Treatment of Pervasive Arousal Withdrawal Syndrome

Pervasive Arousal Withdrawal Syndrome (PAWS) used to be called Pervasive Refusal Syndrome (PRS). It is a profound and life threatening condition. Thankfully it is rare. It has in the past been thought to affect mainly children however in recent times clinicians are increasingly reporting cases in young adults as well. With the right treatment, people can go on to make a full recovery. Hospitalisation is almost always necessary.

How do I know if I have PAWS?

PAWS often develops following a viral illness, or a time of ill health. Young people with PAWS refuse to eat, drink, walk, talk or care for themselves in any way for several months or more. They completely withdraw socially, including from their family.

Signs and symptoms of PAWS include:

  • Withdrawal
  • Refusal to eat, drink, walk or talk
  • No desire to care for themselves
  • Verbal and physical aggression, especially towards those trying to help and care for them
  • Resisting help or treatment

What are the causes and effects of PAWS?

The cause of Pervasive Arousal Withdrawal Syndrome is difficult to pinpoint. Some evidence suggests a link with periods of extreme stress, theorising that PAWS is an extreme form of avoidance behaviour. Children and young people diagnosed with PAWS can often be sensitive, high achievers, living with low self-esteem who may struggle with the pressure of living up to either their own or others’ expectations.

PAWS treatment

Treatment can take a while – sometimes one or two years and, in some cases, longer. Most children suffering from Pervasive Arousal Withdrawal Syndrome will require inpatient care from a multidisciplinary team. At Ellern Mede these will include a Consultant Child & Adolescent Psychiatrist, a Family Therapist, a Child Psychologist or Psychotherapist. Other members of the team include a Dietician, Physiotherapist, Specialist Nurses and support staff.

Teams work very closely with the parents and families of the patient. The PAWS prognosis is good if the treatment is appropriate.



We wanted to write to tell you all that our daughter has maintained weight since her discharge and has also recently been discharged by the local CAMHS team. She is positive and settled. Thank you for all your help and support during her stay at Ellern Mede.

NHS referrals

Ellern Mede has provided specialist Tier 4 eating disorder services to the NHS since 2000. We respond to referrals within 24 hours.

Private referrals

Call now for immediate access to Ellern Mede specialist private eating disorder services. Accepted referrals begin treatment within two weeks or faster in emergencies.