Family accommodation occurs when family members of children with obsessive-compulsive disorder (OCD) make adjustments to alleviate the child’s distress and anxiety, or to prevent negative outcomes related to their OCD symptoms. While accommodation may initially provide some relief, this relief will be short-lived, since family accommodation only perpetuates the OCD cycle.
When parents and caregivers first learn about accommodation and how their actions may have unintentionally impacted a child’s OCD symptoms, some might feel sadness, guilt, or shame. If you notice these emotions in yourself, it is so important that you give yourself compassion. You’ve been struggling with something that you didn’t choose and may not have fully understood before this point.
You have always done the best you could with the knowledge you had. The only way to approach things differently in the future is by learning more about how to avoid family accommodation, which you’re already doing. Here are 5 different forms this behavior can take:
1. Modifying
Modifying can happen in many different ways but for a lot of families, it means changing their routines to accommodate the child who has OCD. For example, a child may have an extensive routine that they feel they must perform every time the family sits down for dinner. Maybe this routine revolves around fears of contamination, or maybe around something entirely different, but regardless of the “content” of the OCD thoughts, the child’s behavior is being dictated by OCD.
Families can often unintentionally accommodate these fears and rituals by modifying their meals, following strict guidelines set forth by the child, indulging outlandish requests…the list could go on and on. As a parent or caregiver of a child with OCD, you are likely well aware of OCD’s creativity and how these things can initially seem “helpful.” They may shorten the time it takes to get through mealtime, lessen the likelihood that the child will refuse to eat, avoid the nightly tantrum, or even just allow for some peace and nice family time, even if it’s only temporarily.
The problem with this behavior, though, is that OCD will always demand more. Any modifications that are made will never be enough. The more you feed OCD, the more it grows. Always keep in mind that you are aiming for long-term results, which means the hard work will have to be done upfront, right when OCD makes its initial demands. You will have to stand your ground and not give OCD even an inch.
2. Participating
Parents, and even siblings or extended family members, can unwittingly participate in OCD rituals and compulsions. Sometimes, they may be completely unaware of this. Other times, they may know they’re participating but choose to ignore it because it seems easier to just “go along with it,” even when they know it may not be in the best interest of their child’s progress in treatment.
I have personally worked with many parents and caregivers who’ve felt anxiety of their own at the thought of having to see their child resist engaging in rituals. They often will go to extensive lengths trying to “help” their child avoid discomfort. Full disclosure: I am a therapist highly trained in anxiety and OCD, I have OCD, I’m raising children with OCD, and I have still been guilty of this!
So I get it: As a parent or caregiver, you want nothing more than to rid your child of suffering. At the same time, we know that participating in OCD-related behaviors will often only prolong their suffering. When we view the situation through that lens, we can become more prepared to stand firm against participating in any compulsions, no matter how difficult it may feel at that moment.
3. Avoiding
When our children are struggling with OCD, it can seem easier to just avoid anything that we think might cause an anxiety attack or frustrate them. However, while this instinct might make sense in some cases, it’s not helpful when dealing with OCD. The more we avoid potential triggers, the more we inadvertently teach our children that they can’t handle tough emotions, reinforcing the false narrative OCD tells them.
As parents and caregivers, we need to help our children build confidence in their ability to face challenges. An important part of this is recognizing our own capacity to tolerate their distress without stepping in to soothe them or control the situation. Although this can be incredibly difficult to practice, as none of us want to see our children in discomfort, we need to trust that their anxiety will eventually pass on its own. By doing so, we can empower them to grow stronger in the face of OCD, rather than letting it dictate their life.
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4. Appeasing
Appeasing is slightly different from participating in a child’s compulsions. It involves allowing your child to engage in their rituals while we, as their parent or caregiver, turn a blind eye. We may know that their behaviors aren’t aligned with their treatment plan, but when we’re feeling burned out or overwhelmed, it can be tempting to let things slide rather than make an effort to step in and challenge OCD.
There are many reasons why we can fall into this pattern. Maybe we fear an emotional outburst or a scene in public. Or, perhaps we tell ourselves that allowing our child to perform a compulsion “just this once” won’t significantly impact the bigger picture. No matter the reason, though, we must recognize appeasing for what it is: a form of accommodation that feeds the OCD cycle.
This is why it’s so important to build a support system for yourself—so you can have relationships and resources to turn to when it feels hard to resist accommodating behaviors. Having this support can help remind you that there is hope, because you can get past these difficult moments to a place where you realize that your work has not been in vain. With patience and persistence, you can help your child learn the skills they need to manage OCD.
5. Allowing
While allowing often goes hand-in-hand with appeasing, it’s a more active form of accommodation. Allowing involves giving into the self-defeating mindset that “it will never get better” or that “if this helps my child cope with their emotions, it must be okay.” But although it’s more active than appeasing, allowing is often unintentional, and tends to be a response to a parent or caregiver’s own emotional overwhelm.
With so much on your plate, it’s understandable to feel overwhelmed. But remember, what you allow will continue. Allowing compulsions to persist won’t resolve the issue. Instead, your child needs you to be their strongest advocate, and to believe in their ability to learn and practice the skills that will ultimately free them from OCD’s grip.
The more you stay the course, the more likely it is that your child will make meaningful progress—and that your burden will lighten in the process. In fact, I’ve seen it happen many times. I believe it’s possible for your family, too.
How to reduce family accommodation
Now that you’re aware of the behaviors that may be accommodating your child’s OCD symptoms, you can begin to take steps toward reducing them. It’s important to work with an OCD specialist during this process, as it can be emotionally charged, and they’ll have the expertise to help you navigate it.
One key to reducing accommodation is helping your child understand that this new approach is not intended to be a punishment for them. They may already feel guilt or shame about their OCD symptoms, so it’s essential to make it clear that these adjustments are targeting their condition, not them. Encourage your child to approach these changes with an attitude of self-compassion and remind them that you’re on their side, helping them manage a condition that is beyond their control.
Exposure and response prevention (ERP) therapy, the gold-standard treatment for OCD, can be a highly effective tool in reducing family accommodation. Through ERP, your child will learn to gradually face their triggers while resisting the urge to perform compulsions. During this process, your child’s OCD specialist can also work with your family to help you reduce family accommodation. The combination of these elements can help your child learn that they can tolerate the anxiety OCD creates, leading to your family experiencing less disruption from OCD.
At NOCD, our licensed therapists specialize in OCD and receive comprehensive training in treating OCD with ERP therapy, including specific training in treating children and adolescents. They’ll create a personalized treatment plan for your child and help you incorporate ERP into your family’s lifestyle.
To learn more about how NOCD can help your child manage OCD, and your family more effectively support them, book a free 15-minute call with our team.