Diagnosis of Attachment-Based Parental Alienation

I receive many requests for help and guidance.  When I am contacted, professional standards of practice prevent me from commenting on the specifics of an individual case.  However, the relationship dynamics involved with the pathogenic parenting of “parental alienation” processes are exceedingly similar across families, because they originate in the same type of parental psychopathology (a narcissistic personality disorder with borderline features that is decompensating into persecutory beliefs regarding the targeted/rejected parent’s abuse potential relative to the child).

Recently I received the following question from a parent, and I thought my response to this parent might be helpful to other parents (and to mental health professionals).

“Hello Dr. Childress, What assessment tools do you use to identify the possibility of a likely Parental Alienation Dynamic?  Would you need to interview the children?”


The assessment of “parental alienation” (i.e., pathogenic parenting) involves clinical interviews primarily with the child, but also with the targeted parent and child.  Additional interviews with the “alienating” parent can be helpful to confirm the diagnosis but are not necessary to making the diagnosis of “pathogenic parenting” associated with “parental alienation” processes (pathogenic: “patho” = pathology; “genic” = genesis, creation; pathogenic parenting is the creation of pathology in a child through highly aberrant and distorted parenting practices).

An attachment-based model of “parental alienation” is diagnosed from the presence of three separate symptom features that are evident in the child’s symptom display:

1.    Suppression of the normal range functioning of the child’s attachment system relative to one parent involving a child initiated “cut-off” of the child’s relationship with a parent.

2.   The presence in the child’s symptom display of a specific set of narcissistic and borderline personality disorder features, involving:

a.)  Grandiosity: A grandiose judgment of a parent in which the child perceives himself or herself to be in an elevated status position in the family hierarchy above that held by the targeted-rejected parent, so that the child feels entitled to judge the parent;

c.)  Entitlement: A sense of entitlement in which the child feels that his or her desires should all be met to the child’s satisfaction, and if the targeted-rejected parent doesn’t meet the child’s entitled expectations to the child’s satisfaction then the child feels justified in inflicting a retaliatory retribution on the targeted-rejected parent for the supposed parental failure;

d.)  Haughty Arrogance: A haughty and arrogant attitude of contempt regarding the supposed parental inadequacy (and personal inadequacy) of the targeted/rejected parent;

e.) Absence of Empathy: A complete absence of normal-range empathy and compassion for the feelings of the targeted-rejected parent;

a.)  Splitting:  Extremes in the child’s perception of relationships with his or her parents, in which the child overly idealizes one parent as being the all-good, perfect parent, while the other parent is viewed as being the entirely bad, horrible and wretched parent.

3. An intransigently held, fixed and false belief system (i.e, a delusion) regarding the fundamental inadequacy of the targeted-rejected parent who the child typically characterizes as being “abusive” (typically the allegation is that the supposedly inadequate parenting of the targeted-rejected parent is emotionally abusive).

If this specific set of 3 symptoms is present in the child’s symptom display, the only possible origin of this particular symptom set is through pathogenic parenting by a narcissistic/(borderline) parent, who represents the allied and supposedly “favored” parent in the family relationship pattern.  This specific symptom set CANNOT originate authentically to the functioning of the child’s nervous system.  This specific symptom set can only be acquired by the child from pathogenic parenting emanating from the allied and supposedly “favored” parent.

One of the key diagnostic criteria is number 3, the presence in the child’s symptom display of a delusional belief regarding the fundamental inadequacy of the parenting practices of the targeted-rejected parent.  In order to determine this third criteria, that the child’s beliefs about the parenting practices of the targeted-rejected parent are not based in reality, the parenting practices of the targeted-rejected parent must be clinically evaluated.  This involves joint parent-child sessions in which the parenting behavior of the targeted-rejected parent, and the child’s responses to the parenting behavior of the targeted-rejected parent, are assessed.

