Diagnostic Indicators and Associated Clinical Signs

Diagnostic Indicators

The presence in the child’s symptom display of a characteristic set of three diagnostic indicators represents definitive clinical evidence for the presence of pathogenic parenting by the allied and supposedly “favored” parent as representing the sole cause for the child’s symptomatic rejection of a relationship with the targeted parent.

(for more on the theoretical underpinnings for an attachment-based model of “parental alienation, see Childress, 2013a: “Reconceptualizing Parental Alienation” on my website or my blog post “Three Levels of Analysis”).

The three definitive Diagnostic Indicators for the presence of an attachment-based model of “parental alienation” are:

Criterion 1: Attachment System Suppression

A: The child’s symptom display evidences a selective and targeted suppression of the normal-range functioning of the child’s attachment bonding motivations toward one parent, in which the child seeks to entirely terminate a relationship with this parent (i.e., a child-initiated cutoff in the child’s relationship with a normal-range and affectionally available parent).

B: A clinical assessment of the parenting practices of the rejected parent provides no evidence for severely dysfunctional parenting (such as chronic parental substance abuse, parental violence, or parental sexual abuse of the child) that would account for the child’s desire to completely sever the parent-child bond.

C: The parenting of the targeted-rejected parent is assessed to be broadly normal-range, with due consideration given to the wide spectrum of acceptable parenting practices typically displayed in normal-range families, and with due consideration given to the legitimate exercise of parental prerogatives in establishing family values, including parental prerogatives in the exercise of normal-range parental authority, leadership, and discipline within the parent-child relationship.

Criterion 2: Narcissistic Personality Symptoms

The child’s symptom display toward the targeted-rejected parent evidences a specific set of five narcissistic and borderline personality disorder symptoms that are diagnostically indicative of parental influence on the child by a parent who has narcissistic/(borderline) personality traits. The specific set of narcissistic and borderline personality disorder symptoms displayed by the child toward the targeted-rejected parent are,

Grandiosity: the child displays a grandiose self-perception of occupying an inappropriately elevated status in the family hierarchy above that of the targeted-rejected parent, from which the child feels entitled to sit in judgment of the targeted-rejected parent as both a parent and as a person. (DSM-5 Narcissistic Personality Disorder criterion 1)

Entitlement: an over-empowered sense of child entitlement in which the child expects that his or her desires will be met by the targeted-rejected parent to the child’s satisfaction, and if the rejected parent fails to meet the child’s entitled expectations to the child’s satisfaction, the child feels entitled to enact a retaliatory punishment on the rejected parent for the judged parental failure. (DSM-5 Narcissistic Personality Disorder criterion 5)

Absence of Empathy: a complete absence of empathy for the emotional pain of the targeted-rejected parent that is being caused by the child’s hostility and rejection of this parent. (DSM-5 Narcissistic Personality Disorder criterion 7)

Haughty and Arrogant Attitude: the child displays an attitude of haughty arrogance and contemptuous disdain for the targeted-rejected parent. (DSM-5 Narcissistic Personality Disorder criterion 9)

Splitting: the child evidences the psychological process of splitting involving polarized extremes of attitude, expressed in the child’s symptoms as the differential attitudes the child holds toward his or her parents, in which the supposedly “favored” parent is idealized as the all-good and nurturing parent while the rejected parent is entirely devalued as the all-bad and entirely inadequate parent. (DSM-5 Borderline Personality Disorder criterion 2)

Anxiety Variant

Some children may display extreme and excessive anxiety symptoms toward the targeted-rejected parent rather than narcissistic and borderline personality disorder traits.

In the anxiety variant of attachment-based “parental alienation” the child’s anxiety symptoms will meet DSM-5 diagnostic criteria for a Specific Phobia.

The type of phobia displayed by the child will be a bizarre and unrealistic “father type” or “mother type.”

Criterion 3: Delusional Belief System

The child’s symptoms display an intransigently held, fixed and false belief (i.e., a delusion) regarding the fundamental parental inadequacy of the targeted-rejected parent in which the child characterizes a relationship with the targeted-rejected parent as being emotionally or psychologically “abusive” of the child.

The child may use this fixed and false belief regarding the supposedly “abusive” inadequacy of the targeted parent to justify the child’s rejection the targeted parent (i.e., that the targeted parent “deserves” to be rejected because of the supposedly “abusive” parenting practices of this parent).

The presence of all three symptoms in the child’s symptom display represents definitive diagnostic evidence for the presence of pathogenic parenting emanating from the allied and supposedly “favored” parent as being the direct and sole causal agent for the cutoff of the child’s attachment bonding motivations toward the other parent.

