From the Research
Refusal syndrome is a severe psychiatric condition that requires a multidisciplinary approach, with the primary intervention being establishing a therapeutic relationship while avoiding power struggles, as evident from the study by 1. The condition is characterized by pervasive refusal, active/angry resistance to help, and social withdrawal, leading to an endangered state.
- The syndrome often affects girls, with a mean age of 10.5 years, and is associated with a premorbid high-achieving, perfectionist, conscientious personality, as well as environmental stressors and a psychiatric history of parents or child 1.
- Treatment should be multidisciplinary, characterized by patience, gentle encouragement, and tender loving care, with hospitalization in a child and adolescent psychiatric unit often required 1.
- Medications are not first-line treatment but may include olanzapine (2.5-5mg daily) or mirtazapine (15-30mg daily) if there's significant anxiety or depression.
- Nasogastric feeding may be necessary in severe cases of food refusal, and family therapy is essential to address underlying family dynamics that may contribute to the condition.
- The syndrome often develops in response to severe trauma, perceived loss of control, or as a maladaptive coping mechanism, and recovery is typically slow and gradual, requiring patience and consistent support, with most patients eventually achieving full recovery with appropriate treatment and support 1.
- Early intervention improves outcomes, and it is essential to increase knowledge of refusal syndrome, not only because of its disabling, potential life-threatening character but also because there is hope for recovery through suitable treatment 1.