Case study: obsessive difficult temperament and its response to serotonergic medication

The syndrome of "obsessive difficult temperament" is described, and its response to serotonergic medication is reported. Diagnostic criteria are proposed for this temperamental pattern characterized by functional impairment due to obsessive rigidity, irritability, withdrawal, and poor self-regulation. The clinical characteristics, prior treatment, family history, and medication response are presented for a case series of eight children, five female and three male, presenting initially for assessment at ages 8 to 11 years, with obsessive difficult temperament which improved significantly as a result of serotonergic medication.