The following text was taken from the AFCC materials provided in Denver.
The DSM-V has not been adopted, nor is there any agreement that the following
diagnosis should be added. Ultimately it was not adopted.
Proposed Text for Parental Alienation Disorder in DSM-V
The essential feature of parental alienation disorderis that a child -
usually one whose parents are engaged in a high-conflict divorce - allies
himself or herself strongly with one parent (the preferred parent) and
rejects a relationship with the other parent (the alienated parent) without
legitimate justification. The primary behavioral symptom is the child's
resistance or refusal to have contact with the alienated parent (Criterion A).
The behaviors in the child that characterize parental alienation disorderinclude
a persistent campaign of denigration against the alienated parent and
weak, frivolous, and absurd rationalizations for the child's criticism
of the alienated parent (Criterion B).
The following clinical features frequently occur in parental alienation
disorder, especially when the child's symptoms reach a level that
is moderate or severe (Criterion C). Lack of ambivalence refers to the
child's belief that the alienated parent is all bad and the preferred
parent is all good. The independent-thinker phenomenon means that the
child proudly states the decision to reject the alienated parent is his
own, not influenced by the preferred parent. Reflexive support of the
preferred parent against the alienated parent refers to the pattern of
the child's immediately and automatically taking the preferred parent's
side in a disagreement. The child may exhibit a disregard for the feelings
of the alienated parent and an absence of guilt over exploitation of the
alienated parent. The child may manifest borrowed scenarios, that is,
rehearsed statements that are identical to those made by the preferred
parent. Also, the child's animosity toward the alienated parent may
spread to that parent's extended family.
The diagnosis of parental alienation disordershould not be used if the
child's refusal to have contact with the rejected parent is justifiable,
for example, if the child was neglected or abused by that parent (Criterion D).
Parental alienation disordermay be mild, moderate, or severe. When the
parental alienation disorderis mild, the child may briefly resist contact
with the alienated parent, but does have contact and enjoys a good relationship
with the alienated parent once they are together.
When the parental alienation disorderis mild, the child may have a strong,
healthy relationship with both parents, even though the child recites
criticisms of the alienated parent.
When the parental alienation disorderis moderate, the child may persistently resist
contact with the alienated parent and will continue to complain and criticize
the alienated parent during the contact. The child is likely to have a
mildly to moderately pathological relationship with the preferred parent.
When the parental alienation disorderis severe, the child strongly and
persistently resists contact and may hide or run away to avoid seeing
the alienated parent. The child's behavior is driven by a firmly held,
false belief that the alienated parent is evil, dangerous, or worthless.
The child is likely to have a strong, severely pathological relationship
with the preferred parent, perhaps sharing a paranoid world view.
While the diagnosis of parental alienation disorderrefers to the child,
the preferred parent and other persons the child is dependent on may manifest
the following attitudes and behaviors, which frequently are the major
cause of the disorder: persistent criticisms of the rejected parent's
personal qualities and parenting activities; statements that influence
the child to fear, dislike, and criticize the alienated parent; and various
maneuvers to exclude the rejected parent from the child's life. The
behavior of the preferred parent may include complaints to the police
and child protection agencies with allegations about the rejected parent.
Parental alienation disordermay be the basis for false allegations of sexual
abuse against the alienated parent. The preferred parent may be litigious
to the point of abusing the legal system. The preferred parent may violate
court orders that are not to his or her liking. Specific psychological
problems - narcissistic personality disorder, borderline personality disorder,
traumatic childhood experiences, and paranoid traits - may be identified
in these individuals. Also, the rejected parent may manifest the following
attitudes and behaviors, which may be a minor or contributory cause of
the disorder: lack of warm, involved parenting; deficient parenting skills;
and lack of time dedicated to parenting activities. However, the intensity
and duration of the child's refusal to have contact with the rejected
parent is far out of proportion to the relatively minor weaknesses in
the rejected parent's parenting skills.
Although parental alienation disordermost often arises in the context of
a child custody dispute between two parents, it can arise in other types
of conflicts over child custody, such as a dispute between a parent and
stepparent or between a parent and a grandparent. Sometimes, other family
members - such as stepparents or grandparents - contribute to the creation
of parental alienation disorder.On occasion, other individuals - such
as therapists and child protection workers - contribute to the creation
of parental alienation disorderby encouraging or supporting the child's
refusal to have contact with the alienated parent. Also, parental alienation
disorderdoes not necessarily appear in the context of divorce litigation,
but may occur in intact families or years following the divorce.
