Family accommodation in adult obsessive–compulsive disorder: clinical perspectives

Figures & data

Table 1 Examples of family accommodation according to the principal obsessive–compulsive symptom dimensions

	Forbidden thoughts and checking	Contamination and cleaning	Symmetry and ordering
Direct participation in patient’s compulsive behavior	Escorting the patient when he/she has to go near windows or at upper floors (to make sure that he/she will not lose control and throw him/herself out of the window) Escorting him/her when he/she is in social situations (to ensure that he/she will not lose control and harm someone/e.g., push someone under the bus) Controlling that doors are locked and/or lights have been switched off because the patient is afraid of being responsible for something dangerous happening	Having to pass towels to the patient, taking particular care that they do not touch contaminated surfaces Washing carefully the bathroom/some surfaces (even with particular products) before the patient enters the bathroom for his/her washing compulsion Controlling that the patient with OCD is correctly taking a shower without touching anything dirty or potentially contaminating	Reassuring the patient that objects have not been touched or moved from their position while they were away from home Assisting the patient when he/she is controlling the right position of an object and/or providing reassurance that they correctly moved the object in the right position
Assisting the patient in avoidance of OCD triggers	Cutting food for patient in order to let him/her avoid touching knives (because of the fear of losing control and harming someone) Avoiding talking about things that might trigger obsessions, for example, avoiding naming suicide/homicide/aggression; avoiding watching television news or reading newspapers because it might happen that bad news are reported	Opening doors/touching door knobs for patients in order to let him/her avoid touching contaminated surfaces Not inviting people home due to the patient’s contamination fears Having to undress before entering the home and putting the dirty clothes in a specific place at home, avoiding contaminating the house with these dirty clothes and having to immediately wash themselves before entering uncontaminated rooms	Refraining from moving objects on tables or work desk Refraining from cleaning some furniture because it implies moving objects Not inviting people home because patient is afraid that guests will touch and move objects from their correct position

Abbreviation: OCD, obsessive–compulsive disorder.

Table 2 Family accommodation scores in family members of pediatric patients with OCD

Authors	No. of patients Age, mean (±SD) (age range)	No. of family members	Scale	FAS total score Mean (±SD)	Scores of specific factors/subscales
					Participation in rituals	Modification of routines or activities	Distress associated with accommodation and refusal to accommodate	Consequences when not accommodating
Storch et al^Citation41	57 12.99 (±2.54) (7–17)	57	FAS-PR	23.20 (±11.70)	9.29 (±2.47)	7.11 (±0.51)	1.65 (±0.80)	5.12 (±0.90)
Peris et al^Citation43	65 12.25 (8–17)	65	FAS-PR	18.36 (±10.49)	9.09 (±5.29)	3.38 (±3.26)	1.27 (±1.07)	4.28 (±3.17)
Lebowitz et al^Citation44	26 12.07 (±3.0) (7–17)	26	FAS-PR	18.77 (±9.0)*	11.92 (±5.7)	6.85 (±4.4)	2.35 (±1.4)	6.08 (±3.8)
Lebowitz et al^Citation45	61 13.1 (±3.4) (7–18)	61	FAS-PR	16.49 (±7.8)*	10.16 (±4.6)	6.34 (±4.4)	2.17 (±1.4)	5.6 (±3.8)
Wu et al^Citation46	59 13.37 (±2.79) (7–19)	59	FAS-PR	26.31 (±13.25)	10.49 (±4.82)	8.64 (±5.95)	7.19 (±4.32)
Gorenstein et al^Citation47	33 12.9 (±2.7) (8–17)	43	FAS-PR	25.44 (±8.61)	9.19 (±4.52)	7.88 (±4.23)	8.37 (±2.56)
Flessner et al^Citation39	96 11.6 (±2.7) (7–17)	96	FAS-PR (12-item) FAS-AT FAS-IC	31.0 (±9.5) 13.4 (±5.1) 17.8 (±5.8)
Futh et al^Citation48	43 14.88 (±2.32) (9–18)	71	FAS-PR (12-item)	21.39 (±12.89)
Bipeta et al^Citation49	35 13.11 (±3.16) (7–17)	35	FAS-PR (12-item) FAS-AT FAS-IC	27.29 (±13.64) 10.09 (±8.03) 17.23 (±8.56)

Note:

* Sum of scores on items 1–9 of the FAS-PR.

Abbreviations: FAS, Family Accommodation Scale (13-item); FAS-AT, Family Accommodation Scale-Avoidance of Triggers; FAS-IC, Family Accommodation Scale-Involvement in Compulsions; FAS-PR, Family Accommodation Scale-Parent Report (13 items); OCD, obsessive–compulsive disorder.

Table 3 Family accommodation scores in family members/caregivers of adult patients with OCD

