A review of the records of one psychiatric clinic over a sixteen-year period revealed seventeen patients who met the criteria for a diagnosis of severe obsessive-compulsive neurosis. Retrospective review of these cases revealed that eighty-two per cent of the children's parents themselves suffered from severe psychiatric or medical impairment, and that twenty-nine per cent of the children suffered from serious medical illnesses. All seventeen patients had been treated, most with "intensive" psychotherapy. Fifteen patients could be located for follow-up, of whom ten agreed to a structured interview. Seven of the ten still suffered from obsessive-compulsive symptoms, and all reported serious problems with social life and peer relationships. The authors hypothesize that the obsessive-compulsive symptoms of the children served as a defense against anxiety generated by their extremely stressful life situations. The children's intellectual cognitive style and the availability in some instances of obsessive-compulsive parental models may have contributed to their choice of an obsessive-compulsive defense.