DSM-5 Diagnosis

When this particular symptom set is displayed by the child, the appropriate DSM-5 diagnosis is:

309.4  Adjustment Disorder with mixed disturbance of emotions and conduct

V61.20 Parent-Child Relational Problem

V61.29 Child Affected by Parental Relationship Distress

V995.51 Child Psychological Abuse, Confirmed

(for an analysis of the DSM-5 diagnosis of an attachment-based model of “parental alienation” see “Childress, 2013b: DSM-5 Diagnosis of ‘Parental Alienation’ Processes” on my website)

Response to Intervention

When these diagnostic indicators are sub-threshold for a clinical diagnosis of attachment-based “parental alienation,” then a 6-month Response to Intervention (RTI) trial can be initiated addressing a non-alienation interpretation of the child’s symptomatology to clarify the diagnosis.

The additional presence of the theoretically grounded associated clinical signs of attachment-based “parental alienation” can also help confirm a diagnosis of an attachment-based model of “parental alienation” when the three definitive diagnostic indicators are present but may be sub-threshold for a firm diagnosis of attachment-based “parental alienation.”

Associated Clinical Signs

The diagnosis of pathogenic parenting by the allied and supposedly “favored” parent is made solely on the presence in the child’s symptom display of the three primary diagnostic indicators:

1. Attachment system suppression
2. Five specific narcissistic & borderline personality disorder symptoms
3. The presence of delusional beliefs about the supposedly inadequate parenting of the targeted-rejected parent

Additional associated clinical signs are also often present in attachment-based “parental alienation.” The associated clinical signs, however, are not diagnostic. There are potentially a variety of other factors that can result in the presence of any individual associated clinical sign, and the absence of the associated clinical signs does not influence the diagnosis of pathogenic parenting by the allied and supposedly “favored” parent when the three primary diagnostic indicators of an attachment-based model of “parental alienation” are present in the child’s symptom display.

The diagnosis of pathogenic parenting by the allied and supposedly “favored” parent is made solely on the presence in the child’s symptom display of the three primary diagnostic indicators.

In order to limit the length of this blog post, the following is simply a “Headings” list description of the associated clinical signs, and a more complete elaboration of each clinical sign and the underlying theoretical justification for its presence from within an attachment-based model of “parental alienation” will be described separately in subsequent blog posts for each clinical sign individually.

• Child Empowerment: Efforts by the allied and supposedly “favored” parent to empower the child’s active agency in rejecting the targeted parent by advocating that the child be allowed to “decide” issues related to custody and visitation (“we should listen to the child”), including efforts by the allied and supposedly “favored” parent to have the child testify in Court.

• “Abuse”: The use of the terms “abuse” or “abusive” by the allied and supposedly “favored” parent to inaccurately characterize the parenting practices of the other parent.

• Display of the “Protective Parent” Role: Displays by the allied and supposedly “favored” parent of the coveted role as the all-wonderful protective parent (e.g., “I only want what’s best for the child”), including the display of protective behaviors (e.g., unnecessarily providing the child with food or clothing to take to the other parent’s home) or “retrieval behaviors” (e.g., excessive or hidden phone calls, texts, and emails to the child when the child is in the care of the other parent).

• Child Placed in Front: The allied and supposedly “favored” parent places the child in the leadership position of rejecting a relationship with the other parent, particularly at visitation transfers, and then adopts a “helpless stance” of parental incompetence (e.g., “What can I do, I can’t make the child go on visitations with the other parent.”).

• Shared Victimization: The allied and supposedly “favored” parent and child support each other in their bond of “shared victimization” by the targeted-rejected parent (e.g., “I know just what the child is going through, the other parent treated me the same way during our marriage.”)

• Repeated Disregard of Court Orders: The allied and supposedly “favored” parent repeatedly disregards Court orders for visitation and custody, which requires that the targeted-rejected parent repeatedly return to Court to seek enforcement of prior Court orders.

• Characteristic Themes Offered for the Child’s Rejection:

The Insensitive Parent

• “She always thinks of herself, she never considers what other people want.”
• “It always has to be his way. He never does what I want to do.”

Anger Management

• “He gets angry about the littlest things. He has anger management problems.”
• “She can’t control her temper. She’s always getting angry over nothing.”

Doesn’t Take Responsibility

• “I don’t trust my mother. She’s such a liar. She doesn’t take responsibility for anything she does wrong.”

Vague Personhood

• “I don’t know, it’s just something about the way she says stuff… it’s so irritating… like her tone of voice or something.”
• “He just bothers me. He’ll ask me questions and things. It’s just annoying. I just want him to leave me alone.”

New Romantic Relationship of Parent

• The theme is that the targeted parent is neglecting giving attention to the child because of the parent’s new romantic relationship or spouse
  
• “He is always spending time with his new girlfriend. He doesn’t spend enough special time with just me.” (“… so that’s why I never want to see this parent again, because I want more special time with this parent.” – ???)

