Delusions – Encapsulated Delusions – Encapsulated Persecutory Delusions

Google the term “encapsulated delusion.”

“Encapsulated delusion: a delusion that usually relates to one specific topic or belief but does not pervade a person’s life or level of functioning.”

“Encapsulated delusion: An isolated mistaken but unshakable belief in something for which there is neither evidence nor common acceptance, occurring in the absence of other signs or symptoms of psychiatric illness.”

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The American Psychiatric Association defines a persecutory delusion as:

“Persecutory Type: delusions that the person (or someone to whom the person is close) is being malevolently treated in some way.” (APA; 2000)

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A delusion is a fixed and false belief that is maintained despite contrary evidence.

A delusion is a psychotic pathology. At its core, the pathology we are dealing with in attachment-based “parental alienation” (not PAS) is a psychotic pathology involving an encapsulated delusion that the targeted parent represents an abusive threat to the child.

Delusions can be bizarre (such as a delusion that extraterrestrials are implanting thoughts in the patient’s head) or non-bizarre (such as a husband’s delusional belief that his wife is having an affair when she isn’t – called a “jealousy delusion”; APA, 2000).

There is no point in arguing with a delusion because, by definition, the delusion is a false belief that is maintained despite contrary evidence. No amount of contrary evidence will alter the person’s fixed belief system.

What I find so incredibly troubling from a professional standpoint is that so many mental health professionals – whose job it is to diagnose pathology – are absolutely missing the diagnosis of a psychotic pathology that’s sitting right in front of them. That’s astounding to me.

Diagnosing pathology is the job of a mental health professional. For a mental health professional to entirely miss recognizing a psychotic pathology sitting right in front of them in their office represents astounding professional incompetence. I don’t expect a lawyer to recognize psychotic pathology, or an architect, or a policeman, or an engineer. But a mental health professional? That’s exactly our job. Astounding professional incompetence.

For nearly 15 years earlier in my psychology career I worked on a clinical research project at UCLA involving schizophrenia. Every patient in this project was rated every two weeks on their symptoms using a 7-point scale from “not at all present,” through “moderate symptoms,” to “severe symptoms” (the Brief Psychiatric Rating Scale; BPRS).

This symptom rating scale included delusions, called “Unusual Thought Content” on the scale. The cutoff for a delusional belief was a rating of 4 or higher. Below a rating of 4 the patient’s thought content was considered unusual but it was not delusional. Above a rating of 4 the symptom moves into the realm of a delusion.

In order to maintain inter-rater reliability among all the clinicians who were rating patients’ symptoms, every year we had to go through “reliability training” with the Diagnostic Unit located at the VA. This involved a series of lectures from the head of the Diagnostic Unit regarding symptom features and then we each had to watch and rate 10 videos (new videos each year). Our ratings for these 10 videos were then compared with the “gold standard” ratings made by the head of the Diagnostic Unit. If we achieved 90% consistency with the head of the Diagnostic Unit then we were considered reliable symptom raters. If we did not achieve 90% consistency in our ratings with those of the head of the Diagnostic Unit, then we received additional training and rated additional videos until we achieved 90% consistency.

For 15 years I went through this yearly reliability training on rating symptoms on a 1-7 scale, learning the fine-grained analysis of what made a symptom a 3 or a 4 – what the difference was between a severity rating of a 5 or a 6. When was an unusual thought odd but normal-range, and when does it cross the line into a delusional belief… what features of a symptom elevate it from a mild delusion (a rating of 4) to a moderate delusional belief (a rating of 5) or a severe delusional belief (a rating of 6 or 7).

For fifteen years, every year, I underwent training on 10 videos comparing my ratings with the “gold standard” ratings made by the head of the Diagnostic Unit for a major longitudinal research project at UCLA on schizophrenia.

I know what a delusion looks like. The pathology of “parental alienation” (as described in Foundations, not by PAS) represents a delusion.

The professional term for this type of delusion is an encapsulated persecutory delusion. As noted above, the American Psychiatric Association defines a persecutory delusion as:

“Persecutory Type: delusions that the person (or someone to whom the person is close) is being malevolently treated in some way.” (APA; 2000)

In the case of attachment-based “parental alienation” the persecutory delusion centers around “someone to whom the person is close” – i.e., the child.

Beck & Rector (2002) describe the delusional process:

“The pathogenic belief has taken control of the information processing so that the interpretations of events show a systematic bias and appear to others to be contradictory to the evidence or to logic.” (p. 457)

“The dominant beliefs and consequently the interpretations are relatively impervious to reality-testing by the patient. The patient is unwilling or unable to consider that his ideas and interpretations might be wrong. In psychiatric terms, he lacks insight.” (p. 457)

Delusion. Encapsulated delusion. Encapsulated persecutory delusion. Psychotic.

We are dealing with a psychotic level of pathology. That’s what everyone needs to understand.

In our day-to-day lives, people don’t generally expect to run into psychotic distortions to reality. We generally assume that other people are relatively anchored in our same shared reality. But with this particular form of pathology that assumption is NOT warranted.

Delusion. Encapsulated delusion. Encapsulated persecutory delusion. Psychotic.

For 15 years I underwent yearly reliability training at UCLA in rating delusions on a 1-7 scale of severity. I know what a delusion looks like. The pathology of “parental alienation” represents the manifestation of a delusional belief system. An encapsulated persecutory delusional belief system.