Authors	No. of patients Age, mean (±SD) (age range)	No. of family members	Scale	FAS total score Mean (±SD)	Scores of specific factors/subscales
					Participation in rituals	Modification of routines or activities	Distress associated with accommodation and refusal to accommodate	Consequences when not accommodating
Amir et al^Citation50	73 27.62 (±11.42) (11–59)	73	FAQ	18.52 (±9.81)
Albert et al^Citation51	15 56.4 (±8.1) –	22	FAS	18.32 (±7.22)*	11.31 (±2.76)	9.72 (±2.52)	6.22 (±1.35)
Ferrão et al^Citation29,**	49 35.22±10.74 41.35±11.45 (18–65)	49	FAS	20.0 6.5			3.29 (±2.83) 1.27 (±0.92)	5.24 (±3.00) 3.31 (±2.62)
Stewart et al^Citation42	110 30.8 (±11.2) (16–68)	110	FAS (12-item)	20.6 (±12.2)
Albert et al^Citation26	97 35.6 (±12.3) –	141	FAS	22.94 (±9.58)	8.68 (±4.04)	7.53 (±4.44)	6.72 (±3.59)
Vikas et al^Citation18	32 29.87 (±10.65) (18–60)	32	FAS	11.78 (±8.75)	7.56 (±5.21)	4.78 (±4.63)	1.31 (±1.20)	4.21 (±3.79)
Pinto et al^Citation37	41 41.8 (±15.3) (≥18)	41	FAS (12-item) FAS-SR	10.4 (±7.6) 14.1 (±14.7)
Cherian et al^Citation52	94 27.6 (±8.5) (16–65)	94	FAS	21.67 (±17.39)	8.46 (±7.89)	6.39 (±5.03)	1.66 (±1.31)	4.16 (±4.03)
Gomes et al^Citation53,#	114 40.5 (±13.9) (18–65)	114	FAS (12-item)	17 (9.8–24.5) 10 (5.3–21.8)
Wu et al^Citation54	61 32.57 (±14.91) (≥18)	54	FAS-PV FAS-SR	14.34 (±12.87) 16.19 (±12.87)

Notes:

* Sum of scores on items 1–9 of the FAS.

** Comparative study: mean age and total scores refer to patients responsive and refractory to treatments.

# Scores are expressed as mean (95% CI) for partners and other family members, respectively.

Abbreviations: FAQ, Family Accommodation Questionnaire (13-item); FAS, Family Accommodation Scale (13-item); FAS-PV, Family Accommodation Scale-Patient Version (19-item); FAS-SR, Family Accommodation Scale-Self-Rated (19-item); OCD, obsessive–compulsive disorder.

Table 4 Percentages of family members of pediatric patients with OCD reporting the principal accommodating behaviors

Authors	No. of family members	Scale	Frequency of at least some accommodating behavior (%) (of the same accommodating behavior on a daily basis – extreme score)
			Patient reassurance	Participating in patient’s compulsive behavior	Assisting the patient in avoidance	Modifying personal routine	Modifying family routine	Assuming responsibilities that are normally the patient’s responsibility
Storch et al^Citation41,**	57	FAS-PR	− (40)	− (38)	− (31)	− (14)	− (17)	− (11)
Peris et al^Citation43,*	65	FAS-PR	96.9 (56.3)	66.2 (46.2)	78.1 (21.9)	38.5 (4.6)	64.6 (1.5)	47.7 (1.5)
Flessner et al^Citation55,*	96	FAS-PR (12-item)	97.9 (63.5)	77.1 (32.3)	85.4 (33.3)	53.1 (3.1)	68.7 (4.2)	60.4 (4.2)
Futh et al^Citation48,*	43	FAS-PR (12-item)	− (37)	− (20)	− (14)	− (13)	− (13)	− (7)
Bipeda et al^Citation49,**	35	FAS-PR (12-item)	− (54.3)	− (45.7)	− (34.3)	–	–	–

Notes: Severity criteria differed according to the FAS version used:

* Frequency: extreme = every day.

** Percentages of parents who endorsed one of the two highest items (score of 3–4 on each item). Dash indicates not available.

Abbreviations: FAS-PR, Family Accommodation Scale-Parent Report (13 items); FAS, Family Accommodation Scale; OCD, obsessive–compulsive disorder.

Table 5 Percentages of family members/caregivers of adult patients with OCD reporting the principal accommodating behaviors

Authors	No. of family members	Scale	Frequency of at least some accommodating behavior (%) (of the same accommodating behavior on a daily basis – extreme score)
			Patient reassurance	Participating in patient’s compulsive behavior	Assisting the patient in avoidance	Modifying personal routine	Modifying family routine	Assuming responsibilities that are normally the patient’s responsibility
Stewart et al^Citation42,*	110	FAS	88.1 (45.5)	42.1 (15.0)	57.9 (13.1)	71.4 (20.0)	60.2 (19.4)	69.6 (22.8)
Albert et al^Citation26,**	97	FAS	91.5 (47.5)	74.5 (35.5)	89.4 (42.6)	68.1 (19.9)	85.1 (14.9)	79.1 (7.1)
Pinto et al^Citation37,*	41	FAS FAS-SR	63.4 (7.3)	9.8 (2.4)	29.3 (7.3)	14.6 (12.2)	43.9 (34.1)	36.6 (12.2)
Gomes et al^Citation53,***	114	FAS	65.8 (33.3)	53.5 (27.2)	25.4 (11.4)	56.1 (3.5)	63.2 (6.1)	35.1 (6.1)
Wu et al^Citation54,*	61	FAS-PV	56 (6.56)	33 (3.28)	54 (13.11)	15 (3.28)	51 (26.23)	41 (6.56)
		FAS-SR	59	33	41	19	46	37

Notes: Severity criteria differed according to the FAS version used:

* frequency: mild=1 day/week, moderate=2–3 days/week, severe=4–6 days/week, extreme = every day;

** frequency: mild=1–3 days/month, moderate=1–2 days/week, severe=3–6 days/week, extreme = every day;

*** frequency from mild to severe = at least a score of 1, extreme = every day.

Abbreviations: FAS, Family Accommodation Scale; FAS-PV, Family Accommodation Scale-Patient Version; FAS-SR, Family Accommodation Scale-Self-Rated; OCD, obsessive–compulsive disorder.

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