Family Functioning in OCD
Renae M. Reinardy, Psy.D. & Kristin L. Holland, MA, LPC
Therapeutic Advice
What is OCD?
• DSM-5 Criteria
•
•
•
•
Presence of obsessions, compulsions, or both
Time consuming, distress, impairment
Not due to substances or medical condition
Not caused by another disorder
• Prevalence
• 1 in 50 adults, 1 in 100 children
• Females slightly higher as adults, males higher in childhood
• Fourth most common mental disorder
What are Obsessions & Compulsions?
Obsessions:
Compulsions:
Repetitive
Rituals
Persistent
Repetitive behaviors
Thoughts, images, urges
Mental acts
Not pleasurable
Feels driven to perform
Involuntary
Neutralize
Intrusive
“Fix”
Unwanted
Avoidance
Cause distress or anxiety
Repeat until “just right”
Not pleasurable
Themes Found in OCD
Obsession
Compulsion
Contamination
Washing
Checking
Cleaning
Self-harm
Checking
Harm to others
Excessive reassurance seeking
Sexual
Avoidance
Religious/moral
Tapping
Just right/Tic-like
Praying
Perfectionism
Confessing
Symmetry
Rereading
Relationship
Researching
Treatment of OCD
• Exposure
•
•
•
•
Stand toe to toe with fear
Do the opposite
Exposure to triggers
Example: client may touch bottom of shoe
• Response Prevention
•
•
•
•
Resist fix-it behaviors/rituals
Do it out of order
Less than perfect
Example: Client resists washing hands before eating
Treatment of OCD
• Habituation happens
• Diminished emotional response with repeated exposure
• Gradual vs. flooding
• In office vs. In-Vivo
• Medications
• Work best if combined with ERP
• Involving the family
• How might family involvement impact OCD symptoms and ERP?
Family Accommodation
• Modification of personal and family routines in response to OCD
symptoms
• Accommodation in OCD is common and is strongly and consistently
correlated with overall symptom severity
• Case studies
(Lebowitz, E.R., Panza, K.E. & Bloch, M.H., 2012)
• Family accommodation in response to contamination fear
• Family accommodation in response to fear of developing a brain
tumor/religious obsessions
• Take a moment and think about how OCD has impacted your family
Cycle of Accommodation
“What if I go
to Hell?”
Distress
Asks mom for
reassurance
Cycle of Accommodation
Some short-term
reduction in distress
Long term, obsessions
continue (Remember,
you can’t rationalize
with OCD)
Daughter more likely
to seek reassurance
from mom, chasing
the short-term relief
Cycle of Accommodation
Over time, mom
grows frustrated her
words don’t have any
long-term impact
Frustration often
leads to conflict and
added stress
Added stress often
leads to a worsening
of OCD symptoms
Assessing Family Accommodation
MEASURE :
RATED BY:
FAS
Clinician
FAS-IR
Clinician
FAS-PR
Parent of child with OCD
FAS-SR
Relative of patient with OCD
FAS-PV
Patient with OCD
Family Accommodation Scale for OCD
FAMILY ACCOMMODATION SCALE FOR OCD
Please respond to the following questions in regards to the ways you have responded to your loved one
with OCD during the past 2 weeks.
1. Have you reassured your loved one when s/he expressed worries, fears, or doubts related to an
obsession or compulsion?
Yes No
2. Have you helped your loved one complete his/her rituals?
Yes
No
3. Have you waited for your loved one to complete rituals, resulting in interference with plans you have
made?
Yes No
4. Have you tolerated situations/behaviors that you would prefer your loved one not do?
Yes
No
5. Have there been things that you did not say or do because of your loved one’s OCD?
Yes
No
6. Have you assisted your loved one in avoiding people, places, or things/situations?
Yes
No
7. Have you helped your loved one undertake or complete compulsions?
Yes
No
8. Have you engaged in compulsions or behaviors that you consider odd or senseless at your loved
one’s request, or because you thought s/he would want you to do these things?
Yes No
9. Have you helped him/her to complete tasks or make simple decisions when OCD interfered with
his/her ability to do so?
Yes No
10. Have you modified your social, work, or family responsibilities because of your loved one’s OCD?
Yes No
11. Have you modified what you consider ordinary family routines because of your loved one’s OCD
symptoms?
Yes No
12. Do you currently do some of the things for the family that would be your loved one’s responsibilities
if s/he did not have OCD?
Yes No
**Calvacoressi, L.; Mazure, C.; Goodman, G.; McDougle, C.; & Price, L. Family Accommodation Scale
for OCD.
How do we Guard Against Accommodation?
• Negotiation & limit setting
• Preserve individual rights (e.g., can have friends over, sit on any furniture)
• Preserve individual and family routines (e.g., being on time, minimizing
avoidance)
• Consider family contract - plan ahead; don’t define limits in middle of conflict
• Gradual process
• Development of a family response script
• Supportive/nurturing tone; stay calm & avoid being antagonistic
• Focus on combating OCD together; avoid personal criticism
• Keep communication clear and simple; avoid lengthy rationales & debates
From the Human Side
Things to Remember
• Be realistic
• Recognize and praise small improvements
• Self-care is important
• Avoid day-to-day comparisons
• Expect occasional setbacks as a normal part of recovery
• Modify expectations during times of change/stress
• Be sensitive to mood
• It’s not all about the OCD
In Conclusion…
• With ERP, there is great hope!
• By minimizing family accommodation, family members can help their
affected loved one face their fears and combat OCD
• Family members can serve as a huge source of support and motivation
• Setting limits & maintaining a supportive environment can aid in relapse
prevention
• Improvement in OCD symptoms positively correlates with family
functioning
• Seek out a family therapist who specializes in OCD and ERP if your family is
having difficulty identifying and minimizing accommodating behaviors