Pervasive Refusal Syndrome: A Less Severe Variant with Defined Aetiology

Lask et al. (Archives of Disease in Childhood, 66, 866-869) described pervasive refusal syndrome in 1991. The severe behavioural syndrome described could not be accounted for under other diagnostic categories and required hospitalization. The aetiology of this condition was not clear; Lask et al. hypothesized an aetiology of sexual abuse but this could only be proven in one case in their series. Subsequently Nunn and Thompson (Clinical Child Psychology and Psychiatry, 1, 121-132, 1996) proposed an aetiology based on the theory of learned helplessness. We report on a further case fulfilling criteria for pervasive refusal syndrome. This patient presented with symptoms which were milder than described by Lask et al. A clear aetiology of traumatic sexual abuse involving intimidation was uncovered without the confounding factors of severe family dysfunction or social deprivation that were present in Lask et al.'s series. This is the first case of abuse described where the perpetrator is a minor. The syndrome resolved rapidly once the abuse was discovered and the child is well at 1-year follow-up. This case suggests that pervasive refusal can exist as a spectrum disorder of varying severity. The clear aetiology found in this case supports the original aetiology hypothesized in Lask et al.'s description and supports the hypothesis of the post-traumatic nature of the syndrome.