Published in:
01-01-2021 | Editorial
Pervasive refusal syndrome revisited: a conative disorder
Published in: European Child & Adolescent Psychiatry | Issue 1/2021
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Pervasive Refusal Syndrome (PRS) is a rare but serious child psychiatric disorder; its prevalence is unknown. A PubMed search on February 23, 2020 with the search terms: “Pervasive AND Refusal AND Syndrome” resulted in only 34 hits during the period 1988–2019, with finally only 31 hits valid dating from the period 1991–2019. PRS is characterized by a pervasive refusal of activities such as social engaging, speaking, eating and drinking and selfcare, and it is often accompanied by an active—and often angry—resistance to help. These are considered the core criteria (Table 1). This frequently leads to an endangered state of the child, and to exhaustion of parents as well as professionals involved (1). The seriousness of PRS also is reflected by the severe suffering of both the child and its family, and often requires intensive multidisciplinary (inpatient) hospital treatment periods > 6 months. It frequently results in splitting mechanisms and a dividing of the treatment team, and last but not least: it is hard to diagnose, or not recognized at all.
Table 1
Adapted diagnostic criteria for PRS (From Jaspers et al., see [1])
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Diagnostic criteria for pervasive refusal syndrome
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A. Partial or complete refusal in three or more of the following domains: (1) eating, (2) mobilization, (3) speech, (4) attention to personal care
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B. Active and angry resistance to acts of help and encouragement
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C. Social withdrawal and school refusal
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D. No organic condition accounts for the severity of the degree of symptoms
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E. No other psychiatric disorder could better account for the symptoms
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F. The endangered state of the patient requires hospitalization
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