A meta-analytic review of the relationship between family accommodation and OCD symptom severity

• Family accommodation (FA) is when family members support OCD maintaining processes.
• Behavioral and cognitive theories of OCD suggest that FA worsens symptoms.
• A meta-analysis found a significant relationship (r = .35) between FA and OCD symptoms.
• Effect sizes were homogeneous, suggesting no differences between children and adults.
• An RCT with mediation analysis is needed to test causal direction and mechanisms.

Accommodation of obsessive compulsive disorder (OCD) symptoms by family members is common. This paper presents a systematic meta-analytic review on family accommodation and OCD symptom severity. Fourteen studies investigating the relationship between family accommodation and OCD symptoms were selected. The medium effect size of the relationship between family accommodation and OCD symptom severity was significant (r = .35; 95% CI: .23 to .47), based on a Hunter–Schmidt random effects model with a total of 849 participants. Although there was some evidence of publication bias, Rosenthal's fail-safe N suggested that 596 studies with zero effect would be needed to reduce the mean effect size to non-significant. Findings are discussed in the context of the limitations of the studies, and in particular the reliance on cross-sectional designs which impede causal conclusions. Future research to evaluate a family accommodation intervention in a randomized controlled design and using mediation analysis to explore change mechanisms is called for.