Structural Equation Modeling Relationship between Symptoms of Social Anxiety Disorder Based on Early Maladaptive Schemas, Anxiety Sensitivity Components, and Perfectionism in Adolescents

Document Type : Original Article


Department of Psychology, Payame Noor University, Tehran, Iran



Introduction: This study aimed to demonstrate that structural equation modeling of social anxiety disorder is based on Early Maladaptive Schemas (EMS), Anxiety Sensitivity (AS) components, and perfectionism in adolescents.
Method: The study was a descriptive correlation performed with path analysis. The statistical population comprised 250 female students who were selected by a cluster random sampling method in Kermanshah city in 2019. Data were gathered using the Social Anxiety Questionnaire for adults Young Schema Questionnaire-Short Form, Anxiety Sensitivity Index, and the Perfectionism Inventory. The data were analyzed using the path analysis method.
Results: The results showed that the Root Mean Square Error is 0.068 and the Square Root of the Mean Square root is 0.063, which is less than the criterion (0.08) and thus confirms the fit of the model. Moreover, the schemas of disconnection and rejection (p <0.01, β = 0.13), impaired autonomy and performance (p <0.01, β = 0.14), impaired limits (p <0.01), Β = 0.13), other-directedness (p <0.01, β = 0.29), over vigilance and inhibition (p <0.01, β = 0.16) and AS variables (p <0.01= 0.01, β = 0.15 and perfectionism (p <0.01, β = 0.17) have a direct and significant effect on social anxiety.
Conclusion:  Early maladaptive schema, AS components, and perfectionism have a predictive role in social anxiety disorder among adolescents.


  1. Varmazyar, A., B. Makvandi, and N. Seraj Khorrami, Effectiveness of Schema Therapy in Social Anxiety, Rumination, and Psychological Well-Being among Depressed Patients Referred to Health Centers in Abadan, Iran. Razavi International Journal of Medicine, 2021. 9(1): p. 32-39.
  2. Raymond, K.P., Mindfulness, Self-Compassion and Threat Related Attentional Bias: Implications for Social Anxiety and Loneliness in Late Adolescent College Students. 2018, Syracuse University.
  3. Newby, J., et al., Neuroticism and perfectionism as predictors of social anxiety. Personality and Individual Differences, 2
  4. 106: p. 263-267.
  5. Vilaplana-Pérez, A., et al., Much more than just shyness: the impact of social anxiety disorder on educational performance across the lifespan. Psychological medicine, 2021. 51(5): p. 861-869.
  6. Leigh, E. and D.M. Clark, Understanding social anxiety disorder in adolescents and improving treatment outcomes: Applying the cognitive model of Clark and Wells (1995). Clinical child and family psychology review, 2018. 21(3): p. 388-414.
  7. Acquah, E.O., et al., Adolescent loneliness and social anxiety as predictors of bullying victimisation. International Journal of Adolescence and Youth, 2016. 21(3): p. 320-331.
  8. Naderzadeh, H., et al., A structural equation model of relationship between Social Anxiety symptoms, Early Maladaptive schemas and Cognitive Distortions in Adolescents. Journal of Research in Psychological Health, 2019. 13(1): p. 40-57.
  9. Gewelt, S.E., Early Maladaptive Schemas in Anxiety Disorders-An Investigation of Schemas' Relation to Symptoms in a Complex Sample. 2017.
  10. Afshari, A., Predicting Social Intimacy by Early Maladaptive Schemas and Attachment Styles. International Journal of Behavioral Sciences, 2017. 11(2): p. 61-66.
  11. Calvete, E., I. Orue, and B.L. Hankin, A longitudinal test of the vulnerability-stress model with early maladaptive schemas for depressive and social anxiety symptoms in adolescents. Journal of Psychopathology and Behavioral Assessment, 2015. 37(1): p. 85-99.
  12. Brooke, C.M. and R.C. Intrieri, The influence of anxiety sensitivity, & personality on social anxiety symptoms. Current Psychology, 2021: p. 1-12.
  13. Warren, A.M., et al., Anxiety sensitivity, COVID-19 fear, and mental health: results from a United States population sample. Cognitive Behaviour Therapy, 2021. 50(3): p. 204-216.
  14. Stathopoulou, G., et al., Does anxiety sensitivity predict addiction severity in opioid use disorder? Addictive Behaviors, 2021. 112: p. 106644.
