Diagnosis, Karen. Diagnosis.

Well, I had so much hope that when Karen identified her “new pathology” as a Dissociative Identity Disorder (multiple personality) that she had finally returned to established constructs for describing pathology – you know, the ideas and terms that EVERYBODY else in professional psychology uses.

I was wrong.  She’s wandering back into her grandiosity on her more recent blog, again.  She is using professional terms incorrectly – not in their established definitions.  In doing that, she is creating confusion.  She needs to stick to reality. (Karen’s blog).

A fixed and false belief that is maintained despite contrary evidence.  In the case of elevated self-opinion “without commensurate background” it would be considered a grandiose delusion.  Did I mention that grandiose delusions are associated with two pathologies, a grandiose delusion is a “mood-congruent” psychotic delusion in mania, so a biplolar disorder with psychotic features is one place they occur, and a grandiose delusion is associated with narcissistic personality pathology.

From Millon:  “Free to wander in their private world of fiction, narcissists may lose touch with reality, lose their sense of proportion, and begin to think along peculiar and deviant lines.” (Millon, 2011, p. 415)

Millon. T. (2011). Disorders of Personality: Introducing a DSM/ICD Spectrum from Normal to Abnormal. Hoboken: Wiley.

Karen is not only wandering in the world of making up new forms of pathology, she’s now starting to make up new forms of treatment for the new forms of pathology she’s making up.  She’s entirely making everything up, just her, making stuff up.  Listen to her.  She’s making up a new pathology, entirely on her own, and now she’s making up a new treatment for this new pathology she’s making up, entirely on her own.

That’s not professional practice, Karen.  In professional practice, we apply knowledge, we don’t simply make it up on our own because our ideas make us feel warm and fuzzy.  Karen, however… appears to believe she is exempt from this requirement for applying knowledge, and instead considers herself entitled to make up new pathologies and new treatments entirely on her own, because I guess she believes that truth and reality are whatever she asserts them to be.

No, Karen, there is actual truth and there is actual reality.  We’re leaving Wonderland, Karen.  No more summer croquet parties on the lawn, no more afternoon tea with friends, no more hookah smoking caterpillars pontificating about the world.  Reality Karen.  There is an actual reality.

Karen, have you ever heard of the concept of diagnosis?   Serious question, Karen.  Have you ever heard of diagnosis?  Because you are nowhere close yet to actually diagnosing the pathology you’re treating.

Say you have a bad tummy pain and go to your doctor? Does the doctor diagnose you with this new pathology that the doctor is just discovering, Tummy Pain Disorder, or do they diagnose you with Appendicitis?  Does your doctor then treat you with a new form of therapy they’ve created for Tummy Pain Disorder, or does your doctor treat you for Appendicitis?

Which would you prefer as a patient, Karen?  Would you like your physician to diagnose and treat your Tummy Pain Disorder with a new treatment, both of which your doctor just created, or Appendicitis with established treatment?  I think most humans who live in reality would prefer a real diagnosis and real treatment.

But you like your Tummy Pain Disorder, don’t you, Karen.  What are you calling it? Traumatic Spitting, a dissociative identity disorder of a “split” personality – it’s called an Dissociative Identity Disorder by every other mental health professional on the planet, except you Karen.  Do you think that might be a tad confusing for people, when you don’t use professional language in any agreed-upon definitions within professional psychology, but just kind of go making up your own definitions for the words that already HAVE definitions, just not the ones you’re using, do you think that will add to clarity… or confusion?

You know who Aaron Beck is, right Karen, the guy who’s the the grand-high kahuna of CBT therapy?  He’s also heavily involved in CBT cognitive therapy for personality disorders.  Linehan is over in the CBT model with her Dialectic Behavior Therapy for borderline personality pathology.  Listen to what Beck says about the sense of entitlement surrounding narcissistic pathology

From Beck:  “Another conditional assumption of power is the belief of exemption from normal rules and laws, even the laws of science and nature.” (p. 251-252)

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

“exemption from normal rules” – like diagnosis, Karen?

Are you exempt from diagnosing your patients, Karen?  You’re creating a new pathology, you are not diagnosing your patients.  Upset Tummy Disorder is not a replacement diagnosis for Appendicitis.  And creating new therapies when you haven’t even diagnosed the pathology first is extremely questionable professional practice, Karen.

