The Role of Family and Social Relationships in OCD and Spectrum Conditions

Children and adults with obsessive compulsive disorder (OCD) have impairments in social and family functioning, and relatives of those with OCD endorse elevated levels of relationship and psychological distress. The levels of impairments appear equal to or greater than those associated with other disorders. Furthermore, OCD is specifically associated with higher levels of accommodation, or behaviors that facilitate the completion of compulsive rituals, in relatives. Although levels of general social and family impairments do not demonstrate a clear association with treatment response in OCD, higher levels of pretreatment accommodation and hostility in relatives is associated with poorer response to exposure and response prevention (ERP). In contrast, higher levels of nonhostile criticism in relatives may be associated with enhanced response to ERP in patients. Findings are mixed as to whether family-based treatments for OCD, most of which include psychoeducation and attempts to reduce accommodating behaviors in relatives, are associated with enhanced response to ERP.