

Young and colleagues (2003) note that individuals can feel defective about almost any aspect of themselves, including private characteristics (e.g., they perceive themselves to be too bad, needy, stupid, etc.) or public attributes (e.g., they are too ugly, awkward, conspicuous, etc.). As a result, individuals with defectiveness are often vigilant for evidence of their flaws and intensely self-critical, echoing the denigrations or implied messages they received in childhood.

Because these faults seem so significant and intrinsic to self, individuals with a sense of defectiveness feel compelled to hide their defects. Accordingly, this schema can be difficult to identify – people with this EMS often go to great lengths to mask their flaws, meaning they are not immediately apparent to others, or even to themselves. For this reason, defectiveness is sometimes experienced as vague unhappiness or longstanding low mood rather than personal inadequacy.

It is relatively unusual for patients to come in knowing that they feel defective. Most patients mask or avoid these feelings in some way because it is so painful to experience the extraordinary self-hatred and shame connected to this lifetrap. Without realizing it, people strive to keep themselves unaware of their feelings of shame. They come to therapy complaining of other things, of relationship problems or depression.

Young & Klosko, 1994.

Fearing that their deficiencies might be exposed, individuals with this schema are often self-conscious, sensitive to rejection, and concerned with how others judge them (Simone-DiFrancesco et al., 2015). Moreover, their reactions to criticism or blame are sometimes extreme: depending on their coping style, the individual may respond by becoming depressed and withdrawn (i.e., surrendering to their EMS) or highly combative (e.g., overcompensating for their EMS) (Young et al., 2003).

Clearly, defectiveness can significantly impact the ability to form stable, gratifying relationships (Janovsky et al., 2020). Individuals with this schema are often reluctant to express their true thoughts and feelings for fear of rejection, resulting in a lack of authenticity and overlooked needs. Furthermore, defectiveness may motivate behaviors that sabotage connections with others, such as excessive reassurance-seeking, disqualifying positive feedback, intense hostility during conflicts, jealousy, and possessiveness. For others, ‘schema chemistry’ (Young et al., 2003) replicates the interpersonal conditions that fostered defectiveness: individuals with this EMS are sometimes attracted to critical, rejecting, or abusive partners. Either way, defectiveness is highly self-reinforcing: individuals tend to shun relational experiences that challenge their negative self-concept or seek out relationships that reaffirm their sense of unworthiness.

Research suggests that defectiveness is not uncommon amongst neurodivergent people, particularly those with ADHD (Philipsen et al., 2017). While these findings could be attributable to psychiatric comorbidities seen in the people studied, other studies indicate that many people with ADHD experience shame, low self-esteem, and feelings of inferiority (Cook et al., 2014; Nyström et al., 2020; Schrevel et al., 2016). Potential sources of defectiveness for these individuals may include repeated criticism and rejection (Beaton et al., 2022), stigmatization (Nguyen & Hinshaw, 2020), actual or perceived underachievement, limited understanding within their social networks (Schrevel et al., 2016), and challenges around identity development (Cantor, 2008). Further research is needed in this area.

As with all EMS, defectiveness has multiple structural components. Individuals with this schema are prone to several cognitive distortions or ‘unhelpful thinking styles’ (Lorzangeneh & Issazadegan, 2022; Young et al., 2003), including:

• All-or-nothing thinking (e.g., “If I’m not perfect, I’m worthless”).
• Catastrophizing (e.g., “They’d think I’m evil if I opened up”).
• Discounting the positives (e.g., “I don’t have any good qualities”).
• Emotional reasoning (e.g., “I didn’t do anything wrong, but I feel like a bad person”).
• Fortune-telling (e.g., “No one could ever love or accept the real me”).
• Labeling (e.g., “I’m so disgusting”).
• Overgeneralization (“They didn’t invite me out – I’m such an unlikable person”).
• Personalizing (“My friend didn’t call back because he thinks I’m a loser”).
• “Should” statements and imperatives (e.g., “I shouldn’t be the person I am”).
• Social comparison (e.g., “She’s a better person than me”).

Emotions associated with defectiveness include:

• Shame associated with perceived defects.
• Anxiety about personal flaws being exposed.
• Jealousy toward others who do not share these faults.
• Anger and hostility in response to blame or criticism.
• Hopelessness because defects seem so intractable.
• Self-consciousness and unease during social interactions.

As a result, people with defectiveness may experience difficulties when it comes to:

• Self-acceptance and self-compassion.
• Recognizing their strengths, talents, and attractive qualities.
• Tolerating criticism and negative feedback.
• Accepting compliments and positive feedback.
• Self-disclosure (e.g., sharing personal experiences).
• Attributing blame and responsibility to others.
• Making fair and accurate comparisons against others.
• Situations involving intimacy, self-disclosure, or potential exposure (e.g., public speaking).

