When we struggle, it is natural for our family to want to comfort us, reassure us and help us out. It is also natural for us to want to be comforted by them. For example, when a child is hurt, he may look to his mother for comfort and may want to be hugged. Similarly, when an adult is rebuked at work, he may seek comfort from his partner to soothe his frayed nerves. But there is a difference between healthy comforting and unhealthy accommodation. Often, that which may seem to be comforting or reassuring may turn out to be unhealthy accommodation, in retrospect.

               Particularly in OCD (Harm OCD in the current context), comforting may take the form of enabling proxy compulsion, offering reassurance, enabling avoidance and various other compulsions. While some form of support from your family is understandable, if the expected support makes you feel less anxious, and if providing such support requires your family members to make more than normal adjustments which causes them stress, then the accommodation might be unhealthy.

               For example, does your family make small decisions for you that you should be making yourself? Or do your family members take up more responsibilities on themselves because some of them cause you anxiety (like chopping vegetables, any activity using a hammer, a pair of scissors or anything that your mind considers a weapon)? If yes, these could be indications of unhealthy accommodation. It might seem like a perfectly normal expectation to you and your mind might say that if the situation was reversed, you would do the same. However, the drain it causes on your family may not be visible to you. Not to mention the harm it is doing to you by strengthening your Harm OCD further.

Pinto et al (2012) developed a scale called the Family Accommodation Scale for Obsessive-Compulsive Disorder (FAS) for assessing the accommodation provided by the family members of people with OCD. The self-rated version (FAS-SR) has been provided with the permission of the authors as PT6 in the Worksheets file that needs to be taken by your partner. Higher scores indicate more accommodation, which needs to be reduced.  

So, if your family members score high on the FAS, they may need make a few adjustments. They may need to start doing what they have stopped and stop doing what they have started to ‘help’ with your Harm OCD. For example, if they provide reassurance to make you feel better, they may need to reduce it systematically. If they engage in some behavior that relieves your anxiety, like hiding the knives and forks in front of you or not using tools when you are around, they may need to stop this as well.

Remember that they are not to stop everything at once, but systematically and in consultation with you. While accommodation is definitely unhelpful, a clean break is also something that you may not be ready to endure. So, gently and calmly, have a discussion, arrive at a plan and start reducing the accommodation gradually.

To-Do: Get your family members to take PT1 – the FAS-SR test provided in ‘Worksheets for Harm OCD’

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