If the parenting behavior of the targeted-rejected parent is broadly normal range (i.e., no evidence of alcoholism, chronic drug use,excessive anger dysregulation, domestic violence, severely distorted communication processes), then the parenting behavior of the targeted/rejected parent could not reasonably account for the creation of the child’s symptom constellation of the three specific features noted above.  The pathogenic parenting must be originating in the aberrant and distorted parenting of the other parent, the allied and supposedly “favored” parent.

There is no other alternative explanation that would account for the presence of that specific set of symptoms displayed by the child.  That specific set of symptoms CANNOT arise on their own from the authentic functioning of a child’s own nervous system. That specific set of symptoms MUST be induced through interpersonal processes – i.e., through pathogenic parenting.  If the parenting practices of the targeted-rejected parent are assessed to be broadly normal range (with due consideration and latitude given to the broad array of parenting practices displayed in normal-range families, and with due deference given to recognized parental prerogatives in establishing family values through the legitimate exercise of parental authority, leadership, and discipline), then the presence of that symptom set in the child’s symptom display MUST be the induced product of pathogenic parenting by the allied and supposedly “favored” parent.  There is no other alternative explanation possible regarding the origins of that specific child symptom set.

The diagnosis is made based on clinical interviews with the child and targeted-rejected parent.  If the allied and supposedly “favored” parent consents to clinical interviews, then these interviews can confirm the diagnosis, but they are not necessary to make the diagnosis.

Associated Clinical Signs:

The diagnosis of attachment-based “parental alienation” is based SOLELY on the presence in the child’s symptom display of the three characteristic diagnostic indicators noted above.  Additional confirmatory features are also typically present, and while not necessary for the diagnosis, these additional “associated clinical signs” can provide confirming clinical evidence for the diagnosis:

1)   Listen to the Child:  The allied and pathological parent evidences the phrase “...listen to the child…” – such as “I’m only listening to the child” –  “you [i.e., therapists, attorneys, etc.] should just listen to the child” – “why isn’t anyone listening to the child.”  This phrase by the allied and pathological parent comes from a need to empower the child, both to exploit the child’s expressed rejection for the other parent and also from a specific personal need to empower the child, originating from particular psychological dynamics with the allied and pathological parent (involving the reenactment narrative).  Other versions of this effort to empower the child are the allied and pathological parent advocating that “the child should be allowed to decide” if he or she goes on visitations with the targeted-rejected parent and efforts by the allied and pathological parent to have the child testify in Court.  The core issue is a need to empower the child.

2)   Exploiting the Child’s Symptoms:  An exploitation of the child’s symptoms by the allied/pathological parent to limit, restrict, disrupt, and nullify the ability of the targeted-rejected parent to form a relationship with the child.

3)    Protecting the Child:  The allied/pathological parent prominently presents in the role as the “protector” of the child from the abuse (typically emotional abuse) of the targeted-rejected parent.  The need to “protect the child” can reach almost obsessional levels.

4)   Selective Parental Incompetence:  The allied/pathological parent presents as selectively incompetent, typically using the phrase “…what can I do, I can’t make the child…xyz” – for example; “I encourage the child to go on visitations with the other parent, but what can I do, I can’t make the child go if the child doesn’t want to go.” – “I tell the child to cooperate with the other parent, but what can I do, I can’t make the child be nice to the other parent.  I’m not there, how am I supposed to make the child be nice to the other parent?” The presence of this phrase has to do with placing the child into the leadership position so that the the narcissistic/(borderline) parent can exploit the child’s symptoms.

5)  Justifying – “I know just how the child feels…”:  The selective incompetence of the allied/pathological parent is often accompanied by a statement of supposed “understanding” for the child’s hostility and rejection of the other parent – “I tell the child to be cooperative, but what can I do, I can’t make the child be cooperative, I’m not there.  And, actually, I know just how the child feels.  The other parent acted just like that with me during our marriage.”

