Family accommodation in OCD refers to the adjustments or changes family members make to assist or avoid conflict with a relative suffering from obsessive-compulsive disorder. This can include participating in or facilitating rituals, providing reassurance, or avoiding certain triggers. While intended to help, accommodation can inadvertently reinforce OCD symptoms and hinder treatment progress.
Balancing post-COVID safety with the risk of inadvertently accommodating a child’s OCD through excessive hygiene measures.
Key Points
Rationale
Obsessive-compulsive disorder (OCD) affects 0.25-2% of children and adolescents and causes significant disruption to family routines (Stewart et al., 2017).
Family accommodation of OCD symptoms is common, with 60-96% of relatives reporting involvement in rituals or avoidance (Lebowitz et al., 2016).
However, most research focuses on parents, not siblings. Siblings play a unique, lifelong role, so their experiences require direct study rather than generalization from parents (Orsmond & Seltzer, 2007).
Prior work found siblings have high distress and accommodation, but quantitative measures provided limited insight into the impacts on siblings’ lives (Barrett et al., 2000).
This study aimed to explore siblings’ first-hand experiences of living with youth diagnosed with OCD using qualitative methods.
Method
Sample:
Results
Two main themes were identified: OCD as a dangerous dictator, and unifying/polarizing impact on relationships
1. OCD as dictator:
2. Unifying/polarizing
Implications
Strengths & Limitations
The study had many methodological strengths, including:
However, this interpretative phenomenological analysis was limited in a few ways:
Conclusion
This exploratory study provides initial valuable insights into the lived experience of siblings of youth with OCD usingqualitative methods.
The emotive home environment and shifts in family dynamics had significant impacts. Further research with diverse samples is critically needed to understand this vulnerable group’s needs and experiences over time.
Findings suggest siblings should be involved in OCD treatment plans and supported, as they face distress and accommodation demands akin to parents.
References
Primary Paper
Brownings, S., Hale, L., Simonds, L. M., & Jassi, A. (2023). Exploring the experiences and responses of siblings living with a brother or sister with obsessive compulsive disorder.Psychology and Psychotherapy: Theory, Research and Practice, 96(2), 464-479.https://doi.org/10.1111/papt.12454
Other References
Barrett, P. M., Rasmussen, P. J., & Healy, L. (2000). The effect of obsessive-compulsive disorder on sibling relationships in late childhood and early adolescence: Preliminary findings.Bulletin of the Australian Educational and Developmental Psychologist, 17(2), 82-102.
Lebowitz, E. R., Panza, K. E., & Bloch, M. H. (2016). Family accommodation in obsessive-compulsive and anxiety disorders: A five-year update.Expert Review of Neurotherapeutics, 16(1), 45-53.
Orsmond, G. I., & Seltzer, M. M. (2007). Siblings of individuals with autism spectrum disorders across the life course.Mental Retardation and Developmental Disabilities Research Reviews, 13, 313–320.
Stewart, S. E., Hu, Y. P., Leung, A., Chan, E., Hezel, D. M., Lin, S. Y., Belschner, L., Walsh, C., Geller, D. A., & Pauls, D. L. (2017). A multisite study of family functioning impairment in pediatric obsessive-compulsive disorder.Journal of the American Academy of Child & Adolescent Psychiatry, 56(3), 241-249.
Further Information
The OCD accommodation cycle begins with an individual experiencing distress related to their OCD symptoms. In response, family members may provide accommodations to alleviate this distress. While these accommodations offer a short-term reduction in anxiety, they inadvertently foster a continued dependence on parents or caregivers for emotional regulation. Over time, this dependency perpetuates and even maintains the original OCD symptoms, creating a reinforcing cycle.
accommodation cycle
Learning Check
How might having a sibling with OCD uniquely impact family dynamics compared to other mental health disorders? What similarities might exist?In what ways might the sibling experience differ across development – how might a 5 year old sibling be affected differently than a 16 year old?How could parents and clinicians better support siblings of youth with OCD? What supports might be most beneficial at different ages?What might be the long term impacts on siblings of youth with untreated OCD? How might early intervention and treatment change these outcomes?How might cultural factors influence how families respond to and accommodate a child’s OCD symptoms?
Olivia Guy-Evans, MSc
BSc (Hons) Psychology, MSc Psychology of Education
Olivia Guy-Evans is a writer and associate editor for Simply Psychology. She has previously worked in healthcare and educational sectors.
Saul McLeod, PhD
BSc (Hons) Psychology, MRes, PhD, University of Manchester
Saul McLeod, PhD., is a qualified psychology teacher with over 18 years of experience in further and higher education. He has been published in peer-reviewed journals, including the Journal of Clinical Psychology.
