Treatment of Extreme Family Accommodation in a Youth with Obsessive-Compulsive Disorder

Abstract

Obsessive-compulsive disorder (OCD) in youth is typically characterized by high degrees of family accommodation or changes to parent behavior aimed at aiding the youth in avoiding or alleviating distress caused by the disorder. Coercive-disruptive behaviors are also prevalent among youth with OCD and describe forceful attempts to impose family accommodation on parents and siblings. High degrees of family accommodation are associated with greater symptom severity and with poorer response to treatment. Parent-based interventions offer an alternative or enhancement to therapy with the youth. Supportive Parenting for Anxious Childhood Emotions (SPACE) is a parent-based treatment for pediatric OCD and anxiety disorders. SPACE works to systematically reduce family accommodation and provides parents with practical tools for coping with the youth’s responses, including coercive-disruptive behaviors. This chapter presents an overview of SPACE and illustrative case example. Alyssa was a 14-year-old girl with severe OCD whose parents reported severe coercive-disruptive behaviors and extreme family accommodation. Over treatment, parents systematically charted their accommodation and implemented plans to reduce it. The therapist guided the parents in applying SPACE modules to cope with Alyssa’s anger and distress and to improve their ability to work collaboratively with each other. Following treatment, Alyssa showed significant improvement in obsessive-compulsive symptoms, and parents reported greatly reduced family accommodation and coercive-disruptive behaviors. A discussion of complicating factors is included.