The role of early maladaptive schemas (EMS) in self-harm behaviours: a systematic review

Background: Self-harm is a worldwide public health concern with negative long-term consequences. In recent years, a growing body of research has highlighted the role of cognitive vulnerability in the development of self-harm behaviours. Emerging evidence indicates that an early maladaptive schema (EMS) developed during childhood is associated with self-harm behaviours. Understanding the complex role of EMS in the development and maintenance of self-harm is essential for early identification and targeted preventive strategies. Aim: This systematic review aimed to investigate the influence of EMS on self-harm. Methods: Guided by the PRISMA framework, research published between 2020 and 2025 was determined through a systematic search of Scopus and Web of Science. Following rigorous screening and eligibility procedures, ten studies were selected for qualitative analysis. Results: The review demonstrated that individuals with self-harm behaviour consistently reported significantly elevated EMS scores compared to those without such a history. Rumination, depression and emotional dysregulation mediate the association between EMS and self-harm behaviour. This review also suggests incorporating schema strategies, mindfulness and cognitive restructuring into self-harm interventions to address cognitive vulnerabilities effectively. Discussion & Conclusion: These findings highlight the importance of targeting EMS to mitigate self-harm behaviours, particularly in early identification and preventive intervention.

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