When a child struggles with OCD, it’s common for parents to make changes at home. While it often starts as a way to ease stress and keep life moving, those adjustments can unintentionally strengthen OCD symptoms, making daily routines more difficult for everyone.
Stephen Hoffman, MSW, LCSW, primary therapist at the OCD and Anxiety Center for residential care for adolescents at Rogers Behavioral Health, explains what accommodation is and how it impacts everyone in the family.
What is accommodation?
Accommodation is when someone adjusts their behavior or environment to make it easier for a person to continue behaviors related to their mental health challenge. This may involve:
- Giving in to their demands
- Completing tasks for them
- Decreasing their responsibilities
- Helping them avoid situations that may contribute to them feeling uncomfortable
- Engaging in verbal rumination with them
Why do parents accommodate OCD?
It’s important to know that all parents accommodate anxious behavior because both parents and children often don’t understand what’s going on. I often hear from my residents: “I just started doing something, and I’m not sure why. Then I found myself doing it more.”
At first, they think that an extra hand wash, five more minutes in the shower, or an extra 15 minutes in the bathroom isn’t a big deal. Parents are looking for solutions, so they’ll often give in as long as they get their child to school. But eventually, it starts to fall apart. There’s a day when the child doesn’t get to school. Maybe it becomes one or two days a week and then it becomes a pattern. Once this pattern of avoidance has become established and their efforts to intervene are unsuccessful, parents get worn down very quickly by the demands of their child’s OCD.
Many children tell me they never saw OCD coming, and the next thing they knew it was taking up more and more of their life. The same is true for parents. From their perspective, they’re asking, “What in the world?!” They can’t make sense of it. It’s unbelievable how deep this can go in a home. It’s a huge relief when parents realize that they don’t have to live that way anymore.
What does accommodation look like for a child with OCD?
For many parents with children in our programs, accommodation involves letting a child stay home from school. In the moment, they think it’s not a big deal, and for most kids, it’s not. Everyone could use a mental health day once in a while. But as the OCD grows, giving in to the child, or accommodating them, tends to increase as well.
It can also look like bringing food to a child’s room instead of having them eat with the family, getting DoorDash because the child thinks that the family is poisoning their food, or not allowing others to share their bathroom.
Accommodation can also lead to disagreements between parents. One parent is firm while the other gives in. Parents argue about being more supportive and kinder versus needing to set a limit and stick to it. Oftentimes, neither parent can make it work because it takes a blend of those approaches, which is what we teach parents.
How does accommodating affect the family?
In the most severe cases, when OCD takes over a child’s life and family routines, everyone in the household feels the impact. That’s usually the point when parents reach out to our program. These children are often deeply depressed, sometimes even thinking about suicide. They feel hopeless and can’t see a way forward, especially if they’ve stopped going to school. Many of them get to a point where they say there’s nothing they can do about the OCD. They often see it as their lot in life and believe they have no other option than to accept it.
It’s excruciating for parents. They remember a time before the OCD when their child was outgoing, and sports or academics oriented. Now they’re seeing somebody completely different. It’s not uncommon for a parent to say to me, “I don’t even recognize my child.”
OCD takes a toll on everyone. When children turn the corner in our program, they begin to understand that and have empathy toward their family. They recognize that their parents are arguing or their siblings aren’t getting any attention because everything’s about them at home and that’s not right. That realization can lead to a healing moment for everyone involved.
What’s the difference between accommodating and supporting?
There’s a fine line between accommodating and supporting a child with OCD.
Reassuring
One of the biggest forms of accommodation is reassurance. For example, a child might repeatedly ask questions such as, “Am I safe?”, “Is the water okay to drink?”, “Is my food safe?”, or “Am I clean?”, and a parent answers the same question over and over, which feeds into the child’s anxiety.
Validating
Validating is acknowledging emotions and thoughts without giving into them. I look for ways to encourage a child’s progress in treatment. For example, “You did a great job in group today”, or ‘You’ve had an excellent week at school.”
The problem with accommodation is the more a parent provides it, the more the child believes they need it.
How does Rogers’ residential program help children and their parents?
We’re supportive and empathetic, and we know what’s true. We point out those moments where what a child says and thinks because of the OCD doesn’t make sense, which helps create a rift between the child and the OCD that has been controlling their life.
We understand how terrifying it can be for a child to let go of OCD. At some level, it’s made sense to them. What the experience of OCD looks like from the inside looking out and what it looks like from the outside looking in can be completely different. From a parent’s perspective, letting go of OCD seems like it would be a huge relief. But I’ve had kids cry about it, saying things like, “I won’t be me anymore,” or “My personality will change.” They think their OCD thoughts are who they are, which is not true.
Being around other children with OCD, working with the treatment team, and doing experiential therapy helps them break the OCD cycle and see what they’ve been missing so they can get back to being a kid.
We help parents by teaching them how to:
- Handle difficult moments at home (because there will be some)
- Recognize their child’s anxiety
- Know when to step away
- Maintain calm when their child is highly anxious
We also help parents understand that their child’s mental health challenges don’t mean their child is bad or that they’re bad parents. OCD is an illness and it’s in the way.
What encouragement do you have for parents?
Parents often feel guilty about bringing their children to treatment, believing, just as their children do, that they should have been able to figure it out themselves. OCD is not a weakness. If a child or their parents actually had control over OCD, our programs wouldn’t need to exist because everyone would do the work at home. Admitting that you need our help is a big step forward and often our residents are the ones asking to come in for treatment.
I encourage parents to be patient with the recovery process because it takes time to work through obsessive thoughts and behaviors that have become so ingrained. Through treatment, we’re retraining and actually rewiring the brain. It takes time, but it does work.
Ultimately, we want parents to know they can let go. We’ve got this.
Rogers offers OCD and anxiety treatment
Obsessive thoughts and anxiety take a toll. At Rogers, we offer proven treatment to help children, teens, and adults manage symptoms so that they can live a meaningful and healthy life.
When you’re ready, call 833-308-5887 for a free, confidential screening.