It is common for children to resist or avoid contact with the noncustodial
parent after the parents separate or divorce. There are several possible
explanations for a child's active rejection of contact. Parental alienation
disorderis an important, but not the only, reason that children refuse contact.
In the course of normal development children will become polarized with
one parent and then the other depending on the child's developmental
stage and events in the child's life. When parents disagree, it is
normal for children to experience loyalty conflicts. These transitory
variations in a child's relationship with his or her parents do not
meet criteria for parental alienation disorderbecause they do not constitute
"a persistent rejection or denigration of a parent that reaches the
level of a campaign."
If the child actually was abused, neglected, or disliked by the noncustodial
parent or the current boyfriend or girlfriend of that parent, the child's
animosity may be justified and it is understandable that the child would
not want to visit the rejected parent's household. If abuse were the
reason for the child's refusal, the diagnosis would be physical abuse
of child or sexual abuse of child, not parental alienation disorder.This
is important to keep in mind because an abusive, rejected parent may misuse
the concept of parental alienation disorderin order to falsely blame the
child's refusal of contact on the parent that the child prefers. In
shared psychotic disorder, a delusional parent may influence a child to
believe that the other parent is an evil person who must be feared and
avoided. In parental alienation disorder, the alienating parent may have
very strong opinions about the alienated parent, but is not usually considered
out of touch with reality.
When parents separate or divorce, a child with separation anxiety disorder
may become even more worried and anxious about being away from the primary
caretaker. In separation anxiety disorder, the child is preoccupied with
unrealistic fears that something will happen to the primary caretaker,
while the child with parental alienation disorder is preoccupied with
unrealistic beliefs that the alienated parent is dangerous.
It is conceivable that a child with specific phobia, situational type,
might have an unreasonable fear of a parent or some aspect of the parent's
household. A child with a specific phobia is unlikely to engage in a persistent
campaign of denigration against the feared object, while the campaign
of denigration is a central feature of parental alienation disorder.
When parents separate or divorce, a child with oppositional defiant disorder
may become even more symptomatic - angry, resentful, stubborn - and not
want to participate in the process of transitioning from one parent to
the other. In oppositional defiant disorder, the child is likely to be
oppositional with both parents in a variety of contexts, while the child
with parental alienation disorder is likely to focus his or her negativism
on the proposed contact with the alienated parent and also to engage in
the campaign of denigration of that parent.
When parents separate or divorce, a child may develop an adjustment disorder
as a reaction to the various stressors related to the divorce including
discord between the parents, the loss of a relationship with a parent,
and the disruption of moving to a new neighborhood and school. A child
with an adjustment disorder may have a variety of nonspecific symptoms
including depression, anxious mood, and disruptive behaviors, while the
child with parental alienation disorder manifests a specific cluster of
symptoms including the campaign of denigration and weak, frivolous rationalizations
for the child's persistent criticism of the alienated parent.
Parent-child relational problem (a V-code) is the appropriate diagnosis
if the focus of clinical attention is on the relationship between a child
and his or her divorced parents, but the symptoms do not meet the criteria
for a mental disorder. For example, a rebellious adolescent may not have
a specific mental disorder, but may temporarily refuse to have contact
with one parent even though both parents have encouraged him to do so
and a court has ordered it. On the other hand, parental alienation disorder
should be the diagnosis if the child's symptoms are persistent enough
and severe enough to meet the criteria for that disorder.
DIAGNOSTIC CRITERIA FOR PARENTAL ALIENATION DISORDER
A. The child - usually one whose parents are engaged in a high-conflict
divorce - allies himself or herself strongly with one parent and rejects
a relationship with the other, alienated parent without legitimate justification.
The child resists or refuses contact or parenting time with the alienated parent.
B. The child manifests the following behaviors:
- a persistent rejection or denigration of a parent that reaches the level of a
- weak, frivolous, and absurd rationalizations for the child's persistent
criticism of the rejected parent
C. The child manifests two or more of the following six attitudes and behaviors:
(1) lack of ambivalence
(2) independent-thinker phenomenon
(3) reflexive support of one parent against the other
(4) absence of guilt over exploitation of the rejected parent
(5) presence of borrowed scenarios
(6) spread of the animosity to the extended family of the rejected parent.
D. The duration of the disturbance is at least 2 months.
E. The disturbance causes clinically significant distress or impairment
in social academic (occupational), or other important areas of functioning.
F. The child's refusal to have contact with the rejected parent is
without legitimate justification. That is, parental alienation disorderis
not diagnosed if the rejected parent maltreated the child.