Family accommodation in adult obsessive–compulsive disorder: clinical perspectives

Abstract

The term accommodation has been used to refer to family responses specifically related to obsessive–compulsive (OC) symptoms: it encompasses behaviors such as directly participating in compulsions, assisting a relative with obsessive–compulsive disorder (OCD) when he/she is performing a ritual, or helping him/her to avoid triggers that may precipitate obsessions and compulsions. At the opposite side, family responses to OCD may also include interfering with the rituals or actively opposing them; stopping accommodating OC symptoms or actively interfering with their performance is usually associated with greater distress and sometimes even with aggressive behaviors from the patients. This article summarizes progress of the recent research concerning family accommodation in relatives of patients with OCD. Family accommodation is a prevalent phenomenon both among parents of children/adolescents with OCD and relatives/caregivers of adult patients. It can be measured with a specific instrument, the Family Accommodation Scale, of which there are several versions available for use in clinical practice. The vast majority of both parents of children/adolescents with OCD and family members of adult patients show at least some accommodation; providing reassurances to obsessive doubts, participating in rituals and assisting the patient in avoidance are the most frequent accommodating behaviors displayed by family members. Modification of routine and modification of activities specifically due to OC symptoms have been found to be equally prevalent. Specific characteristics of patients (such as contamination/washing symptoms) and of relatives (the presence of anxiety or depressive symptoms or a family history positive for another anxiety disorder) are associated with a higher degree of family accommodation; these family members may particularly benefit from family-based cognitive–behavioral interventions. In recent years, targeting family accommodation has been suggested as a fundamental component of treatment programs and several interventions have been tested. Clinicians should be aware that family-based cognitive–behavior therapy incorporating modules to target family accommodation is more effective in reducing OC symptoms. Targeting family accommodation may be as well relevant for patients treated pharmacologically.

Severity and Dimensions of Obsessive-Compulsive Disorder and Family Accommodation: OCD severity and Family Accommodation

“…These finding are supported by other studies [23]. The dimensions of Symmetry, Ordering, Counting &Arranging are found to be correlated but not at the significant level with family accommodation which indicates as the severity of the dimensions increases, the family members are more likely to accommodate with the patients [23]. As we found in the current study OCD-affected individuals often explicitly request or demand accommodation [3].…”

“…The dimensions of contamination & cleaning, are found to be mildly correlated with family accommodation which indicates as the severity of the dimensions increases, the family members are more likely to accommodate with the patients. These finding are supported by other studies [23]. The dimensions of Symmetry, Ordering, Counting &Arranging are found to be correlated but not at the significant level with family accommodation which indicates as the severity of the dimensions increases, the family members are more likely to accommodate with the patients [23].…”

“…As we found in the current study OCD-affected individuals often explicitly request or demand accommodation [3]. Therefore, it can be said that those symptoms which were explicit in nature as well as acceptable for family members, were found to be positively correlated with family accommodation [23]. Family accommodation inadvertently worsens OCD symptoms and is associated with increased disease severity, overall functioning impairment for the child or adult both [24].…”

“…These symptoms are implicit symptoms, unacceptable and as well as negative in nature therefore family members do not accommodate with patients. It can be a reason of less or no accommodation found with respect to these dimensions [23].…”

Early intervention for obsessive compulsive disorder: An expert consensus statement

“…Fineberg et al, 2013a), those who are more severely unwell (and/or their caregivers) are more likely to seek help and receive treatment sooner, compared with those with a more chronic but fluctuant form of illness. A longer DUI may also be associated with greater family accommodation of symptoms, thereby counteracting the goals of exposure and response prevention, promoting treatment resistance (Albert et al, 2017). Moreover, the effect of accommodating to OCD in a child or young person has a profoundly damaging effect on family relationships and the health of family members/caregivers (Peris et al, 2008).…”