6)  Typical Complaints: The typical complaints regarding the targeted-rejected parent are,

a)  Insensitive to the Child’s Needs: the targeted-rejected parent doesn’t adequately “listen to the child”

b)  Too rigid, inflexible and controlling, the targeted/rejected parent always has to have things his (or her) way

c)  Anger management issues: the targeted-rejected parent has anger management problems;

d) Selfish and self-centered: this allegation combines doesn’t listen to the child and always has to have things his or her own way.

7)   Disregard of Court Orders:  The allied/pathological parent displays a cavalier disregard for the authority of Court orders, so that the targeted-rejected parent must continually return to Court seeking enforcement of Court orders.  This represents the expression of narcissistic personality processes of the allied pathological parent.  Narcissists to not recognize (i.e., perceptually register) the construct of “authority” – only the power to compel.  For the narcissist, the construct of “authority” (such as the Court’s authority) is synonymous with the “power to compel.” If the Court does not compel, then the Court has no authority in the mind of the narcissist.

Note on “Splitting”

The child’s “splitting” symptom is often expressed as an “unforgivable grudge” in which the child maintains that some past parental failure supposedly justifies the child’s rejection of this parent.  One of the leading authorities on borderline personality processes (narcissism is a subset of borderline personality organization), Marsha Linehan describes this “unforgivable grudge” feature of splitting:

“They tend to see reality in polarized categories of “either-or,” rather than “all,” and within a very fixed frame of reference.  For example, it is not uncommon for such individuals to believe that the smallest fault makes it impossible for the person to be “good” inside.  Their rigid cognitive style further limits their abilities to entertain ideas of future change and transition, resulting in feelings of being in an interminable painful situation.  Things once defined do not change. Once a person is “flawed,” for instance, that person will remain flawed forever.”(Linehan, 1993, p. 35; emphasis added)

Linehan, M. M. (1993). Cognitive-behavioral treatment of borderline personality disorder.  New York, NY: Guilford

The American Psychiatric Association (200) defines splitting as,

“Splitting:  The individual deals with emotional conflict or internal or external stressors by compartmentalizing opposite affect states and failing to integrate the positive and negative qualities of the self or others into cohesive images.  Because ambivalent affects cannot be experienced simultaneously, more balanced views and expectations of self or others are excluded from emotional awareness.  Self and object images tend to alternate between polar opposites: exclusively loving, powerful, worthy, nurturant, and kind – or exclusively bad, hateful, angry, destructive, rejecting, or worthless.”  (p. 813; emphasis added)

American Psychiatric Association. (2000). Diagnostic and statistical manual of mental disorders (Revised 4th ed.). Washington, DC: Author.

Splitting is a characteristic feature of both narcissistic and borderline personality organizations, because both of these types of personalities are differing external expressions of the same underlying structures,

“Splitting is an identified symptom of both borderline and narcissistic personality disorders.” (Siegel, 2006, p. 419)

Siegel, J.P. (2006). Dyadic splitting in partner relational disorders. Journal of Family Psychology, 20(3), 418–422.

“Splitting is often thought to be central to pathological narcissism” (Watson & Biderman, 1993,p. 44)

Watson P. J. and Biderman, M.D. (1993). Narcissistic personality inventory factors, splitting, and self-consciousness. Journal of Personality Assessment, 61 (1), 41-57.

Craig Childress, Psy.D.
Licensed Clinical Psychologist, CA PSY 18857

8 thoughts on “Diagnosis of Attachment-Based Parental Alienation”

  1. Dear Dr. Childress,

    Your argument for building a parental alienation model based on the established constructs of attachment theory is impressive and so are your diagnostic criteria. I have witnessed these very behaviors in children empowered by their personality disordered parent to denigrate the other. I have also seen how an alienating parent can easily manipulate the courts, with motions for orders of protection that spark CPS investigations and court appointed special advocates for their children, all of which further empower their sense of entitlement and cement their distrust and hatred of the targeted parent.

    Though the court system is indeed an inappropriate forum for identifying and addressing the needs of targeted parents and their children, even with adoption by our profession and the courts of attachment based parental alienation in the form of a diagnostic DSM or ICD code and no further need to prove its existence to the court, how can we implement a treatment plan that includes the necessary removal of children from the homes and influence of personality disordered alienating parents without the court’s power to enforce such action?

