Anxiety disorders are common in children. Much of anxiety in children is embedded in the parent- child relationship. In Asian countries many cultural practices can lead to insecure attachment and severe stress in children, especially in girls. Appropriate psychotherapeutic intervention must be sensitive to cultural influences.

To report clinical symptoms, individual and family dynamics, important points in psychotherapy for a girl with an anxiety disorder.

A Thai-Chinese 9 year- old girl presented with obsessions about her mother dying and herself killing her mother. She also had hallucinations which she described as “voices telling me to kill my mother”. She was diagnosed as having OCD with psychotic features. The patient was the first twin and was described as a ‘moody’ and ‘not so smart’, while her twin brother, the only male grandchild of the family, was described as ‘pleasant’ and ‘clever’.

Family assessment revealed cultural practices that led to severe frustration and anxiety in this girl. The main factor was the practice of son preference. This, together with severe punishment, led to insecure attachment, feelings of rejection, anger, guilt and shame. Family therapy and behavior management were the main psychotherapeutic interventions in the early phase. CBT was initiated in the later phase. Interesting points in treatment and the VDO tape of psychotherapy sessions will be presented.

The case vignette illustrated the role culture plays in initiating severe anxiety in girls. Understanding such a role will enable therapists to treat anxiety in girls more effectively.