Have you ever heard of diagnosis?  What is the DSM-5 or ICD-10 diagnosis for this “Traumatic Splitting” pathology you’re creating, Karen, your Tummy Pain Disorder?

But, hey, I’m never adverse to a stroll through Wonderland, we always meet such interesting characters, let’s see who we’ll meet on this stroll.  So let’s just walk along with Karen for awhile, shhh, let’s not disrupt her grandiose delusion, she’s having such fun with it.  Not only does it allow her to make up diagnoses willy nilly, apparently she feels entitled to make up treatments now willy nilly too.  She’s having such good fun.

Now, that’s special, developing new treatments for new pathologies she thinks she’s “discovering.”  Oh my goodness.   In developing a “new treatment” for a “new pathology” that she’s “discovering,” Karen Woodall enters the pantheon of the most elite figures of professional psychology who described new pathology and developed new forms of therapy; Sigmund Freud, Carl Rogers, B.F. Skinner, Aaron Beck. Salvador Minuchin… and Karen Woodall.

Thanks so much, Karen.  We needed a new form of psychotherapy. The psychotherapy we had from all of the previous great minds of professional psychology simply weren’t enough… we needed you.  Thank you for bestowing your magnificence upon us, Karen, and for leading all of professional psychology from the darkness of our ignorance into the magnificence our your brilliance.

Thank you, Karen.

DSM-5 Narcissistic Personality Disorder Criterion 3: “Believes that he or she is “special” and unique.”

That’s quite a special thing you’re doing for all of us, Karen, discovering this pathology that no one has ever seen before, and then developing a new therapy for it.  My, that seems like such hard work.  Thank you Karen.  I don’t think there’s anyone else who could have understood this pathology at such depth, wow, you’re special, and to develop a whole new form of therapy, like Freud and psychoanalysis or Minuchin and family systems therapy, or Aaron Beck and CBT… and now you, Karen Woodall.  Wow.  You’re like… unique, aren’t you.  Well maybe not totally unique, you’re like Freud or Minuchin or Beck unique.  One of the elite of all time.

DSM-5 Narcissistic Personality Disorder Criterion 4: Requires excessive admiration.

Thank you, Karen. Thank from all of professional psychology for coming to our rescue in our darkness and ignorance.  We needed you, and you came.  I can’t tell you how grateful we all are to have your magnificence, Karen.  I don’t think there’s another person on that planet would could have “discovered” this new pathology of… what is it again?  Right, Traumatic Splitting.

DSM-5 Narcissistic Personality Disorder Criterion 5: Has a sense of entitlement.

Question.  Karen.  Have you ever heard of this concept called “diagnosis”?  The application of established knowledge to a set of symptoms.  Diagnosis.

Now, I really appreciate what you’re doing for all of us here in professional clinical psychology and all, developing these wonderful new insights into this new form of pathology, and coming up with these new forms of treatment entirely on your own.  That’s great.  Thanks so much for doing that, and for leading us all out of the darkness of our ignorance and into your light made manifest before us as you spread your magnificence with all the world.

Thanks for that, great job, only you could be so wonderful, thanks for saving us.

But my question… have you ever heard of diagnosis?  You know, applying established constructs to a set of symptoms.  Like say… the DSM-5.

You see, with the DSM-5 we stay anchored in symptoms.  We don’t go wandering into worlds of strange stuff, anybody’s strange stuff, not even Freud’s, or Skinner’s, or Minuchin’s.  No one’s theories.  It’s all anchored on symptoms.  That’s what diagnosis is, ever heard of it?

Like for Major Depression.  The DSM-5 lists 8 symptoms for a depressive episode.  If the patient displays five of the eight, then they have a DSM-5 diagnosis of Major Depressive Disorder.  Six of nine symptoms of hyperactivity, the child has ADHD.  Five personality disorder traits, that’s a personality disorder.  See how that works, that diagnosis thing.

There’s a certain set of symptoms specified, “operationally defined” it’s called, and then there is a specified cutoff identified, a criterion number of symptoms needed for the diagnosis.  Below that number – no diagnosis.  Above that number – diagnosis.

