Pervasive refusal syndrome (PRS) is a rare but serious child psychiatric disorder that was first described by Bryan Lask and colleagues in 1991.[1] As of 2011, it is not included in the standard psychiatric classification systems.[2]
PRS is characterized by a determined unwillingness of a person to engage in activities, including eating, drinking, walking, talking and self-care. The person will withdraw socially and exhibits anger and active resistance against attempts to provide care. 75% of the PRS cases occur in girls aged 8 to 15, with a mean age of 10.5, and the disorder can be life-threatening.[3][4]
Cases of PRS are often associated with intelligent children that have a conscientious, perfectionist personality. A family with a psychiatric history or environmental stress factors can also play a role. Treatment of this disorder requires gentle encouragement and patient, loving care. Hospitalization is almost always necessary and the recovery period is lengthy; typically 12.8 months. During the recovery period symptoms disappear in the opposite order they appear. That is to say that if food refusal was the first symptom to appear then it would be the last to disappear and if another symptom appears later on, it will disappear relatively early in the recovery process.[5] About 67% of the cases show complete recovery.[3]
PRS may be linked to learned helplessness, and so it can be important for the patient to be able to manage the rate of their recovery. Music therapy may help in this regard as it provides empowerment by giving the patient choice and control, while allowing for improvisation can result in a sense of affirmation and validation; all important for a successful recovery.[6]