DISABILITY AND FAMILY BURDEN IN OBSESSIVE-COMPULSIVE DISORDER

This paper reviews 2 aspects of obsessive-compulsive disorder (OCD): i mpairment in functioning and family burden associated with OCD. Impair ment is evidence from epidemiological and clinical studies in several areas, particularly in occupational and social maladjustment. Clinic o utpatients show a range of impairment associated with OCD, while hospi talized patients exhibit consistently severe disabilities that rival t hose of patients with schizophrenia. Although behaviourally and medica tion-treated patients improve in adjustment levels, there is some evid ence of persistent impairment, particularly in social and work functio ning. Several studies support extensive family involvement and accommo dation of OCD symptoms, as well as the considerable burden placed on f amilies who reduce their social activities and increase their isolatio n and distress. Findings are equivocal regarding OCD and marital distr ess. Predictors of treatment outcome do not include marital dissatisfa ction, but may include expressed anger and criticism. With regard to t reatment, family support groups are popular but untested interventions , and family-assisted individual and group behaviour therapy have demo nstrated good outcomes in limited trials.