1. Family Functioning in OCD
Renae M. Reinardy, Psy.D. & Kristin L. Holland, MA, LPC

2. Therapeutic Advice

3. What is OCD? DSM-5 Criteria Prevalence
Presence of obsessions, compulsions, or both
Time consuming, distress, impairment
Not due to substances or medical condition
Not caused by another disorder
Prevalence
1 in 50 adults, 1 in 100 children
Females slightly higher as adults, males higher in childhood
Fourth most common mental disorder

4. What are Obsessions & Compulsions?
Repetitive
Rituals
Persistent
Repetitive behaviors
Thoughts, images, urges
Mental acts
Not pleasurable
Feels driven to perform
Involuntary
Neutralize
Intrusive
“Fix”
Unwanted
Avoidance
Cause distress or anxiety
Repeat until “just right”

5. Themes Found in OCD Obsession Compulsion Contamination Washing
Checking
Cleaning
Self-harm
Harm to others
Excessive reassurance seeking
Sexual
Avoidance
Religious/moral
Tapping
Just right/Tic-like
Praying
Perfectionism
Confessing
Symmetry
Rereading
Relationship
Researching

6. Treatment of OCD Exposure Response Prevention
Stand toe to toe with fear
Do the opposite
Exposure to triggers
Example: client may touch bottom of shoe
Response Prevention
Resist fix-it behaviors/rituals
Do it out of order
Less than perfect
Example: Client resists washing hands before eating

7. Treatment of OCD Habituation happens Medications Involving the family
Diminished emotional response with repeated exposure
Gradual vs. flooding
In office vs. In-Vivo
Medications
Work best if combined with ERP
Involving the family
How might family involvement impact OCD symptoms and ERP?

8. Family Accommodation
Modification of personal and family routines in response to OCD symptoms
Accommodation in OCD is common and is strongly and consistently correlated with overall symptom severity (Lebowitz, E.R., Panza, K.E. & Bloch, M.H., 2012)
Case studies
Family accommodation in response to contamination fear
Family accommodation in response to fear of developing a brain tumor/religious obsessions
Take a moment and think about how OCD has impacted your family

9. Cycle of Accommodation
“What if I go to Hell?”
Distress
Asks mom for reassurance

10. Cycle of Accommodation
Some short-term reduction in distress
Long term, obsessions continue (Remember, you can’t rationalize with OCD)
Daughter more likely to seek reassurance from mom, chasing the short-term relief

11. Cycle of Accommodation
Over time, mom grows frustrated her words don’t have any long-term impact
Frustration often leads to conflict and added stress
Added stress often leads to a worsening of OCD symptoms

12. Assessing Family Accommodation
MEASURE :
RATED BY:
FAS
Clinician
FAS-IR
FAS-PR
Parent of child with OCD
FAS-SR
Relative of patient with OCD
FAS-PV
Patient with OCD

13. Family Accommodation Scale for OCD

14. How do we Guard Against Accommodation?
Negotiation & limit setting
Preserve individual rights (e.g., can have friends over, sit on any furniture)
Preserve individual and family routines (e.g., being on time, minimizing avoidance)
Consider family contract - plan ahead; don’t define limits in middle of conflict
Gradual process
Development of a family response script
Supportive/nurturing tone; stay calm & avoid being antagonistic
Focus on combating OCD together; avoid personal criticism
Keep communication clear and simple; avoid lengthy rationales & debates

15. From the Human Side

16. Things to Remember Be realistic
Recognize and praise small improvements
Self-care is important
Avoid day-to-day comparisons
Expect occasional setbacks as a normal part of recovery
Modify expectations during times of change/stress
Be sensitive to mood
It’s not all about the OCD

17. In Conclusion… With ERP, there is great hope!
By minimizing family accommodation, family members can help their affected loved one face their fears and combat OCD
Family members can serve as a huge source of support and motivation
Setting limits & maintaining a supportive environment can aid in relapse prevention
Improvement in OCD symptoms positively correlates with family functioning
Seek out a family therapist who specializes in OCD and ERP if your family is having difficulty identifying and minimizing accommodating behaviors