The Impact of Obsessive-Compulsive Disorder on the Family: Preliminary Findings

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Families of patients with psychiatric disorders are often disturbed. For example, Miller et al. (1986) reported that the families of patients with major depression, alcohol dependence, and adjustment disorders were more dysfunctional than control families, mainly because of impaired communication. Family functioning has also been shown to be intimately involved in the onset, course, and outcome of several psychiatric disorders such as schizophrenia (Falloon et al., 1985). There has been relatively little work exploring family and marital adjustment in obsessive-compulsive disorder (OCD). The Epidemiologic Catchment Area survey showed that individuals with OCD are more likely to be divorced or separated than individuals without OCD (Karno et al., 1988). A recent survey of 419 Obsessive-Compulsive Foundation members found that 73% reported the illness to interfere with family relationships (Hollander et al., 1996). Another survey sponsored by the Obsessive-Compulsive Foundation of 450 family members (who themselves were not obsessional) found that 85% of family members were bothered by their relatives' rituals, 75% were disturbed by their relatives' self-involvement, and 63% reported being drawn into ritualizing behavior by the ill relative (Cooper, 1994). A more systematic study at Brown University on 114 families completing the Family Assessment Device (Epstein et al., 1983) showed that more than 50% of OCD families had scores in the "unhealthy" range for communication, affective responsiveness, behavior control, and general functioning (Van Noppen et al., 1993). Thus, data from several sources indicate that families in which one or more members have OCD tend to be disturbed or dysfunctional in several respects and that marital discord is relatively common in the same families.The issue of family and marital functioning is not trivial. Not only is it considered important by patients and their relatives, but it may potentially affect the onset, course, or outcome of the disorder. For example, patients with OCD whose family life is dysfunctional may respond less well to treatment. We recently had an opportunity to explore family functioning among patients and their spouses enrolled in a study of children at high risk for OCD. The results are preliminary but indicate that the study of family dynamics in OCD families merits closer attention.MethodsSubjects: We assessed 19 persons with DSM-IV (American Psychiatric Association, 1994) OCD with at least one child between the ages 7 and 18 years. None of the subjects had a past diagnosis of schizophrenia or other psychotic disorder; none had current (past 6 months) substance abuse. All had had OCD more than 1 year, and all were receiving outpatient psychiatric care. Twenty comparison subjects were recruited through an advertisement in a hospital newsletter and group-matched for age (within 5 years) and gender. Written informed consent was obtained from all subjects in accordance with procedures approved by our Institutional Review Board.Assessments: Study subjects were assessed using the Structured Clinical Interview for DSM-III-R (Spitzer et al., 1989). The instrument was used to confirm the OCD diagnosis among patients and to ensure that comparison subjects were free of OCD. Along with collecting social and demographic data, subjects completed the Family Assessment Device (FAD; Epstein et al., 1983), which yields measures of problem-solving, communication, roles, behavior control, affective responsiveness, and affective involvement.

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