Family Accommodation In Obsessive-compulsive Disorder Research Articles

The Relationship Between Family Accommodation and Anxiety Sensitivity in Obsessive-Compulsive Disorder.

Objective Anxiety sensitivity (AS) is an issue that has gained importance in obsessive-compulsive disorder (OCD) in recent years. Family accommodation (FA) is the participation of family members in compulsions and rituals. The objectives of this study were to (1) investigate the relationship between FA and AS in OCD and (2) determine the frequency and types of FA in a Turkish OCD sample. Methods This cross-sectional study was conducted with 81 OCD patients. The Yale-Brown Obsession Compulsion Scale (YBOCS), Family Accommodation Scale-Patient Form (FAS-PF), Anxiety Sensitivity Index-3 (ASI-3), Beck Depression Inventory (BDI), and Beck Anxiety Inventory (BAI) were administered to the patients. Results Family accommodationwas extremely prevalent among family members of OCD patients. There were significant relationships between FA and ASI-3 total, ASI-3 cognitive subscale, ASI-3 psychical subscale, YBOCS, and BAI scores. In addition, ASI-3 total, ASI-3 cognitive subscale, and ASI-3 psychical subscale were significant predictors for family accommodation above and beyond the OCD severity. Conclusions The present study identified a significant association between anxiety sensitivity and family accommodation in OCD. Anxiety sensitivity is a relievable psychological trait. Alleviating anxiety sensitivity can decrease accommodating behaviors and may be beneficial in OCD treatment. Anxiety sensitivity may be a novel potential treatment target for OCD.

Quand aider devient nuire : une compréhension des implications de l’accommodation familiale sur l’efficacité des interventions psychologiques dans le TOC

The objective of this article is to present a review of current knowledge of the consequences and determinants of family accommodation in adults, children and adolescents. Family accommodation can be defined as the changes in behavior adopted by family members of a relative suffering from a mental disorder in order to reduce the associated suffering and distress (e.g., participating in OCD rituals or helping with avoidance). This phenomenon is particularly frequent since it is observed in from 70 to 97% of the relatives interviewed in the studies, whether the patients are adults or children. To present this mechanism, this article will discuss the underlying theoretical models in obsessive-compulsive disorder (OCD) as well as outline the epidemiology, consequences and maintaining factors of family accommodation. The second part of this article will deal with the principal programs and methods of treatment of family accommodation. To this end, a review of the literature regarding family accommodation was conducted using the following databases: PubMed, Google Scholar, ScienceDirect, and PsycINFO, without date limitation. Sixty-seven articles were selected to explore the question of family accommodation in OCD, both in child and adult populations. The data in the literature clearly show that family accommodation is an important factor in the perpetuation of OCD and anxiety symptomatology. Indeed, this accommodation would seem to impede attempts to learn new functional behavior by not allowing the person to perceive the negative consequences of his or her symptomatic behavior or by preventing him or her from experiencing habituation to anxiety-provoking stimuli. In addition, several studies have shown a moderate correlation between the intensity of OCD and family accommodation, as well as the negative effects on the quality of the relationship in couples, or an increase in the perceived burden for the relative. Another finding that seems relevant to clinical practice is that family accommodation is negatively associated with the effectiveness of psychotherapeutic interventions. Indeed, it has been shown that a high level of family accommodation is positively correlated with a low response to psychotherapeutic and pharmacological treatments. Family accommodation has been shown to be a factor in the failure of psychotherapies by distorting the learning achieved in therapy, as well as by leading to greater functional deterioration in the patient. This accommodation is also a predictor of non-spontaneous recovery. These data, therefore, indicate the importance of considering this mechanism in the treatment of patients suffering from OCD, regardless of their age or sex. In the second part of the article, we discuss many proposals for interventions, based on CBT models, which have emerged in recent years in order to maximize the effectiveness of therapies for OCD and anxiety disorders. Their aim is to integrate the family member into the therapy so that he or she can understand the interest in changing his or her reinforcing behavior. In addition to understanding the importance of change, they can be helped by the therapist. Most of these programs are for children only, but some do exist for relatives of adult patients. These propositions for the treatment of family accommodation seem to demonstrate interesting evidence in favor of their effectiveness. However, considering the small number of existing programs, and the small sample sizes that have led to their validation, further research is needed on this topic in order to highlight key interventions that can lead to a decrease in family accommodation. In conclusion, despite an acceleration of research during the last decade, family accommodation remains relatively insufficiently studied, particularly in adults. Recently, family accommodation has been demonstrated in cases of depression, all anxiety disorders, autism spectrum disorders, eating disorders and in chronic pain. There is still a lack of evidence for the existence of this process in certain disorders such as schizophrenia or bipolarity, but it is easy to hypothesize that a change in behavior can be found in the relatives of people suffering from these types of pathologies. In consideration of these results and of the negative impact of family accommodation on the treatment of mental pathologies, a better understanding of family accommodation and its consideration in all psychiatric pathologies seems essential in the future in order to increase the effectiveness of treatment proposals.