Psychotic pathology.

The accurate diagnosis of this pathology using the ICD-10 diagnostic system of the World Heath Organization is F24: Shared Psychotic Disorder.

The accurate diagnosis of this pathology using the DSM-IV TR diagnostic system of the American Psychiatric Association is 297.3 Shared Psychotic Disorder.

The accurate diagnosis of this pathology using the DSM-5 diagnostic system is V995.51 Child Psychological Abuse, Confirmed.

According to the DSM-IV TR diagnostic description for a Shared Psychotic Disorder:

“Usually the primary case in Shared Psychotic Disorder is dominant in the relationship and gradually imposes the delusional system on the more passive and initially healthy second person. Individuals who come to share delusional beliefs are often related by blood or marriage and have lived together for a long time, sometimes in relative isolation. If the relationship with the primary case is interrupted, the delusional beliefs of the other individual usually diminish or disappear. Although most commonly seen in relationships of only two people, Shared Psychotic Disorder can occur in larger number of individuals, especially in family situations in which the parent is the primary case and the children, sometimes to varying degrees, adopt the parent’s delusional beliefs.” (p. 333; empahsis added)

Let that sink in…

“…especially in family situations in which the parent is the primary case and the children, sometimes to varying degrees, adopt the parent’s delusional beliefs” – the American Psychiatric Association.

Delusion. Encapsulated delusion. Encapsulated persecutory delusion. Psychotic.

According to the DSM-IV TR diagnostic description of the course of a Shared Psychotic Disorder:

“Without intervention, the course is usually chronic, because this disorder most commonly occurs in relationships that are long-standing and resistant to change. With separation from the primary case, the individual’s delusional beliefs disappear, sometimes quickly and sometimes quite slowly.” (p. 333; emphasis added)

Diagnosis guides treatment.

The core of the delusional process in attachment-based “parental alienation” is the false trauma reenactment narrative of the psychologically decompensating narcissistic/(borderline) parent which is contained in the pattern “abusive parent”/”victimized child”/”protective parent.” 

This false trauma reenactment narrative is contained in the internal working models (Bowlby) of the parent’s attachment networks from their own childhood trauma experience.

The internal working models of attachment described by Bowlby are referred to as “schemas” by the renowned psychiatrist, Aaron Beck (2004):

“How a situation is evaluated depends in part, at least, on the relevant underlying beliefs.  These beliefs are embedded in more or less stable structures, labeled “schemas,” that select and synthesize incoming data.” (Beck et al., 2004, p. 17)

“The content of the schemas may deal with personal relationships, such as attitudes toward the self or others, or impersonal categories.” (Beck et al., 2004, p. 27)

“When schemas are latent, they are not participating in information processing; when activated they channel cognitive processing from the earliest to the final stages.” (Beck et al., 2004, p. 27)

“In personality disorders, the schemas are part of normal, everyday processing of information.” (Beck et al., 2004, p. 27)

“Arntz (1994) hypothesized that childhood traumas underlie the formation of core schemas, which in their turn, lead to the development of BPD.” (Beck et al., 2004, p 192)

“Young’s schema model… patients with BPD were characterized by higher self-reports of beliefs, emotions, and behaviors related to the four pathogenic BPD modes (detached protector, abandoned/abused child, angry child, and punitive parent mode)” (Beck et al., 2004, p. 192)

“The conceptualization of the core pathology of BPD as stemming from a highly frightened, abused child who is left alone in a malevolent world, longing for safety and help but distrustful because of fear of further abuse and abandonment, is highly related to the model developed by Young (McGinn & Young, 1996)… Young elaborated on an idea, in the 1980s introduced by Aaron Beck in clinical workshops (D.M. Clark, personal communication), that some pathological states of patients with BPD are a sort of regression into intense emotional states experienced as a child.  Young conceptualized such states as schema modes.” (Beck et al., 2004, p. 199)

“Young hypothesized that four schema modes are central to BPD: the abandoned child mode (the present author suggests to label it the abused and abandoned child); the angry/impulsive child mode; the punitive parent mode, and the detached protector mode… The abused and abandoned child mode denotes the desperate state the patient may be in related to (threatened) abandonment and abuse the patient has experienced as a child.  Typical core beliefs are that other people are malevolent, cannot be trusted, and will abandon or punish you, especially when you become intimate with them.” (Beck et al., 2004, p. 199; emphasis added)

This is not Dr. Childress making these statements, this is Aaron Beck, one of the preeminent psychiatrists in mental health making these statements.

Internal working models (schemas) of attachment trauma:

“abusive parent” – “victimized child” – “protective parent”

Current targeted parent – current child – current narcissistic/(borderline) parent.

There is a one-to-one psychological correspondence between the internal working models (schemas) in the attachment networks of the narcissistic/(borderline) parent to the current family relationships.

“Abusive parent” = targeted parent
“Victimized child” = current child
“Protective parent” = narcissistic/(borderline) parent

The trauma reenactment narrative.

Delusion. Encapsulated delusion. Encapsulated persecutory delusion. Psychotic.

That’s the pathology we’re dealing with.

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

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

Beck, A. T., & Rector, N. A. (2002). Delusions: A cognitive perspective. Journal of Cognitive Psychotherapy, 16(4), 455-468.

Beck, A.T., Freeman, A., Davis, D.D., & Associates (2004). Cognitive therapy of personality disorders. (2nd edition). New York: Guilford.