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 also links to some personal accounts from adults with PDA. This section explains what a PDA profile is and the assessment process. It is characterized by a cluster of life-threatening symptoms including refusal of food intake, decreased or complete lack of mobilization, and lack of communication as well as a retreat from normal life activities. Pathological demand avoidance (PDA) is a profile that describes those whose main characteristic is to avoid everyday demands and expectations to an extreme extent. Others have insisted that PRS is simply depression, conversion disorder, catatonia or a factitious condition. Pervasive refusal syndrome (PRS) has been proposed as a new diagnostic entity among child and adolescent psychiatric disorders. 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.

PRS has been conceptualised in a variety of ways since then.

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.