Anywhere close to that with your “Traumatic Splitting” disorder there, Karen?  You know, identifying the symptom set and the cutoff criteria… oh, and the research base.  New pathology proposals require research bases like ADHD and autism.  I’m looking forward to yours to support this new Traumatic Splitting dissociative identity pathology you’re proposing.

It’s all symptom driven, diagnosis is.  That’s what makes it so wonderful in anchoring us.  What are the symptoms?  We always start by identifying, with a fair degree of operationally defined specificity, the symptoms.  If all psychologists and mental health people are going to reliably identify a symptom, it has to be described with enough specificity that we call all do that, all the time.  That’s important with diagnosis.  If our symptom descriptions allow too much latitude for interpretation, then our diagnostic model collapses.

Like for a Narcissistic Personality Disorder, DSM-5 Criterion 1…

DSM-5 Narcissistic Personality Disorder Criterion 1:  Has grandiose sense of self-importance

What’s a “grandiose sense”?  Well, that could be open to interpretation.  Me, for example, I think I am an exceptionally good clinical psychologist.  Is that grandiose, or just self-confidence?  But say I thought I was discovering some new scientific breakthrough that wasn’t really a breakthrough, it was just me making stuff up and thinking I was “discovering” something, would that be a “grandiose sense” of my own self-importance?  If I thought everybody needed to listen to me because of my special “new discovery” I’m making up, now I’m not simply claiming to be just a good psychologist, I’m a wonderfully special psychologist apart from other ordinary everyday kinds of psychologists, I’m superior, like I’m some kind of “expert” or something.  Would I have a “grandiose sense” of my own self-importance then?

So you can see where some degree of interpretation comes into the symptom’s identification, but the DSM-5 provides a clear set of symptoms, as clear as they can possibly be made (that’s why they provide a lot of descriptive comment in the text for each diagnostic pathology and a huge research base that the diagnostician can refer to for understanding the symptom features of the diagnostic label).

So Karen, what we do with diagnosis is we start with some structured diagnostic model, most people use the DSM system of the American Psychiatric Association, or the ICD system of the World Health Organization is also commonly used.   The American Psychiatric Association and WHO have worked together to mostly line up the two diagnostic systems, the DSM and ICD, there’s only a few, but important, discrepancies.  For example, the ICD has a diagnosis for a Shared Delusional Disorder, F24, but the DSM does not, they dropped their diagnosis of a shared delusional disorder from the DSM-5 that they previously had in the DSM-IV.

That’s a subtle, but very important difference in the DSM and ICD systems.  The ICD diagnostic system of the World Health Organization assigns all professionally established medical and psychiatric diagnoses a code number.  So it’s sort of the grand-bible of all recognized medical and psychiatric pathologies, each one has a code number. The ICD-10 has a code for a shared delusional disorder; F24… and, here’s the interesting thing, the ICD-10 diagnostic system is THE required diagnostic system for ALL insurance billing in the United States.

All insurance billing requires an ICD-10, not a DSM-5 diagnosis.  That switched over that way a few years ago.  Before that, before the switch, the U.S. used the DSM system and Europe used the ICD system.  The ICD system though, also covers all medical pathologies like cancer and heart disease diagnoses, everything, all possible medical and psychiatric pathologies… that’s the ICD.   The DSM is just psychiatric.  But because it’s from the American Psychiatric Association, the DSM diagnostic system provides a more fully identified and more fully described set of diagnostic pathologies.  The ICD describes a diagnostic category in one or two paragraphs, the DSM describes the diagnostic pathology in five or ten pages.

Insurance billing for medical diagnoses has always used the ICD system, because that’s a comprehensive system for identifying all types of medical diagnoses.  But in the U.S. the insurance companies went American and used the American Psychiatric Association DSM diagnostic codes for billing the treatment of mental health diagnoses.  Well, somewhere a decade ago or so, the insurance companies finally said enough, we’re switching to the ICD for all coding of diagonses.  They gave everyone plenty of warning, so the ICD and DSM set about lining up their codes.  The rollout of a partial switch happened with the ICD-9, and a full switch to the ICD-10 was mandatory for all insurance billing for mental health pathology.

