Coercive and disruptive behaviors in pediatric obsessive compulsive disorder: a qualitative analysis

OCD is a common disorder in children and adolescents. Disruptive or coercive behaviors among children with OCD have not been a focus of much research until recently. Family accommodation of OCD is strongly related to symptom severity, level of impairment, and treatment outcomes. The possibility of family accommodation being forcefully imposed on family members against their will has not been investigated systematically, although clinical experience points to the existence of such situations. The present study represents an early, qualitative exploration of such situations. The parents of 10 children and adolescents with OCD, who reported the existence of violent or disruptive behavior on the part of the child, were interviewed and their narratives analyzed using grounded theory methodology. Findings from the interviews point to the existence of a pattern of coercive behaviors in which rules and prohibitions, driven by the child's OCD, are aggressively imposed on parents and siblings. The emergent themes are analyzed in relation to obsessive compulsive symptom dimensions and in relation to the means and goals they represent for the obsessive compulsive children.