Resignation Syndrome in Children
Daria is a seven-year-old Ukrainian girl. She lives in Sweden. She doesn’t react when spoken to or touched and is fed through a nasogastric tube. Her story and those of other minors are featured in the documentary, Life Overtakes Me. It’s a program produced by Netflix.
Daria exhibits a strange neuropsychiatric condition known as resignation syndrome. In fact, since the 90s, in Sweden, there have been several cases of children suffering from this disorder. They’re the children of refugees from the former Yugoslav and Soviet republics.
The syndrome has a progressive onset. Children begin to withdraw, lose their appetite, and stop going to school. Eventually, they enter a state of stupor – of partial unconsciousness – close to the appearance of a coma. This leads to a catatonic state and unconsciousness. It can last for months or even years.
Resignation syndrome is a strange disorder that’s been occurring in Sweden for decades in the child and adolescent refugee population. In 1958, the Swedish psychiatrist, Anna-Lisa Annel, described this syndrome as an extremely rare disorder that occurred mainly after severe psychological trauma.
It wasn’t until 1998 that Sweden registered the first case of resignation syndrome. They described it as a long-standing disorder affecting psychologically traumatized children and adolescents immersed in migratory processes.
In 2014, the Swedish National Board of Health and Welfare included the diagnosis of resignation syndrome as a separate diagnostic entity. Children and adolescents who are victims of this syndrome are popularly known in Sweden as apathetic children (apatiska barn).
How does it manifest itself and why?
The disorder is characterized by the onset of depression. As it progresses, extreme levels of apathy, immobility, and mutism appear, for no apparent biological reason. Firstly, there’s a decrease in habitual behavioral patterns, daily activities, and motivation. Subsequently, sufferers enter a catatonic state, similar to a coma, for months or years, remaining immobile and inert.
Elisabeth Hultcrantz, a volunteer doctor, states that the disorder is triggered when immigrants are told that they’ve been denied asylum and must return to their countries of origin. In fact, the main cause of the syndrome is trauma in the brain.
Other experts agree that traumatic experiences are a prerequisite for the development of this condition. Moreover, they usually include the threat of deportation to their country of origin.
Recent research on resignation syndrome
In 2019, Hultcrantz and Knorring conducted research with 46 children suffering from resignation syndrome. They stated that all asylum-seeking children who developed withdrawal syndrome in Sweden had been exposed to trauma, persecution, and violence.
Aside from a difficult and traumatic family life, a specific vulnerability is also present in the sufferer of resignation syndrome. This explains why not all minors in similar situations are affected. Additionally, most of the children who develop the disorder tend to have a history of mental illness, depressive disorder, and post-traumatic stress disorder.
All the minors with the syndrome belonged to repressed and persecuted ethnic minorities. For instance, the Balkans, the former Soviet Union, Yugoslavia, and Syria.
The average age at which the first symptoms appeared was 11 years. In most cases, the children entered this state after their families were informed of an upcoming deportation.
As a rule, the minors who experienced this syndrome were those who, previously, had been responsible for their families, in the capacity of translators. Or, they were those who’d experienced the most traumatic events in their countries of origin. For example, violence or murder of one or several members of their family. Alternatively, they’d been the victims themselves.
Has it only been observed in Sweden?
A few cases of children and adolescents with the same or similar symptoms have been reported in other countries. For instance, in Australia, a similar syndrome has been observed in refugee and asylum-seeking children from the island of Nauru.
Apart from being related to previous traumas and threats of deportation, experts don’t know the exact causes of this syndrome. Furthermore, they don’t know why it’s only been reported in Sweden. However, there’s talk of certain social and cultural factors having an influence on the development of the disease (culture-bound factors).
One known case of minors affected by resignation syndrome in the same family is that of the sisters, Djeneta and Ibadeta. They’re refugees from Kosovo. An image of them won a prize in the World Press Photo photojournalism contest in 2018. At the time, Djeneta was two and a half years old and had been bedridden and unresponsive, along with her sister, Ibadeta, for more than six months.
Since there’s so little known about resignation syndrome in children, more research is undoubtedly necessary. Hopefully, this will mean that boys and girls like Daria, Karen, or Leyla will be able to receive more specialized treatment.It might interest you...
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- Sallin, K., Lagercrantz, H., Evers, K., Engström, I., Hjern, A. y Petrovic, P. (2016). Resignation Syndrome: Catatonia? Culture-Bound?. Frontiers in behavioral neuroscience, 10, 7.
- von Knorring, AL. y Hultcrantz, E. (2019). Asylum-seeking children with resignation syndrome: catatonia or traumatic withdrawal syndrome?. Eur Child Adolesc Psychiatry 29, 1103–1109.