Resignation Syndrome: Catatonia? Culture-Bound?

Abstract

Resignation syndrome (RS) designates a long-standing disorder predominately affecting psychologically traumatized children and adolescents in the midst of a strenuous and lengthy migration process. Typically a depressive onset is followed by gradual withdrawal progressing via stupor into a state that prompts tube feeding and is characterized by failure to respond even to painful stimuli. The patient is seemingly unconscious. Recovery ensues within months to years and is claimed to be dependent on the restoration of hope to the family. Descriptions of disorders resembling RS can be found in the literature and the condition is unlikely novel. Nevertheless, the magnitude and geographical distribution stand out. Several hundred cases have been reported exclusively in Sweden in the past decade prompting the Swedish National Board of Health and Welfare to recognize RS as a separate diagnostic entity. The currently prevailing stress hypothesis fails to account for the regional distribution and contributes little to treatment. Consequently, a re-evaluation of diagnostics and treatment is required. Psychogenic catatonia is proposed to supply the best fit with the clinical presentation. Treatment response, altered brain metabolism or preserved awareness would support this hypothesis. Epidemiological data suggests culture-bound beliefs and expectations to generate and direct symptom expression and we argue that culture-bound psychogenesis can accommodate the endemic distribution. Last, we review recent models of predictive coding indicating how expectation processes are crucially involved in the placebo and nocebo effect, delusions and conversion disorders. Building on this theoretical framework we propose a neurobiological model of RS in which the impact of overwhelming negative expectations are directly causative of the down-regulation of higher order and lower order behavioral systems in particularly vulnerable individuals.

Pervasive refusal syndrome: systematic review of case reports

“…This has been particularly notable in the presentations of some children from asylum-seeking families who experienced significant impairment in their ability to perform activities of daily living and rejected support. Some of the terms that have been used to describe these children include resignation syndrome (RS), giving-up syndrome, apathetic children [51], and depressive devitalisation [22].…”

“…The concentration of cases from defined locations and from within a specific social group [22,42,50] has raised the possibility that PRS could be a culture-bound concept [42,51]. Broadly, PRS appears to affect a significant number of asylum seekers from the old Soviet Union however, similar cases have been reported in migrants from Afghanistan, Syria and Sri Lanka who had been held on the Nauru Island [52].…”

Asylum-seeking children with resignation syndrome: catatonia or traumatic withdrawal syndrome?

“…It has been discussed whether the resignation syndrome is a separate, new entity, or if the condition should be regarded as a variant of pervasive refusal syndrome, dissociative stupor, depressive stupor or catatonia [11,12]. According to the definition of pervasive refusal syndrome by Jaspers: the patients refuse actively and angry to acts of help and encouragement, and no other psychiatric condition could better account for the symptoms [13].…”

Does persisting fear sustain catatonia?

“…A ‘resignation syndrome’ marked by stupors unto death is now reported among refugee children coming to Sweden from Syrian wars . In the Uganda conflicts, a stuporous, repetitive ‘nodding syndrome’ progressing to death is reported.…”