title: Pervasive refusal syndrome. Three German cases provide further illustration.
abstract: Pervasive refusal syndrome (PRS) has been proposed as a new diagnostic entity among child and adolescent psychiatric disorders. It is characterized by a cluster of life-threatening symptoms including refusal of hood intake, decreased or complete lack of mobilization, and lack of communication as well as retreat from normal life activities. Active refusal to accept help as well as neglect of personal care have been core features of PRS in the limited number of cases reported in the last decade. There have, however; been cases with predominantly passive resistance, indicating the possibility that there may be a continuum from active refusal to passive resistance within PRS. Postulating this continuum allows for the integration of "depressive devitalization" -- a refusal syndrome mainly characterized by passive resistance -- into the concept of PRS. Here, three case vignettes of adolescent patients with PRS are presented. The patients' symptomatology can be allocated on this continuum of PRS. PRS and dissociative disorders are compared in greater detail and contrasted within this discussion of differential diagnoses at the poles of such a continuum. PRS is a useful diagnosis for cases involving symptoms of predominating refusal and retreat which cannot satisfactorily be classified by existing diagnostic categories, and which can mostly clearly be separated from dissociative disorder.
authors: Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, Würzburg University Hospital. jans@kjp.uni-wuerzburg.de
authors: Thomas
authors: T
authors: Jans
authors: Juliane
authors: J
authors: Ball
authors: Maike
authors: M
authors: Preiss
authors: Michael
authors: M
authors: Haberhausen
authors: Andreas
authors: A
authors: Warnke
authors: Tobias J
authors: TJ
authors: Renner
mesh_terms: D000293:Adolescent; D000856:Anorexia Nervosa / Q000145:classification / Q000175:diagnosis / Q000523:psychology / Q000628:therapy; D015992:Body Mass Index; D002648:Child; D003131:Combined Modality Therapy; D039721:Diagnostic and Statistical Manual of Mental Disorders; D004213:Dissociative Disorders / Q000145:classification / Q000175:diagnosis / Q000523:psychology / Q000628:therapy; D019959:Feeding and Eating Disorders of Childhood / Q000145:classification / Q000175:diagnosis* / Q000523:psychology / Q000628:therapy; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D038801:International Classification of Diseases; D008297:Male; D009155:Mutism / Q000145:classification / Q000175:diagnosis* / Q000523:psychology / Q000628:therapy; D010343:Patient Admission; D012934:Social Isolation; D053608:Stupor / Q000145:classification / Q000175:diagnosis* / Q000523:psychology / Q000628:therapy