    Respectfully,
    Lynn Seskin, Psy.D.
    New York State Licensed Psychologist

    1. Hello Dr. Seskin,

      I agree with your observations regarding the manipulation of the Court system by the narcissistic/(borderline) parent resulting in both the disempowerment of the targeted parent and the inappropriate over-empowerment of the child.

      In my view, we will need the cooperation of the Court system to effect the solution. To obtain this cooperation, mental health will need to speak with a single voice regarding what is occurring and what the child’s psychological and treatment needs require. This, in turn, will require a theoretical framework for the construct traditionally described as “parental alienation” that is based entirely in established and scientifically supported psychological constructs and principles, so that mental health can end its internal division regarding “parental alienation” and speak with a single voice regarding the severity of the psychopathology involved. When mental health speaks with a single voice, the Court system will be able to act with the decisive clarity necessary to resolve “parental alienation.”

      A full child custody evaluation is not necessary. The issue is NOT one of child custody, the issue is one of CHILD PROTECTION. My position is that a more focused “Treatment Needs Assessment” (see sample in my website article “Proposed Treatment Team Model” at http://www.drcachildress.org) can appropriately and reliably identify the degree of family psychopathology involved.

      With professionally competent mental health practitioners (i.e., these children and families represent a “special population” requiring specialized professional knowledge, training, and expertise to appropriately diagnose and treat, particularly centering around professional expertise in the nature and functioning of the attachment system, and on the nature and functioning of narcissistic and borderline personality disorder processes), a more focused “Treatment Needs Assessment” will be able to provide the Court with the guidance needed.

      Note: Failure to possess the necessary professional knowledge, training, and expertise (regarding the attachment system and personality disorder processes) needed to appropriately diagnose and treat this “special population” of children and families may represent practice beyond the boundaries of professional competence, in violation of professional practice standards.

      Attachment based “parental alienation” involves severely pathogenic parenting by a narcissistic/(borderline) parent that is inducing very serious developmental, personality, and psychiatric symptomatology in the child. In my professional view, the level of psychopathology being acquired by the child through the pathogenic parenting practices of the narcissistic/(borderline) parent warrants a DSM-5 Diagnosis of “V995.51 Child Psychological Abuse, Confirmed,” (or at the very least, “Suspected”) which would require a child protection response from the mental health clinician (i.e., the pathogenic parenting is inducing 1) a severe distortion to the normal-range functioning of the child’s attachment system, 2) prominent development of narcissistic and borderline personality traits in the child, and 3) a delusional belief system is being acquired by the child through the pathogenic parenting of the narcissistic/(borderline) parent that is resulting in the loss to the child of an affectionally bonded relationship with a normal-range and affectionally available parent.

      Personally, if a DSM-5 diagnosis of “V995.51 Child Psychological Abuse, Confirmed” is made based on the presence of the three diagnostic indicators of attachment-based “parental alienation,” then I would suggest that a “Suspected Child Abuse” report be made by the mental health professional to the appropriate child protection agency, recognizing full-well that the workers at the child protection agency are unlikely to know how to evaluate for the presence of child psychological abuse involving pathogenic parenting by a narcissistic/(borderline) parent.

      However, their ignorance should not dissuade more expert clinicians from taking the proper action. Attachment-based parental alienation” is not a child custody issue, it is a child protection issue.

      The pathogenic parenting of the narcissistic/(borderline) parent that is inducing serious developmental, personality, and psychiatric pathology in the child which is severely distorting the healthy developmental trajectory of the child, and that is resulting in the (likely permanent) loss for the child of a relationship with a normal-range and affectionally available parent (who could otherwise provide an invaluable protective psychological buffer to the distorting developmental influence of the psychopathology of the narcissistic/(borderline) parent), represents, in my professional view based on my professional knowledge regarding the critical importance of the attachment system in children’s emotional and psychological development, a DSM-5 diagnosis of “V995.51 Child Psychological Abuse, Confirmed,” which would then warrant a report made to the appropriate child protective service agency under mandated reporting laws.

