Depressive Devitalization and Pervasive Refusal Syndrome are suggested to be subgroups of the same refusal syndrome. Children might previously have been diagnosed with a number of differential diagnoses, though none of these accounts for all symptoms seen in the syndromes. The individual impact of aetiological factors requires further investigation. None of the differential diagnoses explored could account for all features. This paper describes the PRS case cluster, the complexities faced by clinicians managing these cases, and the lessons that can be learned from this outbreak. Symptoms between the two syndromes differed only in pattern of refusal and neurological symptoms. In 2018, 15 of these children developed the rare and life-threatening pervasive refusal syndrome (PRS). Possible aetiological factors identified included: Children having a perfectionist, ambitious and conscientious premorbid personality, psychiatric problems of children and parents, and traumatic events. Databases searched included PsychINFO, Medline, Pub med, COCHRANE and PILOTS. The research was based on a literature study. The aim of this study was to identify possible aetiological factors, outline the similarities between Depressive Devitalization and Pervasive Refusal Syndrome and to explore possible differential diagnoses. PRS has been proposed as a new diagnostic entity in child and adolescent psychiatry, although the diagnostic criteria are debated. The syndrome is called Depressive Devitalization. Background: Pervasive refusal syndrome (PRS) is a rare but severe condition, characterised by social withdrawal and a pervasive active refusal in terms of eating, mobilisation, speech and personal hygiene. A number of asylum-seeking children in Sweden have developed a pervasive loss of function associated with profound social withdrawal.