So in the U.S. and in Europe, all mental health professionals have diagnostic access to the ICD-10 diagnosis of F-24, a shared delusional disorder, and since there is no current corresponding diagnostic category in the DSM-5 for that ICD-10 code, that means we should turn to the DSM-IV when this diagnostic category WAS still in the DSM system.  The DSM diagnostic system of the American Psychiatric Association had a diagnostic category corresponding to an ICD-10 diagnosis of a shared delusional disorder, but they dropped it for the DSM-5, they moved it to a “specifier” rather than a stand-alone diagnostic category, which essentially makes it diagnostically inaccessible in actual practice.

But a shared delusional disorder was in the DSM-IV, it’s called a Shared Psychotic Disorder.  Listen to this description of the diagnostic pathology by the American Psychiatric Association.

From the DSM-IV:  “The essential features of Shared Psychotic Disorder (Folie a Deux) is a delusion that develops in an individual who is involved in a close relationship with another person (sometimes termed the “inducer” or “the primary case”) who already has a Psychotic Disorder with prominent delusions (Criteria A).” (p. 332)

That fits this pathology, doesn’t it?  The allied parent has the persecutory delusion (the primary case; the “inducer”) and the child is the secondary case and acquires the persecutory delusion from the allied parent.  A parent-child relationship qualifies as a “close relationship,” so far so good.

From  the DSM-IV:  “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.” (p. 333)

Still fits.  The allied parent, the “primary case,” is in a dominant parental role with the child, “gradually imposes” yes, that’s exactly what’s happening, “more passive and initially healthy” that’s the child, yes still fits, “often related by blood” yes, “and have lived together for a long time” yes, in “relative isolation” in the family, yes.  So we’re still spot-on in the diagnostic pathology description.

Now here’s an interesting statement from the American Psychiatric Association because it carries treatment implications.  It was a communication from the diagnostic committee of the American Psychiatric Association to the diagnosing professionals… if you’re seeing this pathology, this is what typically helps…

From the DSM-IV:  “If the relationship with the primary case is interrupted, the delusional beliefs of the other individual usually diminish or disappear.” (p. 333)

A protective separation of the child from the “primary case” of the persecutory delusional pathology is the treatment recommendation offered by the American Psychiatric Association for a shared delusional disorder.  Works for me. I’m not going to argue with the American Psychiatric Association when they come up with their diagnoses.  You tell me.  I apply the criteria to make a diagnosis.

From the DSM-IV:  “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)

A shared delusion can occur “especially in family situations” we still have a complete fit of diagnosis pattern, “in which the parent is the primary case” yes, “and the children, to varying degrees, adopt the parent’s delusional beliefs” yes.

We have a full and complete fit for this child-family pathology with the diagnostic description provided by the American Psychiatric Association.  Diagnosis is symptom-driven, not theory driven.  There are no theories in the DSM, there are symptoms and diagnostic categories for defined patterns of symptoms.

But let’s look even further at what the American Psychiatric Association says about exactly this pathology;

From the DSM-IV Associated Features and Disorders:  “Aside from the delusional beliefs, behavior is usually not otherwise odd or unusual in Shared Psychotic Disorder.” (p. 333)

Yes, the child is functioning okay at school, there’s no overt or “otherwise odd or unusual” behavior from the parent or child.  The diagnostic description still fits exactly, without deviation from the description for a shared delusional disorder diagnosis in the DSM-IV.

From the DSM-IV:  “Impairment is often less severe in individuals with Shared Psychotic Disorder than in the primary case.” (p. 333)

The allied parent is more pathological than the child, yes.

From the DSM-IV:  Prevalence:  “Little systematic information about the prevalence of Shared Psychotic Disorder is available. This disorder is rare in clinical settings, although it has been argued that some cases go unrecognized.” (p. 333)

Yes, all of court-involved family conflict has gone “unrecognized” – yes.

From the DSM-IV Course: “Without intervention, the course is usually chronic, because this disorder most commonly occurs in relationships that are long-standing and resistant to change.” (p. 333)

Again, spot on.  The parent-child conflict with the targeted parent is “chronic,” “long-standing,” and “resistant to change,” yes, yes, yes.

According to the American Psychiatric Association, this pathology MUST receive treatment and it will NOT be resolved by waiting for something to change.

