European Journal of Cardiovascular Medicine

Obsessive-compulsive disorder (OCD) is a chronic psychiatric condition that significantly impacts not only the individuals diagnosed but also their families. The phenomenon of “family accommodation,” wherein family members modify their behavior to alleviate the patient’s distress, is particularly prevalent in OCD and often results in negative consequences for caregivers’ psychological and social well-being.

While research has extensively explored OCD symptoms and treatment, less attention has been directed toward the unique challenges faced by caregivers. Quality of life (QoL) is a multidimensional construct encompassing physical, mental, and social domains, and is deeply intertwined with caregiver burden and family dynamics. This study aims to explore the extent of family accommodation among caregivers of adults with OCD, its impact on their QoL, and potential areas for intervention.

Study Design

This was a quantitative, cross-sectional study conducted from November 2020 to June 2022. Ethical clearance was obtained from the institutional ethics committee. Written informed consent was obtained from all participants.

Participants

A total of 150 caregivers of adults with Obsessive-

Compulsive Disorder (OCD) were recruited from the Department of Psychiatry, Gandhi hospital, Hyderabad, India. Inclusion criteria were age ≥ 18 years, living with an OCD patient for ≥ 6 months, and no prior psychiatric diagnosis.

Tools and Instruments:

Family Accommodation Scale (FAS): A 13-item scale assessing the frequency and distress associated with family accommodation behaviors.

World Health Organization Quality of Life-BREF (WHOQOL-BREF): A well-validated tool measuring quality of life across four domains: physical, psychological, social, and environmental.

Yale-Brown Obsessive-Compulsive Scale (Y-BOCS): Administered to assess the severity of OCD symptoms in patients.

Statistical Analysis:

Data were analyzed using SPSS version 28.0. Descriptive statistics were applied to demographic data. Pearson’s correlation was used to assess the relationships between FAS scores and WHOQOL-BREF domains. Multiple linear regression identified predictors of quality of life scores. A p-value of <0.05 was considered statistically significant.

Demographics

Table 1 presents the demographic characteristics of caregivers and patients. The mean caregiver age was 42.6 ± 8.7 years, and 65% of caregivers were female. Patients had an average age of 34.2 ± 6.9 years, with a mean Y-BOCS score of 28.4, indicating moderate-to-severe OCD.

Family Accommodation and Quality of Life

Regression Analysis:

Family accommodation (β = -0.62, p < 0.01), caregiver burden (β = -0.47, p = 0.03), and patient OCD severity (β = -0.41, p = 0.04) were significant predictors of Quality of Life (QoL).

Table 2:Regression Analysis of Predictors of WHOQOL-BREF

This study highlights the detrimental impact of family accommodation on caregivers' QoL. Excessive involvement in a patient's OCD rituals or avoidance behaviors exacerbates caregiver distress, reduces personal autonomy, and limits social interactions—all contributing to lower QoL. Our findings align with previous studies that emphasize the bidirectional relationship between caregiver burden and patient psychopathology.

Interventions targeting family accommodation, such as psychoeducation and mindfulness-based stress reduction, have shown promise in previous research. Future studies should evaluate the longitudinal effects of such programs.

Family accommodation significantly impairs the QoL of caregivers of adults with OCD, underlining a critical need for targeted interventions. Addressing family accommodation through evidence-based psychosocial strategies could enhance caregivers' mental and social well-being, ultimately benefiting both the patient and the family unit.

1.      Albert U, Baffa A, Maina G. Family accommodation in adult obsessive-compulsive disorder: Clinical perspectives. Psychol Res Behav Manag. 2017;10:293-304.

2.      Wu MS, McGuire JF, Martino C, et al. Family accommodation of obsessive-compulsive disorder and its clinical correlates. J Affect Disord. 2016;193:310-316.

3.      Storch EA, Lehmkuhl HD, Pence SL, et al. Parental accommodation in pediatric obsessive-compulsive disorder: Clinical correlates and treatment implications. J Anxiety Disord. 2009;23(7):849-855.

4.      Reddy YJ, Rao NP, Khanna S. An overview of Indian research in obsessive-compulsive disorder. Indian J Psychiatry. 2010;52(Suppl 1):S200-S209.

5.      Lebowitz ER, Panza KE, Su J, Bloch MH. Family accommodation in obsessive-compulsive disorder. Expert Rev Neurother. 2012;12(2):229-238.

6.      Gupta RK, Kumar A, Bhargava S. Role of family dynamics in obsessive-compulsive disorder: A review. Indian J Psychiatry. 2019;61(2):95-100.

7.      Calvocoressi L, Lewis B, Harris M, et al. Family accommodation in obsessive-compulsive disorder: A synthesis and critique of the literature. Harvard Rev Psychiatry. 2015;23(1):1-8.

8.      WHOQOL Group. Development of the World Health Organization WHOQOL-BREF quality of life assessment. Psychol Med. 1998;28(3):551-558.

9.      Goodman WK, Price LH, Rasmussen SA, et al. The Yale-Brown Obsessive Compulsive Scale. Arch Gen Psychiatry. 1989;46(11):1006-1011.

10.   Schlosser R, Black DS, Reibstein S, et al. Mindfulness-based programs for reducing family accommodation in OCD. Front Psychiatry. 2020;11:831.