Managing family accommodation of OCD in the context of adolescent treatment refusal: a case example

Family accommodation is a common and widely studied phenomenon in families of youth with obsessive-compulsive disorder (OCD). Family accommodation has been associated with increased symptom severity, poorer functional outcomes, and reduced treatment response. While family accommodation is increasingly targeted in family-based treatment of OCD, there are cases where youth refuse treatment. In these circumstances, parent-focused treatments that target reduction of family accommodation can be used to improve outcomes for youth with OCD. This case study illustrates the conceptualization and treatment of family accommodation in childhood OCD in the context of treatment refusal. Treatment was implemented without explicit involvement of the child. Parents reported moderate improvement in OCD symptoms at the end of treatment and a decrease in overall parent–child conflict. The findings illustrate how exposure and response principles can be implemented without direct involvement of the child in cases where youth show low motivation or refusal of treatment.