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."

Further reading

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