Family accommodation in pediatric body dysmorphic disorder: A qualitative study

Abstract

Family accommodation (FA) is significant in a range of disorders, yet it has never been explored in body dysmorphic disorder (BDD). Interviews were conducted with five young people with BDD, five parents, and five clinicians to explore the types, impact, and purpose of FA in BDD. Every participant reported significant FA of BDD, and the types reported were broadly similar to those found in other disorders. Reassurance giving/seeking and engagement in rituals were the two most common forms of FA reported with funding products being the third. Unsurprisingly, the driver for FA was to reduce the young person's distress and risk. Every participant commented on the negative impact FA had, including the financial burden, social implications, emotional well-being of family members, relationships, and conflict within the family, yet all young people also thought there were positive aspects to FA. Findings are discussed in the context of the limitations of this study.

Therapist-guided, Internet-delivered cognitive behaviour therapy for adolescents with body dysmorphic disorder: A feasibility trial with long-term follow-up

“…Parents had their own separate logins and modules and were encouraged to be involved throughout the treatment. Parental modules included psychoeducation, information on family accommodation ( Jassi et al, 2020a ) and how to reduce it, and strategies to assist their child in the different ERP tasks. An overview of the ICBT modules is shown in Supplementary Table 1 .…”

Practitioner Review: Assessment and treatment of body dysmorphic disorder in young people

“…Parents often get drawn into BDD‐related patterns of behaviour (e.g. facilitating avoidance, providing excessive reassurance about appearance and supplying large quantities of cosmetic products), a process often referred to as ‘family accommodation’ (Jassi, Baloch, Thomas‐Smith, & Lewis, 2020). Parents understandably engage in these behaviours in an attempt to reduce their child's distress, but unfortunately they can have the unintended consequence of fuelling BDD.…”

“…Published treatment studies suggest that it is usually beneficial for parents/carers to be included in CBT for BDD in young people, at least during the psychoeducation phase to ensure a shared understanding of BDD (Greenberg et al., 2016; Mataix‐Cols et al., 2015). The level of parental involvement thereafter depends on a range of factors, including: the developmental level of the young person; their ability to practice CBT techniques autonomously in between sessions; and the extent to which parents are involved in BDD‐related rituals, such as providing reassurance, which may inadvertently fuel BDD (Jassi et al., 2020).…”