Author: Hemendinger, Emily

Accommodation and Obsessive Compulsive Disorder: Recognizing and Addressing Accommodation in Your Family

Accommodation is when you actively and directly participate in and/or facilitate a loved one’s compulsions or avoidance

Accommodation...
- Reinforces the OCD and makes it stronger
- Gets in the way of Exposure Response Prevention and
treatment
-It impairs individual and family
functioning
-It may seem helpful in the moment, however it may actually decrease your loved one’s motivation to seek treatment, thus leading them deeper into their OCD
-It does not allow our loved one to increase their distress tolerance, habituate, utilize healthy coping skills, or relate to their distress in an adaptive way
-It only provides temporary relief

No one wants to see their loved one in pain and distress
AND
accommodation doesn’t make the OCD go away.

Accommodation and Obsessive Compulsive Disorder: Recognizing and Addressing Accommodation in Your Family

Common Accommodations

*Buying supplies for compulsions (e.g. soap, cleaning products, etc.) or paying for compulsions/avoidance

*Overly assisting in daily activities

*Providing reassurance

*Avoiding using triggering words, watching triggering media, listening to triggering songs, etc.

*Waiting for a loved one to complete a ritual

*Assisting a loved one in a compulsion or allowing them to use you in a compulsion

*Making decisions for loved ones

*Letting loved one create unusual conditions in the home

*Making changes in routines

Accommodating the OCD is not supportive.
In fact, it is the opposite!

You can provide encouragement and empathy without giving reassurance

Accommodation and Obsessive Compulsive Disorder: Recognizing and Addressing Accommodation in Your Family

Everyone deserves a reality check and to know what is going on, however constant questioning/asking the question in different ways , known as reassurance seeking, is a type of compulsion used to seek certainty

Assurance is to provide truth and helps someone to feel more secure; give confidence/inspire
Giving someone the facts/what’s happening/evidence and they judge for themselves if all is well
Reassurance is done to lessen anxiety or help someone worry less by assuring them again; to free from fear and terror; restore confidence
Telling someone all is well

Accommodation and Obsessive Compulsive Disorder: Recognizing and Addressing Accommodation in Your Family

Focus on meeting the emotional need of your loved one before trying to fix it or solve the practical problem/need
Do this by validating the emotion you think your loved one is experiencing
Validating a feeling, does not mean you agree with it

Use the validation “because” method (EFFT by Adele Lafrance):

“I can imagine you are feeling overwhelmed because I’m not providing you reassurance and because your OCD is making it difficult to sit with the uncertainty and because anxiety feels overwhelming”
“I imagine you are angry with me because you think I’m not being supportive and because you think by not cleaning the dishes again I’m being mean and because you feel that I need to do this in order for you to feel better
“I can understand that me not waiting for you to finish your checking compulsions is causing you anxiety because you feel distressed when can’t finish them and because distress feels overwhelming and unbearable and because your OCD is really loud right now

Accommodation and Obsessive Compulsive Disorder: Recognizing and Addressing Accommodation in Your Family

Support typically means that your loved one will be uncomfortable and/or feel distressed

This may seem scary and you may fear that your loved one will get worse, not be able to handle it, or hate you. It’s important to recognize these fears as blocks that may get in the way of your loved ones treatment
You have to be able to let go and let your loved one feel uncomfortable, to help them move towards a more fulfilling life and healthier mindset
As your loved one is working on building their distress tolerance to a variety of triggers and uncertainty, you can work on building your own distress tolerance to seeing your loved one in distress

Accommodation and Obsessive Compulsive Disorder: Recognizing and Addressing Accommodation in Your Family

Decreasing Accommodations

Make a plan
Discuss with your loved one, the ways that you have been accommodating their OCD and that you would like to work with them on decreasing your participation in their OCD
Decide with your loved one and their therapist what accommodations you will be decreasing and/or eliminating
Try starting with one that you feel you cannot tolerate anymore or has the biggest impact on the family
Therapist will work with you and your loved one on a plan for decreasing and eventually eliminating this accommodation
This will work on increasing your loved one’s responsibility and accountability
Having this written up, as a contract, can be helpful for all those involved

Follow through
Don’t do anything for your loved one, that they can do for themselves
Remind yourself that this is being done to help your loved one feel more confident in themselves and in their ability to manage distress

Accommodation and Obsessive Compulsive Disorder: Recognizing and Addressing Accommodation in Your Family

Final Points

Remember that this is a team effort!
Help your loved one follow up on ERP homework by coming up with a plan on how/when they would like to be reminded. Utilize therapist support in creating this plan
Be responsive, not reactive

Be curious and create uncertainty in your responses:
“I can imagine you’re feeling anxious and uncomfortable. How can I be supportive without helping the OCD/making the OCD stronger?”
“I know this is difficult and if I do that for you, the OCD will get stronger.”
“I’ve already answered that. I understand you are struggling, you’ve got this!”
“I don’t know.”
“Maybe.”
“There’s no way to know for sure. I can’t offer you certainty.”

Accommodation and Obsessive Compulsive Disorder: Recognizing and Addressing Accommodation in Your Family

Final Points

Get your own support!
Support from a professional
Join a support group
Support from a friend, co-worker, community leader, etc. (someone outside of your family system)
Get books on OCD and being a family member/loved one of someone with OCD (“When a Family Member has OCD” by Jon Hershfield is a MUST READ). Share these with your loved one
Practice self-care! This will help model what healthy self-care and boundaries look like for your loved one

References:
Abramowitz, J.S., Baucom, D.H., Boeding, S., Wheaton, M.G., Pukay-Martin, N.D., Fabricant, L.E., Paprocki, C., Fischer, M.S. (2013). Treating obsessive-compulsive disorder in intimate relationships: A pilot study of couple-based cognitive-behavior therapy. Behavior Therapy, 44, 395-407.
Boeding, S.E., Paprocki, C.M., Baucom, D.H., Abramowitz, J.S., Wheaton, M.G., Fabricant, L.E., Fischer, M.S. (2013). Let me check that for you: Symptom accommodation in romantic partners of adults with obsessive-compulsive disorder. Behaviour Research and Therapy, 51, 316-22.
Hershfield, J. (2015). When a family member has OCD. California: New Harbinger Publications.
Lafrance, A., Henderson, K. A., & Mayman, S. (2019). Emotion-focused family therapy: A transdiagnostic model for caregiver focused interventions. American Psychological Association.
Lebowitz, E. R., Panza, K. E., Su, J., & Bloch, M. H. (2012). Family accommodation in obsessive-compulsive disorder. Expert Review of Neurotherapeutics, 12, 229-238.

Hemendinger 2021