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Pervasive refusal syndrome is a severe, pervasive and life-threatening disorder. Most commonly seen in girls between the ages of 8 and 15, although also affecting boys and younger age groups, it is characterised by a profound and pervasive refusal to eat, drink, talk, walk and engage in any form of self-care. A determined resistance to treatment is a striking component of the condition. The causes are unclear, but likely to be complex, multiple and associated with a sense of hopelessness. Treatment needs to be comprehensive and is based on supporting the child in recovering at her own pace, while ensuring physical safety and well-being. The prognosis is good, provided treatment is appropriate, but recovery tends to take a year or more.
The range of eating disorders in children includes selective eating, food avoidance emotional disorder, functional dysphagia, and pervasive refusal syndrome. This chapter provides background information, including theories of etiology concerning early-onset anorexia nervosa and bulimia nervosa. The majority of physical changes in anorexia nervosa are predominantly related to the effects of starvation and dehydration. Herzog reported that major depressive disorder was the most prevalent comorbid disorder, occurring in 37% of patients with anorexia nervosa. The physical manifestations of bulimia nervosa are initially less dramatic than those of anorexia nervosa because weight is usually maintained within normal range. A number of other eating disorders are identified in children. Other eating disorders include food avoidance emotional disorder, selective eating and pervasive refusal syndrome. A number of computed tomography (CT) and magnetic resonance imaging (MRI) studies in female adult and adolescent patients with anorexia nervosa have shown structural abnormalities in the brain.
To our knowledge Pisa syndrome in childhood or adolescence has not previously been described. The syndrome developed in an adolescent girl following administration of neuroleptic medication for psychotic features, and was transiently thought to be abnormal illness behaviour. This case emphasises the need for early diagnosis and rapid effective treatment.
Four cases of anorexia nervosa occurring in Asian children are described. These case histories are set against the recent increase in eating disorders in patients of different racial origin. The role of sociocultural conflict in immigrant Asian families to Western countries is raised as a possible contributor to the emergence of eating disorders and the need to be aware of anorexia nervosa in such childhood populations is stressed.
The question is often asked: “Does family therapy work?” This is an important but useless question. It is important because an enormous amount of time, energy and money is put into the clinical practice of family therapy. It is practised in every continent; there are many training courses and qualifications in very many countries, and there are over 40 journals devoted to families and family therapy. Yet there is a healthy and justified scepticism. So yes, we ought to ask whether it works.
During 1973 there were 169,362 abortions notified to the Chief Medical Officer at the Department of Health. In a leading article the British Medical Journal (1973) acknowledged that ‘bald statistics cannot help to answer the important question of the nature of the physical and emotional sequelae of termination of pregnancy’. The article called for careful prospective studies to assess such sequelae. This paper is a report of a short-term prospective study of the psychiatric sequelae.