This Clinical Case Conference presents a fascinating case of a young girl with disabling and impairing symptoms, from an intact family with an absence of premorbid pathology. Current diagnostic classification symptoms are not adequate to explain her symptomatology, leading to treatment in uncharted waters. This case presentation gives an overview of Pervasive Refusal Syndrome, a diagnosis almost exclusively made in Europe and Austral-Asia, but seldom used or considered in the United States. Catatonia, a diagnosis with many features in common, is reviewed. Clinicians are encouraged to consult outside their geographical boundaries in the best interest of the patient.