Managing Family Accommodation in OCD: A Sibling-focused Case Study

Family accommodation (FA) is prevalent in obsessive-compulsive disorder (OCD). When patients refuse treatment, the impacts are more severe-with poorer clinical outcomes, greater FA, and more caregiver burden. In these cases, caregiver interventions are an essential clinical priority. However, clinical documentation of structured, culturally informed interventions for FA and caregiver burden for adults with OCD, in the absence of patient participation, remains limited. This case study describes an eight-session caregiver-focused intervention for a 26-year-old male experiencing burnout while accommodating his twin sister with OCD, who was refusing treatment. The intervention, grounded in cognitive-behavioral principles, targeted maladaptive caregiving patterns, reinforced boundary-setting, and facilitated shifts in caregiver behaviors and family routines. Post-intervention assessments indicated reductions in FA and emotional distress, with gains maintained at the one-month follow-up. This case highlights the feasibility and clinical utility of caregiver-directed approaches in adult OCD. It underscores the need for structured support for caregivers in collectivist cultures and suggests that even indirect interventions can disrupt symptom-maintaining cycles and promote systemic well-being.