Translation and Cross-Cultural Adaptation of the Family Accommodation Scale for Obsessive-Compulsive Disorder Into Chinese.

Family accommodation is a phenomenon that has been associated with worse treatment outcome of patients with obsessive-compulsive disorder (OCD) and greater severity of symptoms and levels of functional impairment. Yet, there are no Chinese scales to assess family accommodation in OCD among family members. The present study aimed to illustrate the steps of translation and cross-cultural adaptation of the Chinese versions of the Family Accommodation Scale (FAS). After obtaining authorization of the developers, the Chinese versions of the FAS were translated and adapted from the English versions based on a standard protocol, following six steps: forward translation, pilot administration, language adjustment and cultural adaptation, back-translation, review and minor edit, and final approval of the developer. Thirty-five pairs of patients and corresponding relatives with different education levels were administered the FAS in the pretest stage. This study found that the semantic, idiomatic, and conceptual equivalence were obtained between the Chinese versions and original English scales, and the Chinese versions of FAS were well translated and culturally adapted. We also found that the Chinese versions of the FAS can be easily understood by people of different socioeconomic statuses.

Prevalence and predictors of family accommodation in obsessive-compulsive disorder in an Indian setting.

Background:Family accommodation (FA) is a phenomenon whereby caregivers assist/facilitate rituals or behaviors related to obsessive–compulsive disorder (OCD). FA, however, has been explored primarily in the Western population, and it is unclear to what extent it might be present in diverse cultural settings. At present, little is known about the extent and predictors of FA among caregivers of adult OCD patients in India.Aims:The study aims to assess the extent, clinical correlates, and predictors of FA in the caregivers of adults with OCD.Settings and Design:Cross-sectional study conducted in an outpatient setting in a tertiary-care hospital.Materials and Methods:Hundred and one adult patients of either gender with Diagnostic and Statistical Manual of Mental Disorders-5 diagnosis of OCD and 101 caregivers were included. The patients were assessed using Yale–Brown Obsessive Compulsive Scale (YBOCS), Hamilton Rating Scale for Depression (HAM-D), World Health Organization Disability Assessment Schedule Version 2.0 12-item version (WHO-DAS 2.0.12), Clinical Global Impressions Scale for Severity (CGI-S), and Clinical Global Impressions Scale for Improvement. The FA Scale-Self Rated Version (FAS-SR) was applied on caregivers after Hindi translation.Statistical Analysis:Descriptive statistics, group comparisons, and Pearson's product moment correlations were carried out. Multiple linear regression modeling was performed with the total FAS-SR score as the dependent variable.Results:About 92% of caregivers displayed at least some form of FA. Higher scores on HAM-D, YBOCS, WHODAS, and CGI-S were associated with higher scores on FAS-SR scale, which reached statistical significance (P < 0.01).Conclusions:FA in OCD appears to be a frequent phenomenon. Higher FA is associated with higher symptom severity and disability, emphasizing its clinical and research relevance for future studies.

