How Does Family Accommodation Affect OCD Treatment Outcomes?

What you need to know

• Family accommodation of OCD symptoms is common, with 93% of patients reporting at least some accommodation
• Increases in family accommodation after discharge predicted later increases in OCD symptoms
• Targeting family accommodation as patients transition home may help maintain treatment gains

What is family accommodation?

Family accommodation refers to ways that family members participate in or facilitate a person’s OCD symptoms. This can include helping with rituals, providing reassurance, or changing family routines to accommodate OCD behaviors. While family members often intend to reduce the person’s anxiety or distress, accommodation can ultimately maintain or worsen OCD symptoms over time.

How common is family accommodation?

This study found that family accommodation was very common among adults receiving intensive residential treatment for severe OCD:

• 93% of patients reported at least some family accommodation
• 24% reported daily accommodation by family members

These rates are similar to what has been found in previous studies of both children and adults with OCD. The high prevalence highlights how important it is to address family accommodation as part of OCD treatment.

Gender differences in family accommodation

An interesting finding was that female patients reported significantly higher levels of family accommodation compared to male patients. There are a few potential reasons for this:

• Females may be more likely to have contamination-related OCD symptoms, which tend to elicit more accommodation
• Females may be more expressive about their anxiety, leading family members to accommodate more
• There may be cultural factors that make family members more likely to accommodate females

More research is needed to understand the reasons for this gender difference. However, it suggests that clinicians should be especially attuned to family accommodation when working with female OCD patients.

How family accommodation relates to OCD symptoms

The study found that family accommodation was positively correlated with OCD symptom severity - meaning that higher levels of accommodation were associated with more severe OCD symptoms.

Specific OCD symptom dimensions that predicted higher family accommodation were:

• Contamination symptoms
• Responsibility for harm symptoms
• Symmetry/incompleteness symptoms

Interestingly, unacceptable thoughts symptoms (e.g. violent or sexual intrusive thoughts) did not predict family accommodation. This may be because these symptoms often involve more mental rituals that family members can’t easily observe or participate in.

Changes in family accommodation during and after treatment

A key aim of this study was to look at how family accommodation and OCD symptoms changed over the course of intensive treatment and follow-up. Some important findings were:

• Decreases in OCD symptoms during treatment predicted decreases in family accommodation in the month after discharge
• Increases in family accommodation between discharge and 1-month follow-up predicted increases in OCD symptoms between 1-month and 6-month follow-up

This suggests that family accommodation may play an important role in maintaining treatment gains after intensive OCD treatment. When family members increase accommodation after a patient returns home, it may contribute to a worsening of OCD symptoms over time.

Clinical implications

The findings have several important implications for OCD treatment:

1. Family accommodation should be assessed and addressed, even for adult patients.

2. Clinicians should educate families about how accommodation, even when well-intentioned, can maintain OCD symptoms.

3. Family-based interventions that specifically target reducing accommodation may help enhance treatment outcomes.

4. Extra attention should be paid to family accommodation as patients transition from intensive treatment back to their home environment.

5. Follow-up care after intensive treatment should continue to monitor and address family accommodation to help maintain gains.

Limitations and future directions

Some limitations of this study to keep in mind:

• Only about 1/3 of patients provided follow-up data, which may have biased results
• Family accommodation was only measured by patient report, not family member report
• The study did not control for other factors that may influence symptom changes

Future research should:

• Use larger samples with higher follow-up rates
• Include family member reports of accommodation
• Examine how targeting family accommodation during treatment impacts long-term outcomes
• Investigate whether certain types of family accommodation are more problematic than others

Conclusions

• Family accommodation is very common in adults with severe OCD requiring intensive treatment
• Increases in family accommodation after intensive treatment may contribute to later worsening of OCD symptoms
• Addressing family accommodation, especially during the transition home, may help patients maintain treatment gains
• More research is needed on how to effectively reduce family accommodation and optimize long-term OCD treatment outcomes