Phenomenological considerations of family accommodation: Related clinical characteristics and family factors in pediatric obsessive–compulsive disorder

•It is important to consider family accommodation (FA) as a whole and within subtypes.•FA was related to OCD symptom severity and contamination symptoms.•FA was associated with youth depressive and internalizing/externalizing symptoms.•Youth externalizing symptoms mediated the relationship between OCD severity and FA.•Youth externalizing symptoms and family cohesion predicted various subtypes of FA.

Family accommodation is a salient phenomenon within pediatric obsessive–compulsive disorder (OCD), with a large number of families engaging in behaviors and modifying family routines in response to the youth’s OCD symptoms. Family accommodation is commonly considered as a unidimensional construct, resulting in limited research on the phenomenological aspects of family accommodation and how different facets (i.e., participation, modification, and distress/consequences) may impact pediatric OCD. As such, the present study sought to examine the extent to which family accommodation, as a whole and within subtypes, was related to OCD symptom severity and symptom dimensions, youth clinical characteristics (i.e., internalizing/externalizing symptoms, depressive symptoms), and family factors (i.e., cohesion and conflict). Family accommodation was related to OCD symptom severity and the contamination symptom dimension, youth depressive symptoms (but not the participation domain), and youth internalizing/externalizing symptoms. Youth externalizing symptoms mediated the relationship between OCD symptom severity and family accommodation. After controlling for OCD symptom severity, youth externalizing symptoms predicted family accommodation in general, as well as the distress/consequences domain. Family cohesion predicted participation in OCD symptoms, above and beyond OCD symptom severity. Detailed results and implications of the findings are discussed.