  15. Thompson, J.S. and N.B. Schmidt, The role of anxiety sensitivity in anger symptomatology: Results from a randomized controlled trial. Journal of Anxiety Disorders, 2021. 83: p. 102462.
  16. Rogers, A.H., et al., COVID-19 and Anxiety Sensitivity Across Two Studies in Argentina: Associations with COVID-19 Worry, Symptom Severity, Anxiety, and Functional Impairment. Cognitive Therapy and Research, 2021: p. 1-11.
  17. Raines, A.M., et al., Anxiety sensitivity and substance use: Differential levels across individuals primarily using opioids, cannabis, or stimulants. Addictive Behaviors, 2021. 116: p. 106791.
  18. Mai-Lippold, S.A., et al., A pilot study on the effect of an energy drink on interoception in high vs. low anxiety sensitivity individuals. European Journal of Health Psychology, 2021.
  19. Lanoye, A., et al., Pilot randomized clinical trial targeting anxiety sensitivity: effects on physical activity. Cognitive Behaviour Therapy, 2021: p. 1-15.
  20. Heimberg, R.G., F.A. Brozovich, and R.M. Rapee, A cognitive behavioral model of social anxiety disorder: Update and extension, in Social anxiety. 2010, Elsevier. p. 395-422.
  21. Abdollahi, A., et al., Perfectionism and test anxiety among high-school students: The moderating role of academic hardiness. Current Psychology, 2018. 37(3): p. 632-639.
  22. Abdollahi, A., The Association of Rumination and Perfectionism to social anxiety. Psychiatry, 2019. 82(4): p. 345-353. 10.1080/00332747.2019.1608783
  23. Sarmiento, C. and C. Lau, Diagnostic and Statistical Manual of Mental Disorders: DSM‐5. The Wiley Encyclopedia of Personality and Individual Differences: Personality Processes and Individual Differences, 2020: p. 125-129. 10.1002/9781118970843.ch198
  24. Drieberg, H., et al., An examination of direct, indirect and reciprocal relationships between perfectionism, eating disorder symptoms, anxiety, and depression in children and adolescents with eating disorders. Eating behaviors, 2019. 32: p. 53-59.
  25. Damian, L.E., et al., Perfectionistic concerns predict increases in adolescents’ anxiety symptoms: A three-wave longitudinal study. Anxiety, Stress, & Coping, 2017. 30(5): p. 551-561. 10.1080/10615806.2016.1271877
  26. Caballo, V.E., et al., Validation of the Social Anxiety Questionnaire for Adults (SAQ-A30) with Spanish university students: similarities and differences among degree subjects and regions. Behav Psychol, 2010. 18(1): p. 5-34.
  27. Tavoli, A., et al., Validity and reliability of the farsi version of social interaction anxiety scale (sias). Iranian Journal of Psychiatry & Clinical Psychology, 2012. 18(3).
  28. Young, J., Schema therapy for borderline and narcissistic personality disorders. Pittsfield, MA: New England Educational Institute, 2003. 30. 10.1371/journal.pone.0206039
  29. Sadoughi, Z., et al., Factor analysis of the young schema questionnaire-short form in a nonclinical Iranian sample. 2008.
  30. Taylor, S., et al., Robust dimensions of anxiety sensitivity: development and initial validation of the Anxiety Sensitivity Index-3. Psychological assessment, 2007. 19(2): p. 176. 10.1037/1040-3590.19.2.176
  31. Foroughi, A.A., et al., Psychometric properties of the Iranian version of the Anxiety Sensitivity Index-3 (ASI-3). Trends in psychiatry and psychotherapy, 2019. 41: p. 254-261. 10.1590/2237-6089-2018-0078
  32. Hill, R.W., et al., A new measure of perfectionism: The Perfectionism Inventory. Journal of personality assessment, 2004. 82(1): p. 80-91. 10.1207/s15327752jpa8201_13
  33. Samaei, S., et al., An investigation of psychometric properties of perfectionism inventory in Iranian sample. Procedia-Social and Behavioral Sciences, 2015. 205: p. 556-563. 10.1016/j.sbspro.2015.09.075
  34. Carlucci, L., et al., Co-rumination, anxiety, and maladaptive cognitive schemas: when friendship can hurt. Psychology research and behavior management, 2018. 11: p. 133. 10.2147/PRBM.S144907
  35. Bosmans, G., C. Braet, and L. Van Vlierberghe, Attachment and symptoms of psychopathology: early maladaptive schemas as a cognitive link? Clinical psychology & psychotherapy, 2010. 17(5): p. 374-385.