So… American Psychiatric Association, any recommendations about treatment?

From the DSM-IV:  “With separation from the primary case, the individual’s delusional beliefs disappear, sometimes quickly and sometimes quite slowly.” (p. 333)

So you, the American Psychiatric Association, are recommending a protective separation of the child from the “primary case” in a shared delusional disorder diagnosis, that’s what you, the American Psychiatric Association are recommending for treatment?  A protective separation.  The American Psychiatric Association.

If this pattern of symptoms lines up with the symptoms being displayed, you’re saying, the American Psychiatric Association is saying, that there MUST be treatment or else the situation will remain “chronic,” “long-standing,” and “resistant to change,” and that the treatment should be the child’s protective “separation from the primary case” – the treatment recommendation of the American Psychiatric Association for a DSM-IV diagnosis of a shared parent-child delusional disorder is the child’s protective separation from the “primary case” of the allied narcissistic-borderline parent.

Karen.

The DSM-IV was superseded by the DSM-5 in 2013.  Remember that?  Sure you do.  Bill Bernet and you, and all the Gardnerian PAS “experts” were putting on a major push to the American Psychiatric Association, trying to get your beloved Gardnerian “parental alienation” pathology mentioned somewhere, anywhere, in the DSM-5.  You just wanted them to use the word somewhere.  So you presented them with all your decades-long “research” and your diagnostic proposals for the pathology.

Remember that?  By the way, what’d they say? Oh, that’s right, “No.”

Do you remember what I was arguing back in that 2012 run-up period to the DSM-5.  I was seriously concerned that they were going to monkey with the Narcissistic personality category, which they ALMOST did, the new proposal for personality disorders went into an Appendix, whew, that was close – and I was also arguing that we needed to keep the Shared Delusional Disorder diagnosis.  That we should be focused on that diagnosis, on keeping that DSM diagnosis.  Remember that?

That was where we should have been putting our focus with the DSM-5, not on some “new pathology” – I mean seriously, holy cow – look at that Shared Delusion diagnosis, spot-on every criteria, leading to a protective separation recommendation made by the American Psychiatric Association.  The moment we – as mental health professionals – give that diagnosis, the moment we do that, the American Psychiatric Association makes a treatment recommendation for the child’s protective “separation from the primary case” BASED on our diagnosis.  Wow.  Simple.  Give that diagnosis.  It absolutely 100%  applies criteria-by-criteria, give that DSM-IV diagnosis and immediately get a recommendation from the American Psychiatric Association for a protective  “separation from the primary case” based – based – on my diagnosis.

That is immense power in diagnosis alone.  Karen, isn’t that amazing?  If you had just been diagnosing the pathology, think of all the wonderful things.

But, instead, your Gardnerian PAS “experts” group led by Bill Bernet went all-in on “parental alienation” and we lost the Shared Delusional pathology from the DSM-5, it got shifted to a “specifier” rather than a diagnosis, and we lost all the descriptive information about the pathology.  Shame.

You know when the American Psychiatric Association told you “No” to your new pathology of “parental alienation” idea, they’re telling you something, Karen.  You’re not listening.  They are telling you that diagnostically, whatever you think you have going on… it’s already in the DSM.  Already there.  You’re just not doing a good diagnostic job.  That’s what they’re telling you, Karen.  You are a bad diagnostician, the pathology you think you’re “discovering” is already in the DSM – you’re just a bad diagnostician.

Go back to the symptoms, and organize them up by DSM category.  You can do that, right Karen?  Not by your willy nilly ideas.  Organize the symptoms into the patterns described in the DSM diagnostic system, and if the symptoms line up with something, give that diagnosis.  And you see, there is it, Karen, it IS in the DSM after all.  You just weren’t doing your job of diagnosis.

You skipped the step of diagnosis.  Instead of diagnosing the pathology, you went running off into your fertile imagination of creating “new” pathologies.

And yet… and here is the truly disturbing part… you treated the pathology, without having first diagnosed the pathology. Oh my goodness, Karen, you DO realize that the treatment for cancer is different than the treatment for diabetes, don’t you? How can you possibly treat a pathology when you haven’t even first diagnosed what it is you’re treating?

That’s insane, Karen.  To treat a pathology you haven’t even diagnosed yet.  You have no idea what it is you’re even treating.