      As a technical note: The psychological child abuse is being enacted through a role-reversal relationship in which the child is being used as a “regulating other” (see my Child Abuse: Regulating Other blog) for the psychopathology of the narcissistic/(borderline) parent, and the process contains suggestive clinical indicators of a trans-generational iteration of sexual abuse trauma that is being mediated by pathogenic “source code” in the attachment system of the narcissistic/(borderline) parent.

      If my professional suspicions regarding the trans-generational origins of the attachment-based “parental alienation” process are correct, then attachment-based “parental alienation” represents a non-sexualized trans-generational iteration of sexual-psychological child abuse in which the child is being used to meet the psychological needs (i.e., as a “regulating other”) of a narcissistic/(borderline) parent.

      The seemingly bonded and “favored” status of the child’s relationship with the narcissistic/(borderline) parent is NOT an indication of a healthy relationship. In fact, it is quite the opposite. It is instead a reflection of an EXTREMELY distorted parent-child relationship bond (i.e., the psychological “seduction” of the child emanating from the trans-generational iteration of sexual abuse “source code” in the attachment system of the narcissistic/(borderline) parent) that represents a trans-generational iteration of the continuance of child abuse.

      The psychopathology associated with attachment-based “parental alienation” is severe. Attachment-based parental alienation” is not a child custody issue, it is a child protection issue.

      Craig Childress, Psy.D.
      Licensed Clinical Psychologist, CA PSY 18857

    1. I’m sorry to hear of your family’s struggles. The answer to your question is, I don’t know. If you had cancer and asked, “How do I educate the doctor on how to diagnose and treat cancer?” the question in and of itself says you’re in trouble. When patient’s have to educate professionals it’s an upside down world. Ultimately, the solution will require that children and families experiencing this type of issue be granted “special population” status within the profession, which means that diagnosing and treating this special population of children and families will require specialized professional knowledge, training, and expertise for professional competence. Until we achieve that, then there will be far too many incompetent mental heath professionals diagnosing and treating the distorted family processes associated with attachment-based “parental alienation.” I’m sorry, I wish I had a better answer available. I’m doing what I can. Craig Childress, Psy.D.

      1. Thank you so much for replyingg with a REAL answer and thankyou for all the pertinent info. Just reading your work has liberated our vision to confirm our own assessment. Your work brings HOPE that the truth will be revealed and gives good tools to present to the unknowing system agents Even if for whatever reason they do nott respopnd at least they will have been told. …God bless you and all the children that need saving….Jack

      2. Hi again We are sending your professioal to professional letter to the Psychologist. He doesn’t GET IT
        yet…at least he has not responded to many of our inquiries..

        My question is would it be helpful if there was a letter for the Court. I do see reference to Court lack of awareness but wondered if a specific letterwould help….also there are no trained people in our area/state…….Thankyou again…..peace Jack

  2. Thank you for this blog and your clear outlining of how PA operates. We are within the UK court system which, other than in just a very tiny minority of situations, does not recognise PA (more often referred to as Implacable Hostility in this system). I don’t know if you are aware of Karen Woodall of the Centre for Separated Families who is doing great work in this area.
    I would appreciate it if you could post about what is going on for the child when they disown a parent in this way and disengage using these reasons, phrases and arguments. Can you throw any lifelines about what needs to happen for these children to break out of this situation if no outside help is given (or if offered hasn’t been accepted). What goes on in a teenagers head if a lifeline (a court guardian) is put in place by a court but is then used just to further justify the position that the non resident parent is at fault and he only solution is to totally cut off contact?

    1. Hello Cathryn, I believe that one of the primary problems is that the family factors creating “parental alienation” have been defined outside of standard and established psychological principles and constructs. From the perspective of clinical psychology, there is no such thing as “parental alienation” or “implacable hostility.” Neither of these constructs exists within clinical psychology. Trying to define the family processes as “parental alienation” or “implacable hostility” becomes extremely problematic.

