Family accommodation in obsessive–compulsive disorder

Abstract

Family accommodation refers to ways in which family members take part in the performance of rituals, avoidance of anxiety-provoking situations or modification of daily routines to assist a relative with obsessive–compulsive disorder (OCD). Our goal is to review the available data on the role of family accommodation in both children and adults with OCD. A search of available peer-reviewed English language papers was conducted through PubMed and PsycINFO cross-referencing the keyword OCD with accommodation, family relations and parents. The resulting 641 papers were individually evaluated for relevance to the scope of the review. It was found that accommodation is common in OCD and is strongly and consistently correlated with OCD symptom severity. Family accommodation also appears to be increased when the proband has cleaning contamination symptoms and increased internalizing or externalizing problems. Family accommodation is associated with increased parental OCD and anxiety symptoms. Levels of accommodation are associated with treatment outcomes for both behavioral and pharmacological treatment. Significant improvement of OCD symptoms with treatment is associated with reductions in family accommodation. Family accommodation represents important clinical data that is worth measuring, monitoring and tracking in clinical care. Therapies targeting family accommodation may be successful in improving treatment outcomes in OCD.

Keywords::

• anxiety disorders
• cognitive–behavioral therapy
• family accommodation
• family members
• obsessive–compulsive disorder
• treatment outcomes

Financial & competing interests disclosure

The authors acknowledge the Messer Anxiety Program at the Yale Child Study Center (ERL), National Institute of Mental Health support of the Yale Child Study Center Research Training Program (MHB), the NIH 1K23MH091240-01 (MHB), the APIRE/Eli Lilly Psychiatric Research Fellowship (MHB), the AACAP/Eli Lilly Pilot Research Award (MHB), the Trichotillomania Learning Center (MHB), NARSAD (MHB), and UL1 RR024139 from the National Center for Research Resources, a component of the NIH, and NIH roadmap for Medical Research (MHB). The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.

No writing assistance was utilized in the production of this manuscript.