No, that can’t be.  That’s absurd.  You would NEVER treat a pathology for 20 years without EVER having diagnosed what the pathology is that you’re treating.  That’s laughable.  You’d never do that.  The treatment for cancer is different than that treatment for diabetes, you’d never just start treating something without first diagnosing what it is.

You’ve clearly been using the DSM-IV diagnosis of a Shared Psychotic Disorder extensively during your work, first as a DSM-IV diagnosis and now as an ICD-10 diagnosis.

So, let’s see, the DSM-IV came out in 2000, the DSM-5 in 2013, so the active period for the DSM-IV and the Shared Psychotic Disorder diagnosis was from 2000 to 2013 and you’ve been twenty years treating this court-involved family conflict stuff, so pretty much the entire time you’ve been treating this pathology, the DSM-IV was the active diagnostic system.

And oh my goodness, the spot-on accurate diagnosis of a Shared Psychotic Disorder is right there, in the DSM-IV, and it makes a recommendation, from the American Psychiatric Association for a protective “separation from the primary case” – what’s your clinic called, Karen, oh, that’s right, the Separation Clinic – and the APA is saying… authorizing you, Karen Woodall, to recommend a protective separation of the child from the “primary case” of a shared persecutory delusional disorder, because that’s what the American Psychiatric Association recommends based on your diagnosis Karen in applying their diagnostic criteria from the DSM-IV.

So clearly and obviously you’ve been diagnosing this pathology as a Shared Psychotic Disorder pretty much your entire career, haven’t you?  Because you wouldn’t start treating something that you hadn’t even diagnosed yet? That’s absurd. No one would do that.  Would your physician just start treating you for something without having first diagnosed what’s wrong.  That’s an absurd suggestion.  No rational human would do that, just start treating something without having diagnosed it first.  My goodness gracious, the treatment for cancer is different that the treatment for diabetes.  No one would do that.

So… if the diagnostic entity of a Shared Psychotic Disorder has been in existence your entire career working with this pathology, first as a DSM-IV diagnosis and now as an ICD-10 diagnosis, I’m sure you’ve made this diagnosis countless times, and argued on behalf of your clients, the targeted parents, countless times that a protective “separation from the primary case” of the shared persecutory delusional disorder is the treatment recommendation from the American Psychiatric Association for your diagnosis.

Haven’t you.  Sure you have.  You must have.  Because you wouldn’t possibly treat something you haven’t even diagnosed yet. That’s absurd, nobody treats something without first diagnosing what it is they’re treating.  So you must have used this DSM-5 and ICD-10 diagnosis countless times before, right Karen.

What’s been the response when you share the protective separation recommendation of the American Psychiatric Association for your diagnosis?  I’ll bet your targeted parent clients really appreciated getting that diagnosis from you, didn’t they.  Must of helped them a lot when they went to seek a protective separation order from the court, to have your DSM-IV or ICD-10 diagnosis of a Shared Psychotic Disorder and the recommendation of the American Psychiatric Association for a protective separation order based on your DSM-IV or ICD-10 diagnosis.

I’ll bet your targeted parent clients were pretty happy about that, weren’t they Karen.

All you have to do is give the diagnosis, Karen, and immediately the power of the American Psychiatric Association recommending the child’s protective “separation from the primary case” becomes available to you and to the targeted-rejected parent.  So surely you must have given this DSM-IV diagnosis countless times across your 20-year career that spans the exact period of this diagnosis in the DSM-IV, a Shared Psychotic Disorder.

I’m sure you’ll agree, Karen, lucky for us the ICD-10 kept the diagnosis of a Shared Psychotic Disorder, F24.  Whew.  Now we just give that ICD-10 diagnosis, and since there isn’t a corresponding diagnosis in the DSM-5, we turn to the corresponding description from the DSM-IV for this pathology, and we still maintain our access to the DSM-IV descritors for the pathology.  Whew, that was close, wasn’t it Karen.  I’ll bet you’re as relieved about that as I am.