Clinical observation suggests that defectiveness often co-occurs with other schemas (Young & Klosko, 1994; Young et al., 2003). EMS that are sometimes associated with defectiveness include:

• Abandonment. The client believes that other people will abandon them if/when they discover their flaws.
• Approval-/admiration-seeking. Recognition and admiration help the client feel more worthwhile.
• Dependence/Incompetence. The client sees themselves as inadequate or inferior to others due to their dependence and/or incompetence.
• Emotional deprivation. The client attributes a lack of connection, affection, and understanding to their inherent shortcomings.
• Emotional inhibition. The client believes that people will discover how bad or worthless they are if they express themselves.
• Entitlement. The client compensates for defectiveness by self-aggrandizing and presenting themselves as superior to others.
• Failure to achieve. The client believes they are defective for failing or fail at things because they are fundamentally defective or inferior to others.
• Mistrust/Abuse. The client sees themselves as bad, unworthy, or dirty because of their abuse. “The child who recognizes the hatred or murderousness implied by the parent’s acts of abuse is forced to see himself as worthless or unlovable” (Fonagy, 2000, p. 1134).
• Pessimism. The client attributes negative outcomes in part to their inherent flaws.
• Punitiveness. The client often punishes themselves for their flaws and perceived deficiencies.
• Self-sacrifice. The client is driven to take care of others because they feel worthless, undeserving, or bad.
• Social isolation. The client’s global sense of unlovability within their family or perceived inferiority to others generalizes to all their social interactions.
• Unrelenting standards. The client believes that perfection will make them worthier of love.

Defectiveness is associated with a range of difficulties, including addictions (Sakulsriprasert et al., 2023), avoidant personality disorder (Kunst et al., 2020), body image problems (Abedi et al., 2018), borderline personality disorder (Thimm & Chang, 2022), burnout (Simpson et al., 2019), childhood trauma (Pilkington et al., 2021), chronic pain (Voderholzer et al., 2014), dependent personality disorder (Nordahl et al., 2005), depression (Bishop et al., 2022), eating disorders (Maher et al., 2022; Nicol et al., 2020), IBS (Phillips et al., 2013), OCD (Kim et al., 2014), paranoia (Sundag et al., 2018), obsessive compulsive personality disorder (Nordahl et al., 2005), paranoid personality disorder (Nordahl et al., 2005), PTSD (Price, 2007), relationship problems (Janovsky et al., 2020), self-harm (Nicol et al., 2021), social anxiety (Pinto-Gouveia et al., 2006), and suicidal ideation (Pilkington et al., 2021). 

Development origins

Defectiveness is associated with unmet emotional needs relating to acceptance, connection, and nurturance. Formative experiences that play a role in the development of this EMS may include:

• Parental criticism, blame, humiliation, or disappointment.
• Childhood trauma (e.g., emotional or sexual abuse).
• Unfavourable comparisons against others (e.g., siblings).
• Bullying and peer-victimization.

Research confirms that specific developmental experiences are associated with defectiveness, including early trauma (e.g., emotional, physical, and sexual abuse) (May et al., 2022; Pilkington et al., 2021) and bullying during adolescence (Calvete et al., 2016). Parenting styles that are belittling, controling, fearful, punitive, and emotionally inhibited/depriving have also been associated with this EMS (Bach et al., 2018; Sheffield et al., 2005).

“Many people struggle with defectiveness, and it sounds as though this might be relevant to you too. Would you be willing to explore this schema more with me?”

Clinicians might begin by providing psychoeducation about defectiveness and EMS more generally:

• Schemas are negative themes and patterns that start in your childhood and continue throughout your life. Some are very common.
• Schemas usually get stronger as time passes, becoming the negative filters people use to understand and predict the world. You could think of them as dark sunglasses – they color and distort our experiences in unhelpful ways
• Schemas operate ‘behind the scenes’: we’re not usually aware of them or when they are active. However, with practice, you can become more aware of them. It is a bit like a theatre – you can learn to bring your backstage schemas to the main stage.
• One common schema is ‘defectiveness’. If you have this schema, you see yourself as inherently flawed and unacceptable. This can lead to intense shame, self-criticism, and self-consciousness.
• Signs that you have a defectiveness schema include using negative labels to describe yourself (e.g., ‘bad’, ‘worthless’, or ‘ugly’), hiding your flaws from others because they seem so unacceptable, and being very sensitive to blame or criticism.
• People develop schemas because some of their emotional needs were not met while they were growing up. As children, schemas help us make sense of early experiences and to get by. If you have a defectiveness schema, you might have been criticized, rejected, humiliated, or bullied as a child. Some people with this schema had parents who were disappointed in them or made negative comparisons against others, like a sibling.
• Schemas are painful, so people learn to cope with them in different ways. You might respond to defectiveness by criticizing yourself or allowing others to put you down (you surrender to your schema), avoiding intimate relationships or trying to hide the ‘real’ you (you escape your schema), or trying to be perfect or superior to others (you counter-attack your schema).

Standard treatment techniques for working with defectiveness are listed below. They include:

• Self-monitoring (e.g., schema diaries).
• Cognitive interventions (e.g., historical review, decentring, flashcards).
• Emotion-focused interventions (e.g., imagery rescripting, chairwork, letter-writing).
• Relational interventions (e.g., limited reparenting, empathic confrontation).
• Behavioral interventions (e.g., experimentation, behavioral pattern-breaking).

In light of the unmet needs associated with defectiveness, individuals with this EMS also require a specific ‘need-meeting’ style of interaction from the outset of therapy. This includes acceptance, appreciation, and compassion, as well as praise, affirmation, and modeled imperfection (Cutland Green & Balfour, 2020; Lockwood & Samson, 2000; Young et al., 2003).

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