      However, the constructs of narcissistic and borderline personality disorders and of cross-generational parent-child coalitions are firmly established psychological principles and constructs. See my blog “Nothing New – No Excuse.” In my view, it is basically irrelevant if the Courts, therapists, and child custody evaluators recognize “parental alienation.” The construct of “parental alienation” doesn’t exist in clinical psychology (note that in all of my writing I put the term “parental alienation” in quotes, because it is not a defined clinical construct). The construct of “parental alienation” is a convenient popular euphemism for a clinical process, it is, however, not a defined clinical construct. BUT the Courts, therapists, and child custody evaluators should all absolutely recognize the constructs of narcissistic and borderline personality dynamics, and the Courts, therapists, and child custody evaluators should all absolutely recognize the construct of cross-generational parent-child coalitions within families, which is a central and defined clinical construct in family systems theory.

      Narcissistic and borderline personalities are defined clinical constructs in the DSM diagnostic system, and a cross-generational parent-child coalition is an established and clearly defined and accepted clinical construct within family systems theory (see the quotes from both of THE two preeminent family systems theorists, Salvador Minuchin and Jay Haley in my post “Nothing New – No Excuse” in which both of these preeminent family systems theorists independently identify and define the construct of a cross-generational parent-child coalition).

      Narcissistic and borderline personalities exist. Cross-generational parent-child coalitions exist. When both exist together, it creates a particularly malignant and virulent form of cross-generational parent-child coalition that results in “cutoff” in family relationships (the clinical term “emotional cutoff” is a defined term in family systems theory by another preeminent family systems theorist, Murray Bowen). Cutoffs in family relationships are considered highly pathological. In the case of the child’s formation of a cross-generation parent-child coalition with a narcissistic/(borderline) parent, the cutoff in the parent-child relationship with a normal-range and affectionally available parent is initiated by the child, which represents an extremely aberrant display of the child’s attachment system.

      In re-defining the construct of “parental alienation” within standard and established psychological constructs, the issue becomes one of “pathogenic parenting” in which the aberrant and distorted parenting practices of the narcissistic/(borderline) parent are inducing significant child psychopathology (i.e., the three diagnostic indicators in the child’s symptom display). The focus shifts from the parenting of the allied and supposedly “favored” parent to the degree of psychopathology evident in the child’s symptom display.

      If the child is not evidencing symptoms of psychopathology, then no worries, everything is normal range and okay. But if the child is evidencing significant developmental psychopathology (diagnostic indicator 1), significant personality psychopathology (diagnostic indicator 2), and significant psychiatric psychopathology (diagnostic indicator 3) then we have a case of pathogenic parenting in which the distorted parenting practices of a narcissistic/(borderline) parent are inducing significant psychopathology in the child. “Parental alienation” is not a child custody issue, it is a child protection issue.

      Nor is “parental alienation” a new or exotic construct, we just need to define it using standard and established psychological principles and constructs. Fine, the Court doesn’t recognize “parental alienation.” Does it recognize the constructs of narcissistic and borderline personality disorders? Does it recognize family systems theory and the construct of a cross-generational parent-child coalition? If it does, and it should, then we can move beyond the present impasse into a productive discussion of child protection issues relative to the child’s induced psychopathology.

      The time is long overdue for a fundamental paradigm shift in how we conceptualize the construct of “parental alienation.” We need to define the construct entirely from within standard and established psychological principles and constructs. An attachment based model of “parental alienation” does this in a sufficiently comprehensive and detailed way to allow the replacement of the current poorly defined construct of “parental alienation” with this alternative attachment-based/personality-disorder-based/family-system-based definition — see my Master’s Lecture Series seminar for California Southern University at

      http://www.calsouthern.edu/content/events/parental-alienation-an-attachment-based-model/.

      Craig Childress, Psy.D.
      Clinical Psychologist, PSY 18857

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