As you remember, Karen, I only became active over here with this court-involved family conflict pathology starting around the 2012 period, at the time I was posting a lot of stuff to my website on the personality disorder linkages, that’s what I was unlocking during that 2012 period.  You can still see all my early stuff up on my website, I posted the DSM-IV Shared Psychotic Criteria to my website.  It’s still up there:

DSM-IV TR Shared Psychotic Disorder Criteria

I leave everything I post up there, so if I’m posting DSM-IV TR diagnostic criteria, you know this is pre-2013 when the DSM-5 came out.

So you can see how I come over here to this pathology and I immediately start hitting the DSM-IV diagnosis of a shared delusional belief, a Shared Psychotic Disorder.  I’m a little worried by the intensity of the diagnostic label as “Psychotic” – it is, but it can be disorienting to someone unfamiliar with psychosis – it’s not running around crazy lunatic psychosis, it’s more contained, it’s a delusion, a false and distorted thinking pattern, persecutory, jealousy delusions, eroto-manic (the movie-star stalker).  An encapsulated pocket of delusional belief that’s shared between two people in a close relationship, the “primary case” creates the shared delusion in the secondary case, the formerly healthy person.

So no sooner than I get over here than I’m starting to highlight the DSM-IV pathology of the shared delusional disorder.   It’s a diagnosis.  I give every patient a diagnosis.  How can I possibly develop a treatment plan if I don’t know what I’m treating.  That is absurd.  So obviously I start with a diagnosis, and I have a DSM-IV diagnosis of Shared Psychotic Disorder spot-on describing this pathology, and with a protective “separation from the primary case” of the allied parent as the treatment-oriented recommendation of the American Psychiatric Association for my diagnosis.

I’m the one making the diagnosis.  There is no “peer review” of my DSM-IV diagnosis – apply the DSM criteria to symptoms, pattern match, make the diagnosis.  Pretty goll darn straightforward.

What’s forensic psychology’s malfunction about diagnosis? Oh, they openly say, “We don’t diagnose anything (identifying what the problem is) because we don’t like placing labels on people.”   Well that’s the nuttiest thing I ever heard.   We’ll have to address their nuttiness around diagnosis at some point.

You do realize mental health people, that we are mental health people, we’re the ones who are supposed to be diagnosing pathology.   Plumbers aren’t.  They’re supposed to fix our plumbing.  Attorneys aren’t.  They argue our cases for us in court.  Hmmm, who is it that’s tasked with the professional obligation of diagnosing pathology, oh, right, the mental health professional.

So if I’m starting with this DSM-IV diagnosis back in 2010-2012, and you’ve already been here and been established with your Separation Clinic, Karen, for what, ten years by that point.  So clearly you’ve been using this DSM-IV diagnosis lots and lots by that point.   Because, holy cow, Karen, the American Psychiatric Association is recommending a protective “separation from the primary case” based solely on your diagnosis.  If someone challenges your diagnosis, they’re welcome to get a second opinion.  Our diagnosis is our diagnosis.  We apply criteria, we match pattern, we make diagnosis.

You know that, Karen.  You know the power we have in diagnosis, right?  You do diagnose pathology, right Karen?

You see how I walked through step-by-step, sentence-by-sentence, the diagnostic descriptions of the DSM-IV.  It all applies spot-on.  So clearly, Karen, as an “expert” in this pathology with 20 years of experience that spans the exact period of the DSM-IV and the Shared Psychotic Disorder, you surely have given this DSM-IV diagnosis countless times, and argued for a protective separation of the child from the “primary case” of the shared perscutory delusional disorder, the allied parent, many-many times, based on the treatment recommendations made by the American Psychiatric Association based on your diagnosis, right Karen?  .

So tell us, what was it like to apply this DSM-IV diagnosis, what happened?  Because surely you wouldn’t treat a pathology without having first diagnosed what it is, the treatment for cancer is entirely different than the treatment for diabetes, so that’s just absurd that you would skip diagnosing a pathology and would just jump into treating something that you had no idea what it even was.  So you clearly have been applying the diagnosis of a Shared Psychotic Disorder a lot.

It’s still in the ICD-10 too, F24.  Lucky for us and targeted parents, right Karen.  So now we can keep using it as our formal diagnosis by just switching to the ICD-10 system and referencing back to the DSM-IV (because there’s no corresponding DSM-5 diagnosis for ICD-10 F24 Shared Psychotic Disorder).

