University of New South Wales, Sydney, Australia.
Eur Child Adolesc Psychiatry. 2014 Mar;23(3):163-72. doi: 10.1007/s00787-013-0433-7. Epub 2013 Jun 23.
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.
21 年前，Lask 及其同事首次描述了普遍拒绝综合征（PRS），即儿童在没有器质性解释的情况下“剧烈的社会退缩和坚决拒绝行走、说话、进食、饮水或任何方式照顾自己数月”。从那时起，PRS 就以各种方式被概念化。这些包括创伤后应激障碍、习得性无助、“致命养育”、内部父母丧失、冷漠或“放弃”综合征、抑郁性失活、原始“冻结”、严重丧失日常生活活动能力和“操纵性”疾病，这意味着儿童可能被下药以增加寻求庇护家庭庇护的机会。其他人则坚称 PRS 只是抑郁症、转换障碍、紧张症或人为病症。本文回顾了这些概念化，探讨了 PRS 周围的一些核心复杂性，并提出了一个基于自主神经系统过度唤醒的神经生物学解释模型。它涉及到临床意义，并提出了一个新的疾病名称，反映了我们认为比最初描述时更深入地理解这种疾病。
