Von Folsach and Montgomery put forth four essential risk factors: 1 a premorbid personality, 2 a history of child psychiatric problems, 3 parental psychiatric problems and 4 sudden stressful events. There have been other theories regarding the cause of PRS, for instance, the psychodynamic theory of fatal mothering and a potential neurobiological role of the insula. Viral infections are repeatedly seen to be a factor in PRS many cases are thought to begin with a viral infection.
The helplessness and hopelessness can transmit from parents to children and from children to parents as they watch one another battling with uncontrollable proceedings. Trauma, in general, appears to be an important factor, due to the fact that PRS is also repeatedly seen in refugees and witnesses to violence. It was first described by Bryan Lask and colleagues in 1991. Nevertheless, once the person is healthy, relapse is very infrequent. About 67% of the cases show complete recovery. During the recovery period symptoms disappear in the opposite order they appear. Hospitalization is almost always necessary and the recovery period is typically more than a year. It is not included in the standard psychiatric classification systems. A family with a psychiatric history or environmental stress factors can also play a role. The disorder usually begins with a virus, or the child having a pain, even though no substantial cause can be found. PRS starts slowly, but the child then worsens quickly becoming reluctant or not capable to do anything for themselves. It is characterized by refusal to eat, drink, talk, walk or self-care, and a firm resistance to treatment. Children with the disorder abandon their involvement in all phases of their life. Pervasive refusal syndrome, also known as pervasive arousal withdrawal syndrome, is a mental disorder in children.
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