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Pervasive refusal syndrome (PRS) 21 years on: a re-conceptualisation and a renaming

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An Invited Commentary to this article was published on 23 June 2013

Abstract

Twenty-one years ago, Lask and colleagues first described pervasive refusal syndrome (PRS) as a child’s “dramatic social withdrawal and determined refusal to walk, talk, eat, drink, or care for themselves in any way for several months” in the absence of an organic explanation. PRS has been conceptualised in a variety of ways since then. These have included a form of post-traumatic stress disorder, learnt helplessness, ‘lethal mothering’, loss of the internal parent, apathy or the ‘giving-up’ syndrome, depressive devitalisation, primitive ‘freeze’, severe loss of activities of daily living and ‘manipulative’ illness, meaning the possibility that the children have been drugged to increase chances of asylum in asylum-seeking families. Others have insisted that PRS is simply depression, conversion disorder, catatonia or a factitious condition. This paper reviews these conceptualisations, explores some of the central complexities around PRS and proposes a neurobiological explanatory model, based upon autonomic system hyper-arousal. It touches upon the clinical implications and suggests a new name for the condition reflecting what we believe to be a more sophisticated understanding of the disorder than was available when it was first described.

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Acknowledgments

We are truly grateful to all the children and parents from whom we have learnt so much.

Conflict of interest

The authors declare that they have no conflict of interest.

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Authors and Affiliations

  1. University of New South Wales, Sydney, Australia

    Kenneth P. Nunn

  2. Westmead Children’s Hospital, Sydney, Australia

    Kenneth P. Nunn

  3. Care UK, London, UK

    Bryan Lask

  4. Great Ormond Street Hospital for Children, London, UK

    Bryan Lask & Isabel Owen

Authors
  1. Kenneth P. Nunn
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  2. Bryan Lask
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  3. Isabel Owen
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Corresponding author

Correspondence to Isabel Owen.

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Nunn, K.P., Lask, B. & Owen, I. Pervasive refusal syndrome (PRS) 21 years on: a re-conceptualisation and a renaming. Eur Child Adolesc Psychiatry 23, 163–172 (2014). https://doi.org/10.1007/s00787-013-0433-7

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  • DOI: https://doi.org/10.1007/s00787-013-0433-7

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