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Clinical and Family Correlates of Coercive–Disruptive Behavior in Children and Adolescents with Obsessive–Compulsive Disorder

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Abstract

Obsessive–compulsive disorder (OCD) in youth is frequently associated with disruptive behaviors such as attacks of rage or temper. A common but insufficiently understood form of disruptive behavior in OCD is forceful attempts to impose symptom accommodation on family members. This study examined: (a) the phenomenology of coercive–disruptive behaviors in pediatric OCD, (b) child and family correlates of coercive–disruptive behavior; and (c) indirect effects of coercive–disruptive behavior on OCD symptom severity, mediated by family accommodation. We addressed these aims by evaluating the families of 61 treatment-seeking youth diagnosed with OCD, using structured interviews and maternal report scales. Most mothers reported coercive–disruptive behavior. Coercive–disruptive behavior was associated with severity of OCD symptoms, but not with particular symptom dimensions. Coercive–disruptive behavior was associated with anxiety, oppositionality and hyperactivity, but not with depression or inattentiveness. At the family level, coercive–disruptive behavior was associated with family accommodation and related parental distress but not with dimensions of family style. Hierarchical regression indicated that the family-level variable of accommodation contributed to predicting coercive–disruptive behavior, above and beyond child-level variables. The indirect pathway through family accommodation accounted for 97.13 % of the total effect of coercive–disruptive behaviors on OCD severity, supporting the mediational model. Overall, the data suggest that coercive–disruptive behaviors are common in youth with OCD and are more strongly linked to youth clinical features than to family style. Coercive–disruptive behaviors are a cause for concern and may lead to increased family accommodation, which has frequently been found to predict worse clinical outcomes.

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Acknowledgments

The authors acknowledge the contribution of Ms. Krista Basile to this paper. Dr. Lebowitz is thankful for the support of the Messer Program for Anxiety Disorders at the Yale Child Study Center.

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Authors and Affiliations

  1. Child Study Center, Yale University, 230 S. Frontage Rd., New Haven, CT, 06519, USA

    Eli R. Lebowitz, Jelena MacLeod & James F. Leckman

  2. University of South Florida, Tampa, FL, USA

    Eric A. Storch

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  1. Eli R. Lebowitz
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  2. Eric A. Storch
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  4. James F. Leckman
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Correspondence to Eli R. Lebowitz.

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Lebowitz, E.R., Storch, E.A., MacLeod, J. et al. Clinical and Family Correlates of Coercive–Disruptive Behavior in Children and Adolescents with Obsessive–Compulsive Disorder. J Child Fam Stud 24, 2589–2597 (2015). https://doi.org/10.1007/s10826-014-0061-y

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