Obwohl Zwangsstörungen im Kindes- und Jugendalter mittlerweile als gut behandelbar gelten, sind die Behandlungsergebnisse in der Praxis häufig unbefriedigend. Dies liegt daran, dass nachweislich wirksame Interventionen nicht oder unzureichend angewendet werden. Die vorliegende Arbeit gibt eine Übersicht über evidenzbasierte psychotherapeutische und medikamentöse Behandlungsmöglichkeiten. Die Behandlung der Wahl ist die Kognitive Verhaltenstherapie mit Exposition und Reaktionsverhinderung, die, falls erforderlich, um eine Pharmakotherapie mit einem selektiven Serotonin-Wiederaufnahme-Hemmer ergänzt wird. Befunde zu Prädiktoren, Moderatoren und Mediatoren der Behandlung sind uneinheitlich. Neue Entwicklungen in der Psychotherapie beinhalten Anwendungen der Expositionsbehandlung, die nicht einem Habituationsrational folgen, sondern auf Angsthemmung und Angsttoleranz sowie auf kognitive (Erwartungsverletzung) oder metakognitive Veränderungen abzielen. Bei Kindern mit geringer Behandlungsmotivation und starker Einbindung der Familie in die Zwänge des Kindes sind elternbezogene Interventionen indiziert. Behandlungsfehler in der Expositionsbehandlung sollten in der Ausbildung von Kinder- und Jugendlichenpsychotherapeuten besonders berücksichtigt werden.

Keywords:
Zwangsstörung, Kindheit, Kognitive Verhaltenstherapie, Metakognitive Therapie, Pharmakotherapie, Behandlungsfehler
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