Behavioral disorders occur more commonly in children who fail the initial standard treatment protocol of cathartics and designated toileting time. Whether such disorders are causally related or the result of encopresis, these children require a much more intensive, multimodal therapy. Treatment failures should have an in-depth history that reviews the potential developmental, emotional, behavioral, and psychosocial issues that may be causative. Use of the treatment protocols that have been outlined in this article can be time-consuming and will often require the help of a behavioral therapist. However, if they are successfully implemented, research shows that positive behavioral changes frequently occur in the child. The pediatrician can be instrumental in preventing long-term family, emotional, and social consequences by aggressively treating these difficult cases.