The Japanese version of the Family Accommodation Scale for Obsessive-Compulsive Disorder: Psychometric properties and clinical correlates

Although a variety of obsessive-compulsive disorder (OCD)-related family pathologies, such as family accommodation, may exist in Japanese OCD patients, few studies on this topic have been conducted, and a validated assessment tool is not available in Japan. The Family Accommodation Scale (FAS) is the most widely used measure of accommodation behavior in OCD patients. The aims of this study were to develop a Japanese version of the FAS—Self-Rated Version (FAS-SR), to examine its reliability and validity, and to study the clinical correlates of family accommodation in OCD. We subsequently examined the psychometric properties of the Japanese version of the FAS-SR in a sample of 41 Japanese OCD patients and 41 relatives. The Japanese version of the FAS-SR demonstrated good internal consistency and test-retest reliability. It showed good convergent and divergent validity when concomitantly assessed with other measures, such as OCD symptom severity, functional impairment, family functioning, psychological distress, a variety of psychiatric symptoms and cognitive-reflection-impulsivity. Additionally, family psychopathology, especially somatization, obsessive-compulsive symptoms, depression, hostility and psychoticism, were significantly correlated with family accommodation in OCD. The Japanese version of the FAS-SR has acceptable psychometric properties for assessing family accommodation in Japanese patients with OCD in both research and clinical settings.

Anxiety sensitivity and family accommodation in obsessive-compulsive disorder

BackgroundAlthough anxiety sensitivity (AS) presents in adults with obsessive-compulsive disorder (OCD), it has received minimal empirical attention. There are postulated connections between AS and family accommodation, but this relationship has yet to be formally examined. Methods: The present study included 58 adults with OCD who completed a clinician-rated measure of OCD symptom severity, as well as self-report measures assessing AS, family variables, impairment, and co-occurring psychopathology. Results: Participants' AS moderately correlated with family accommodation, family functioning, and depression, while strongly correlating with anxiety symptoms. The Fear of Cognitive Dyscontrol AS subscale moderately correlated with multiple domains of functional impairment, and predicted family accommodation beyond the effects of OCD symptom severity. Family accommodation mediated the relationship between the Fear of Cognitive Dyscontrol AS subscale and functional impairment. Limitations: The study was cross-sectional in nature, limiting the ability to establish directionality and causation. The sample was also limited to adults with OCD and their own symptomology, necessitating further investigations of these constructs in pediatric samples and psychopathology in the caregivers/relatives. Conclusions: These findings highlight the importance of considering fears regarding the loss of mental control within the context of family accommodation in OCD when evaluating functional impairment.

Predictors of Family Accommodation in Obsessive-Compulsive Disorder

Obsessive-compulsive disorder (OCD) is a serious, disabling illness. Family members are frequently involved by attempting to stop rituals or by performing rituals for their relative. Factors associated with family accommodation of OCD have been largely overlooked in the literature. This study aims to identify the frequency and clinical predictors of OCD family accommodation behaviors. Participants include those with a first admission to the McLean/Massachusetts General Hospital OCD Institute (N = 110). The Family Accommodation Scale was completed independently by family members. Univariate relationships between factors and family accommodation were assessed via graphs, parametric and non-parametric testing. Multiple regression analyses modeled relationships between family accommodation and predictor variables. Family accommodation was reported in 96.9% of cases, and predominantly occurred at least daily (59.1% of cases). Most common behaviors included providing reassurance and waiting for ritual completion. Two of 13 potential predictors were significantly correlated with family accommodation both in univariate regression analysis and in the final regression model (F = 10.15; p < 0.0001; R-square = 0.17; adjusted R-Square = 0.15). These include OCD severity (p = 0.0007) and the cleaning/contamination symptom dimension (p = 0.03). Family accommodation is ubiquitous in OCD. Psychoeducation regarding potential deleterious effects of accommodation must not be overlooked in management of this illness.

Family accommodation in obsessive-compulsive disorder.

Family accommodation of patients with obsessive-compulsive disorder, i.e., participation in symptoms and modification of personal and family routines, was assessed in relation to family stress, functioning, and attitudes toward the patient. Primary caretakers for 34 patients with obsessive-compulsive disorder were interviewed to assess the nature and frequency of accommodating behaviors. The caretakers also completed several measures of family functioning. Of the 34 spouses or parents, 30 (88.2%) reported accommodating the patient. Family accommodation correlated with poor family functioning, rejecting attitudes toward the patient, and several types of family stress. Family accommodation of patients with obsessive-compulsive disorder was associated with global family dysfunction and stress. This study suggests that families' efforts to accommodate patients may be intended to reduce patient anxiety or anger directed at relatives.