Wednesday, 29 May 2013

Should you help a person with OCD do their checks?

Imagine you and your partner are about to enjoy a meal together. They have obsessive compulsive disorder (OCD) and get incredibly anxious until they've completed a time-consuming sequence of checks and rituals involving their cutlery. Do you offer to help with the checks in the hope of assuaging their anxiety?

The process of helping an OCD patient in this way is called "accommodation" and though it may be motivated by compassion and empathy, the authors of a new paper say that it can be a barrier to recovery and puts a strain on relationships. Accommodation is thought to be counter-productive because it prevents a key component of CBT for OCD, which is learning that everything will be okay even if checks and rituals are not completed (known as "exposure and response prevention").

Sara Boeding and her colleagues investigated 20 heterosexual couples, each including one person with OCD, as they embarked on 16 joint sessions of cognitive behavioural therapy. Accommodation was measured at baseline and after the course of treatment was over, as were the symptoms of the partner with OCD, and relationship satisfaction.

The researchers found that accommodation was commonplace - all partners of someone with OCD reported doing at least some of their checking for them. Higher rates of accommodation went hand in hand with more serious OCD symptoms, both at the study start and after treatment was complete. This study is unable to show that accommodation by one partner caused the other partner's worse symptoms - the causal direction could run either way. However, past longitudinal research in a family setting has shown that reductions in accommodation precede patient improvement.

In the current study, Boeding's team also found that individuals who performed more of their partner's OCD checks tended to report less relationship satisfaction, consistent with past research suggesting the process of accommodation can be "taxing and frustrating" for care-givers. In turn, patients with a partner who performed more accommodation tended to report that their partner was more critical of their OCD. "Although accommodation might serve to alleviate patient distress momentarily, it does not do so within the framework of a positive, satisfying relationship," warned Boeding and her colleagues.

This is a pilot study with a small sample size, and in 19 of the couples, the patient was the woman. This limits how much we can take larger lessons from these results. However, it's the first time that OCD accommodation has been studied in a couple context and this marks an important first step towards understanding the role of relationship context in recovery from OCD. Although it is tempting to help a person with OCD complete their checks and rituals, Boeding's team advised that it is more beneficial in the long run "to provide esteem support and encourage the patient to 'get through' the anxiety until it habituates, rather than trying to avoid or neutralize it for the patient."


Boeding, S., Paprocki, C., Baucom, D., Abramowitz, J., Wheaton, M., Fabricant, L., & Fischer, M. (2013). Let me check that for you: Symptom accommodation in romantic partners of adults with Obsessive–Compulsive Disorder. Behaviour Research and Therapy, 51 (6), 316-322 DOI: 10.1016/j.brat.2013.03.002

--Further reading--
What is it like to have OCD?

Post written by Christian Jarrett (@psych_writer) for the BPS Research Digest.


Scott McGreal said...

I'm surprised that this has not been addressed in research before. I recall years ago reading an authoritative book on the treatment of anxiety disorders that stated firmly that partners and family members of people with OCD must not perform their checks for them, as this just facilitates avoidance undermining the treatment. I'm also not surprised that partners who perform checks frequently would be less satisfied with the relationship, it would get tiresome quickly! The impact of OCD on close relationships seems like a fruitful area of study.

Robin said...

Another side of this is, if someone with a need to perform checking rituals has part of the check performed by someone else, how does the person with OCD trust it's been performed adequately / accurately?

This may well lead to increased anxiety in the person with OCD as it adds an uncertainty to their day.

Christian Jarrett said...

good point

Emily Grant said...

Exactly what I was about to comment (well probably put better than I could)
If you fall into the perfectionist type category of OCD in particular, then it would make sense that you would have to perform the ritual yourself?

blink said...

Agreed this is interesting territory for research, and the correlations are noteworthy. I am not at all convinced about the direction of causality, however. In particular: "Higher rates of accommodation went hand in hand with more serious OCD symptoms" and more accommodating partners were rated "more critical of their OCD". I think the default assumption should be that the severity of OCD is driving both results.

Janet Singer (ocdtalk) said...

As the mother of a son who suffered from severe OCD, this article only confirms to me how crucial it is to involve parents and all family members in education and therapy for OCD. Of course when a loved one is suffering, our instinct is to "help" them, and we accommodated our son because we thought it was the right thing to do. We now know this is actually the wrong thing to do. I know this study involved couples, but it carries over to other relationships, I'm sure. The other thing I want to comment on is this sentence in the article:
"Accommodation is thought to be counter-productive because it prevents a key component of CBT for OCD, which is learning that everything will be okay even if checks and rituals are not completed (known as "exposure and response prevention")."
I believe this is misleading. What CBT teaches is not that everything will be okay if compulsions are not performed, but rather that the OCD sufferer can live with the uncertainty of not knowing whether everything will be okay.
As an advocate for OCD awareness, I talk about my son's amazing recovery from severe OCD on my blog, as well as anything and everything to do with the disorder.

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