Families of origin in obsessive-compulsive disorder.

Family data were collected on 174 relatives of 10 severely obsessive-compulsive patients. No instances of obsessive-compulsive disorder were found, although 11.6 per cent of first degree relatives had been hospitalized for other psychiatric illness. These rather isolated families had cultures that emphasized cleanliness and perfection, but other family members did not develop rituals or obsessive rationales as the patient did. Typically, one or both parents in an unfulfilled marriage directed symbiotic needs toward the patient. Parents and offspring became trapped in an increasingly powerless struggle against symptoms that acted as a barrier to closeness, but that also prevented the patient from developing an autonomous existence. It was concluded that parental symbiotic needs combined with perfectionist family styles, possibly superimposed on a constitutional vulnerability to psychiatric disturbance, form a major contribution to obsessive-compulsive disorder.