Anorectal malformations (ARM) are not externally visible and have an uncertain medical course. Only about half of the patients with ARM have satisfactory bowel functions. Studies of ARM have reported reduced quality of life and psychosocial problems in up to 73% of the patients. The aim of the current study was to document the psychiatric comorbidity and the psychosocial need of patients with ARM in a multidimensional diagnostic for the first time. The screening sample (N = 30) included 23 male and 7 female patients aged 4-17 years. The introduced Comprehensive Grading System with a sophisticated perspective of continence and associated problems showed 23 patients suffering severe burden. 70 % of the families confirmed increased psychosocial need. In the diagnostic one third of the patients had psychiatric diagnoses, one third had mild problems and one third had no difficulties. Therefore, a group program should be offered to all patients. To the patients with severe forms of ARM or with increased psychosocial need, the multidimensional diagnostic program including advices and recommendations should be offered. Psychosocial assistance is important to reinforce acceptance and integration of coping with the illness in one's life. Early intervention can prevent psychiatric disorders later in life.