Family Accommodation Of Symptoms Research Articles

Family Accommodation of Symptoms in Adults With Obsessive-Compulsive Disorder: Factor Structure and Usefulness of the Family Accommodation Scale for OCD-Patient Version.

For individuals with obsessive-compulsive disorder (OCD), family accommodation of symptoms, such as over-reassurance, participation in rituals, or facilitation of avoidance, is one of the key factors associated with symptom severity, maintenance, and related impairment. Most studies have assessed accommodation behaviors based on reports from family members or other loved ones. Recently, a patient-rated questionnaire, the Family Accommodation Scale for OCD-Patient Version (FAS-PV) was developed to assess family accommodation from the patient's perspective. This study investigated the factor structure of the FAS-PV and clinical variables associated with patient-reported family accommodation in a sample of 151 treatment-seeking adults with OCD. A confirmatory factor analysis suggested that a 4-factor model best characterized the scale, with the following factors: (1) participation in symptoms, (2) avoidance of OCD triggers, (3) taking on responsibilities, and (4) modifying responsibilities. Internal consistency was high for the total score and for scores on the 4 subscales of the FAS-PV. Approximately 87% of the sample reported accommodation behaviors at some level. Family accommodation was positively correlated with OCD symptom severity and functional disability, and partially mediated the associations between these 2 factors, so that greater OCD severity was associated with greater accommodation, which, in turn, was associated with greater disability. Our findings parallel those of studies that have employed other versions of the FAS and suggest that the FAS-PV is a useful tool for assessing family accommodation of OCD symptoms from the patient's perspective.

Introduction to the Special Issue: Challenges in Treating Obsessive-Compulsive Disorder With Cognitive-Behavioral Therapy.

Cognitive-behavioral therapy (CBT) is a recommended treatment for obsessive-compulsive disorder (OCD). CBT offers specific interventions with demonstrated efficacy, including both cognitive therapy and exposure and ritual prevention (ERP). Yet, implementing these techniques with individual patients can present clinical challenges. In this special issue, expert clinicians and researchers present cases in which they addressed some common challenges in implementing CBT for OCD, including comorbid depression, poor insight, and family accommodation of symptoms in pediatric OCD. Other papers present how CBT can be tailored to specific OCD manifestations, including post-partum OCD, taboo thoughts, and relationship OCD. Other authors detail how they have augmented standard ERP with additional treatment techniques to maximize outcomes. These articles present a diverse set of case histories and specific treatment techniques that illustrate ways to maximize the effectiveness of CBT for OCD, serving as a useful guide for clinicians in practice and highlighting areas for future research.

Rage as a hidden aspect in pediatric obsessive-compulsive disorder

IntroductionPediatric obsessive-compulsive disorder (OCD) is a multifaceted clinical entity. Rage attacks have been repeatedly described in the phenotype of anxiety disorders in children and adolescents. It has been acknowledged that anxious youth who display rage have more severe clinical profiles and increased levels of dysfunction in most domains, consistent with the notion that rage is a marker of more severe psychopathology. However, this matter remains largely underappreciated in pediatric OCD. Namely, the role and functions of rage in pediatric OCD in relation to family accommodation and illness severity have highly relevant clinical management and treatment implications.ObjectivesWe aim to discuss how does rage look like in pediatric OCD, what are its associated features and its contributions to additional functional impairment. We examine the central role of family accommodation mediating clinical outcomes and review highly relevant diagnostic and treatment challenges.MethodsSelective review of the literature in PubMed (MEDLINE). Illustration with a clinical case vignette.Results and conclusionsRage attacks are relatively common in pediatric OCD, have a negative impact on illness presentation, and contribute to functional impairment above and beyond obsessive-compulsive symptom severity. We hereby illustrate that rage may contribute to family accommodation of symptoms, which may further affect and perpetuate obsessive-compulsive symptom severity and impairment. There is a need to avoid misdiagnosis and to prioritize psychotherapeutic interventions and psychopharmacological treatment approaches. This provides important insights regarding the clinical validity of this component of OCD, aiming to capture further the attention of the clinical and research community.Disclosure of interestThe authors have not supplied their declaration of competing interest.

Family accommodation of obsessional symptoms and naturalistic outcome of obsessive–compulsive disorder

Accommodation of symptoms by families and expressed emotion (EE) may have a negative impact on the outcome of obsessive–compulsive disorder (OCD). The study examines the effect of family accommodation (FA) and EE on the 1-year naturalistic outcome of OCD. Patients with OCD who met the criteria for the Diagnostic and Statistical Manual of Mental Disorders-IV, text revision (DSM-IV TR; N=94) were followed up for 1 year and assessed every 3 months. Assessments included measurement of symptom severity, FA, EE and family burden. By the 12th month, the cumulative probability of remission was 58%. Non-remitters compared with remitters had a significantly higher FA, EE and family burden at the baseline and did not report significant reductions on any of the family variables over the year. In a Cox proportional hazard regression analysis, a higher FA at the baseline significantly predicted time to remission. FA of symptoms has a significant negative impact on the naturalistic outcome of OCD. This emphasises the need to design specific interventions to reduce FA for a better outcome.

A Structural Equation Analysis of Family Accommodation in Pediatric Obsessive-Compulsive Disorder

Family accommodation of symptoms is counter to the primary goals of cognitive-behavioral therapy for pediatric obsessive-compulsive disorder (OCD) and can pose an obstacle to positive treatment outcomes. Although increased attention has been given to family accommodation in pediatric OCD, relatively little is known about associated child and parent characteristics, and their mediating/moderating effects. This study examined a structural equation model of parent and child variables related to parent reports of family accommodation. Sixty-one children with OCD (ages 6-17years, 39% female) and their parents were recruited from a university-based clinic. They were administered clinician- and parent-rated measures of child OCD symptom severity, OCD-specific impairment, internalizing problems, and externalizing problems as well as parent anxiety, depression, empathy, consideration of future consequences, and accommodation. Results generally supported the hypothesized model. Family accommodation mediated the relationship between OCD symptom severity and parent-rated functional impairment; child internalizing problems mediated the relationship between parent anxiety and family accommodation; and parent empathy and consideration of future consequences interacted to predict family accommodation. Child externalizing problems were significantly associated with family accommodation but neither of these two variables was associated with parent depression. Findings suggest that reductions in family accommodation might be maximized by routinely screening for comorbid psychopathology in children with OCD and their parents, and using prescriptive or modular approaches to intervention. Directions for future research are discussed.

Parental Experiences of Having a Child with Obsessive-Compulsive Disorder: Associations with Clinical Characteristics and Caregiver Adjustment

We examined parental experience of having a child with obsessive-compulsive disorder (OCD) in 62 parent–child dyads. Youth with a primary diagnosis of OCD and their parent(s) were administered the CY-BOCS jointly by a trained clinician. Parents completed several measures about their child’s OCD-related impairment and accommodation, emotional and behavioral functioning, parental distress, caregiver stress, and parental experiences of having a child with OCD. Results indicated that parents of children with OCD are considerably distressed about their child’s condition. As expected, negative parental experiences (e.g., anxiety about child’s condition, uncertainty about their future) were directly related to OCD symptom severity and impairment, as well as child internalizing and externalizing problems, family accommodation of symptoms, and caregiver strain. The presence of emotional resources was negatively related to most outcomes, although some of these relationships did not achieve statistical significance. The presence of internalizing symptoms mediated the relationship between parental experiences and parental distress. Given these findings, addressing parental experiences as part of a family based cognitive-behavioral treatment program for pediatric OCD may help reduce parental distress and improve patient prognosis.