  36. Wilt, J., K. Oehlberg, and W. Revelle, Anxiety in personality. Personality and Individual Differences, 2011. 50(7): p. 987-993. 10.1016/j.paid.2010.11.014
  37. Mairet, K., S. Boag, and W. Warburton, How important is temperament? The relationship between coping styles, early maladaptive schemas and social anxiety. International Journal of Psychology and Psychological Therapy, 2014. 14(2): p. 171-190.
  38. Calvete, E., I. Orue, and B.L. Hankin, Early maladaptive schemas and social anxiety in adolescents: The mediating role of anxious automatic thoughts. Journal of anxiety disorders, 2013. 27(3): p. 278-288. 10.1016/j.janxdis.2013.02.011 
  39. Hovenkamp-Hermelink, J.H., et al., Anxiety sensitivity, its stability and longitudinal association with severity of anxiety symptoms. Scientific reports, 2019. 9(1): p. 1-7. 10.1038/s41598-019-39931-7
  40. Khakpoor, S., O. Saed, and A. Shahsavar, The concept of “Anxiety sensitivity” in social anxiety disorder presentations, symptomatology, and treatment: A theoretical perspective. Cogent Psychology, 2019. 6(1): p. 1617658.
  41. Ellison, L., S.M. Witcraft, and L.J. Dixon, Anxiety sensitivity and social anxiety in adults with psychodermatological symptoms. Archives of Dermatological Research, 2020: p. 1-7. 10.1007/s00403-020-02130-w
  42. Alkozei, A., P.J. Cooper, and C. Creswell, Emotional reasoning and anxiety sensitivity: Associations with social anxiety disorder in childhood. Journal of Affective Disorders, 2014. 152: p. 219-228. 10.1016/j.jad.2013.09.014
  43. Stanley, I.H., et al., Anxiety sensitivity and suicidal ideation/suicide risk: A meta-analysis. Journal of consulting and clinical psychology, 2018. 86(11): p. 946. 10.1037/ccp0000342
  44. Watt, M. and S. Stewart, What you should know about anxiety sensitivity. Strides Newsletter, retrieved 01/27/2011: http://www. anxietybc. com/sites/default/files/Watt% 20&% 20Stewart% 20STRIDES% 20Au gust% 2031,% 202009% 20FINAL_0. pdf, 2009. 10.1016/s0022-3999(00)00097-0
  45. Schmidt, N.B., et al., A randomized clinical trial targeting anxiety sensitivity for patients with suicidal ideation. Journal of Consulting and Clinical Psychology, 2017. 85(6): p. 596. 10.1037/ccp0000195
  46. Pirbaglou, M., et al., Perfectionism, anxiety, and depressive distress: evidence for the mediating role of negative automatic thoughts and anxiety sensitivity. Journal of American College Health, 2013. 61(8): p. 477-483. 10.1080/07448481.2013.833932
  47. Gautreau, C.M., et al., Is self-critical perfectionism an antecedent of or a consequence of social anxiety, or both? A 12-month, three-wave longitudinal study. Personality and Individual Differences, 2015. 82: p. 125-130.
  48. Limburg, K., et al., The relationship between perfectionism and psychopathology: A meta‐analysis. Journal of clinical psychology, 2017. 73(10): p. 1301-1326. 10.1002/jclp.22435
  49. Shikatani, B., et al., Examining the role of perfectionism and intolerance of uncertainty in postevent processing in social anxiety disorder. Journal of Psychopathology and Behavioral Assessment, 2016. 38(2): p. 297-306. 10.1007/s10862-015-9516-8
  50. Levinson, C.A. and T.L. Rodebaugh, Clarifying the prospective relationships between social anxiety and eating disorder symptoms and underlying vulnerabilities. Appetite, 2016. 107: p. 38-46. 10.1016/j.appet.2016.07.024
  51. Salmalian, H., M. Maleki Pirbazari, and S. Salehi, The relationship early maladaptive schemas of students with their academic burnout and social anxiety (A Canonical Correlation). Journal of Educational Scinces, 2020. 27(1): p. 183-202. 10.22055/EDUS.2020.32778.3005
  52. Yeganeh, A. and N. Nazarboland, Early Maladaptive Schemas, Metacognitive Beliefs, and Cognitive Emotion Regulation Strategies in Orphanage and Non-Orphanage Adolescents. 2016.