The Non-forgivable Grudge

• “I can’t forgive my mother for what she did in the past. I just can’t get over what happened in the past.”
• “She deserves being rejected for what she did in the past”

(the assertion or implication that the targeted parent “deserves” to be punished for some past failure as a parent/(person) is highly characteristic of attachment-based “parental alienation”)

• Vacancy of Attachment System
• Absence of possessive ownership of the parent (e.g., the child refers to the targeted parent by his or her first name, or the child uses the parental label of “mother” or “father” for the step-parent/spouse of allied and supposedly “favored” parent)

• Characteristic Double-Binds for Targeted Parent

Accepting the Rejection

• If the targeted parent does not comply with the child’s desire to discontinue their relationship, then this is used as “evidence” that the rejected parent isn’t being sensitive to what the child wants. (i.e.g, “Maybe I’d want to spend time with my mom if she’d just let me live with my dad.”)
  
• If the targeted parent complies with the child’s expressed desire to discontinue their relationship, then the child (and alienating parent) use the absence of the targeted-rejected parent’s involvement as “evidence” that the targeted parent doesn’t care about the child.

Banishment

• The child banishes the parent from activities
• “I don’t want my mom to come to my dance performance (baseball games, graduation, etc). It just stresses me out and I can’t concentrate.”
• The rejected parent is then placed in a double-bind: Go to the child’s event and be blamed for not being “sensitive” to what the child wants, or don’t go to the event and be blamed for not caring about the child and for not being involved with the child.

Discipline

• The child provokes parental discipline by being rude, defiant, or disrespectful,
• If the targeted parent responds with discipline, then the child (and alienating parent) use this parental disciplinary response as “evidence” of the overly harsh and punitive parenting practices of the targeted-rejected parent, which is then used to justify the child’s rejection of the targeted parent.
• If the targeted-rejected parent ignores or accepts the child’s defiance or verbal abuse, then this is offered as “evidence” of the poor parenting skills of this parent that is causing the child’s behavior problems with this parent.

No Apology

• The child makes the accusation that the targeted-rejected parent never listens to the child’s complaints and/or never apologizes for parental wrongdoing. The child then offers a distorted and inaccurate characterization of a past episode that places the parent in a double-bind:
• If the targeted-rejected parent tries to correct the child’s false and inaccurate characterization of the event, then this is used as “evidence” that the parent doesn’t listen to the child and doesn’t apologize for past wrongdoing.
• If, however, the parent accepts the child’s distorted characterization, or apologizes for his or her parental response (often at the misguided and insistent prompting of the therapist), then this gives credence to the child’s false and distorted characterization of the event, which the child then uses from that point on as “evidence” to justify the child’s hostility and rejection of the targeted parent (“I just can’t forgive him/her for what happened in the past”)

Preponderance of Clinical Evidence

While not diagnostic, the presence of the associated clinical signs of attachment-based “parental alienation” in addition to the three primary diagnostic indicators represents supportive diagnostic evidence. When added to the three primary diagnostic indicators, the presence of additional clinical signs results in the clear preponderance of clinical data all constellating around the same clinical diagnosis of pathogenic parenting associated with an attachment-based model of “parental alienation.”

 Beyond Reasonable Clinical Doubt

The diagnosis of pathogenic parenting by the allied and supposedly “favored” parent creating the child’s symptomatic rejection of a relationship with a normal-range and affectionally available parent is based SOLELY on the diagnostic features evident in the child’s symptom display.

It is NOT NECESSARY to diagnose the allied and supposedly “favored” parent as a having a personality disorder in order to establish pathogenic parenting inducing the child’s symptom display, since there is no other clinical diagnosis available that could account for the features of the child’s symptom display other than pathogenic parenting associated with an attachment-based model of “parental alienation.”

The diagnosis of pathogenic parenting (associated with attachment-based “parental alienation”) is based SOLELY on the child’s symptom display, and the presence in the child’s symptom display of the three characteristic diagnostic indicators of attachment-based “parental alienation” represents definitive clinical evidence for the presence of pathogenic parenting by the allied and supposedly “favored” parent creating the child’s symptomatic rejection of a relationship with the other parent.

Craig Childress, Psy.D.
Psychologist, PSY 18857

References

Childress, C.A. (2013a). Reconceptualizing Parental Alienation: Parental Personality Disorder and the Trans-generational Transmission of Attachment Trauma. Retrieved 11/18/13 from http://www.drcachildress.org/asp/Site/ParentalAlienation/index.asp

Childress, C.A. (2013b). DSM-5 Diagnosis of “Parental Alienation” Processes. Retrieved 11/18/13 from http://www.drcachildress.org/asp/Site/ParentalAlienation/index.asp