Family accommodation in obsessive-compulsive disorder: Dynamics and dimensions

ABSTRACT Background: Obsessive-compulsive disorder (OCD) is commonly encountered in day-to-day practice. Because of its severe, chronic, and disabling nature, OCD frequently affects those around the patient. Consequently, it leads to caregivers’ involvement, specifically family accommodation (FA) behaviors in response to OCD symptoms. FA is highly prevalent but understudied in India. Aim: To determine the prevalence, nature, and predictors of family accommodation in caregivers of patients with OCD. Materials and Methods: This was a cross-sectional study conducted on patients and caregivers of patients with OCD using purposive sampling in a medical college of northern India. Severity of OCD was measured using the Dimensional Yale-Brown Obsessive Compulsive Scale, and FA was measured using the Family Accommodation Scale for Obsessive-Compulsive Disorder (Interviewer-Rated). Results: Initially, 162 participants, or 81 pairs of patients and caregivers, were screened. Of them, 59 dyads were found eligible for study. Nearly all caregivers ( n = 56, 94.9%) reported at least one accommodating behavior. The most frequent FA behaviors were providing reassurance ( n = 55, 93.2%), refraining from saying/doing things ( n = 45, 76.3%), facilitating compulsions ( n = 44, 74.6%), and waiting ( n = 44, 74.6%). Higher FAS-IR scores were associated with greater OCD severity ( P < 0.001), contamination ( P < 0.01), and taboo ( P < 0.05) symptom dimensions, and female caregivers ( P < 0.001). Conclusion: Family accommodation is almost universal in caregivers of patients with OCD. The level of family accommodation is mitigated by the severity and nature of obsessive-compulsive symptoms and various patient and caregiver-related sociocultural factors.