Whew, I think you’ll agree with me that we’re lucky the ICD-10 kept the Shared Psychotic diagnosis.  I’ll bet targeted parents are thrilled when you tell them, that based on our diagnosis alone, the American Psychiatric Association will recommend the child’s protective separation from the allied narcissistic-borderline parent.  They must be so happy to hear that.

Because, as you and I both know, it’s all based on our diagnosis.  You do know how to diagnose something, don’t you Karen?  I mean, you wouldn’t treat something for twenty years without ever having diagnosed what it is you’re treating.

I see you’ve been traveling a lot, talking to people, educating them about this pathology.  That’s great.  Tell us, what’s been their reaction when you tell them about the ICD-10 diagnosis and protective separation recommendation of the APA based solely on your individual diagnosis.  Pretty excited I bet.  What about when you tell them that if they apply the three diagnostic criteria of AB-PA that are grounded in Bowlby, Minuchin, Beck, then the DSM-5 diagnosis – our current DSM- the DSM-5 diagnosis is V995.51 Child Psychological Abuse, Confirmed.  I’ll bet they go through the roof with excitement when you tell them that.  You do tell them that the pathology is diagnosable using the DSM-5 and AB-PA as Child Psychological Abuse, don’t you?.

They must be so excited to hear that.  What’s been their response when you tell them about the Shared Psychotic Disorder diagnosis and the Child Psychological Abuse diagnosis available through AB-PA?  I can only imagine their excitement at hearing about this.

Imagine… all this time people have been saying this “parental alienation” pathology isn’t in the DSM-IV or DSM-5.  Of course it is, right Karen.  In the DSM-IV it was a Shared Psychotic Disorder, and in the DSM-5 it’s Child Psychological Abuse, page 719.  Boy, I’ll bet they are so happy to hear that when you explain that to them. Of course the pathology is already in the DSM, we just have to diagnose it properly, right Karen.

But… I’m confused, Karen.  If they’ve been saying “parental alienation” is not in the DSM all this time, and you’ve known that it is actually in the DSM this whole time, as a shared delusion of a Shared Psychotic Disorder, why didn’t you clear up their confusion? Of course it’s in the DSM-IV, it’s a Shared Psychotic Disorder. Why didn’t you say something, Karen?

You do know how to diagnose pathology, right Karen? And you certainly wouldn’t start treating something before you diagnosed what it was, right Karen?  So why didn’t you correct them and point out that this pathology is in the DSM-IV, as a shared delusional disorder, with the American Psychiatric Association recommending a protective separation of the child from the allied “primary case” of the persecutory delusion?  What did they say when you pointed that out to them, Karen, that it IS in the DSM-IV?

Or does your role as a grandiose self-appointed “expert” in a supposedly new form of pathology exempt you from the requirements of diagnosis, Karen?  You’re special because of your special knowledge, you’re not bound by the same standards of professional practice for diagnosis as everyone else, us average psychologists, because you’re an “expert” – you get to skip actually diagnosing pathology, you get to just make up stuff… because.  Because you’re just entitled to do that, right Karen.

These people you’re educating on your travels must be so excited when you tell them about diagnosis.  I can imagine their amazement when they learn that this power of our diagnosis, that we’ve had it this whole time.  Wow, that must be something, when they hear that.

You do diagnose before you treat pathology, don’t you Karen? Tell me that you do diagnose a pathology before you begin to treat it – DSM-5; ICD-10.

And seriously, Karen, isn’t that American Psychiatric Association recommendation for a protective separation from the “primary case” wonderful.  You and I both know how useful that can be for targeted parents in presenting their cases to the court, to have a direct quote from the American Psychiatric Association recommending a protective “separation from the primary case” based solely on your DSM-IV/ICD-10 diagnosis of F24 Shared Psychotic Disorder.

Everyone must be so excited when you tell them this about diagnosis.  But you’ve known all this all along, haven’t you Karen.  Because you certainly wouldn’t treat a pathology that you haven’t even diagnosed yet.  That’d be absurd.  No one does that.  The treatment for cancer is different than the treatment for diabetes, you have to diagnose a pathology first, to know what the treatment plan is.  Right, Karen?

Of course. That would be absurd. Right, Karen.

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