Diagnostic Indicators & Associated Clinical Signs for an Attachment-Based Model of “Parental Alienation” (AB-PA)

There are three Diagnostic Indicators that will always be present in an attachment-based model of “parental alienation” (AB-PA),

1) Attachment Suppression: the child will show suppression of attachment bonding motivations toward a normal-range parent.

2) High Protest Behavior: the child will evidence either high-anger protest (DI-2a) diagnostically defined as the presence of five specific narcissistic personality traits, and/or high-anxiety protest (DI-2b) as defined by meeting DSM-5 diagnostic criteria for a Specific Phobia with the parent as the target.

3) Persecutory Delusion: the child will evidence a persecutory delusion toward a normal-range parent.

A normal-range parent is diagnostically defined as a rating from the assessing mental health professional as either Level 3 (Normal-Range Problematic) or Level 4 (Normal-Range Healthy) parenting on the Parenting Practices Rating Scale.

Abusive-range parenting is diagnostically defined as a rating from the assessing mental health professional as either Level 2 (Highly Problematic) or Level 1 (Abusive) parenting on the Parenting Practices Rating Scale.

In addition to the three Diagnostic Indicators of AB-PA that are always present, there are also 12 Associated Clinical Signs which, while not always present, are often present surrounding the shared persecutory delusion of AB-PA.

ACS-1: Use of the Word “Forced”

This symptom represents a manipulative communication used to disable efforts to resolve the child’s symptoms by disempowering any attempts to change the child’s views and behavior.

    • The child shouldn’t be “forced” to have a relationship with the other parent.
    • “What can I do? I can’t “force” the child to go on visitations with the other parent.” (“…get in the car”, etc.)

The accurate reframing of the situation actual situation is that the child is being given the “opportunity” to have a bonded relationship with both parents.

ACS 2: Empowering the child:

The child is empowered by the allied parent to reject the other parent.

ACS-1 and ACS-2 are typically used in tandem; we should not influence the child (ACS-1) and the child should be allowed to decide (ACS-2).

    • “The child should decide on visitation”
    • “We need to listen to the child”
    • Seeking the child’s testimony in court, empowering the child to reject the parent directly to the judge

ACS 3: “The Exclusion Demand”

The child seeks to exclude the targeted parent from the child’s activities (sporting events, award ceremonies, music recitals).

    • The child’s role is as a “regulatory object” to stabilize the narcissistic/(borderline) parent.
    • The narcissistic/(borderline) parent becomes dysregulated when the targeted parent attends the child’s activities, and the child feels the stress of keeping the narcissistic/(borderline) parent regulated.
    • It is the allied parent who wants to exclude the other parent, and the child is then manipulated as the “regulatory object” to achieve the parent’s objectives.

This symptom is not present in any other pathology and is not present in normal-range children. When this symptom is present, it is nearly 100% diagnostic of AB-PA.

ACS 4: Parental Replacement

The child rejects ownership of the targeted parent, either by calling the targeted parent by his or her first name or by calling the new step-parent spouse of the allied narcissistic/(borderline) parent by the parental appellations of “mom” or “dad.”

This never happens with an authentic child attachment system.  When the symptom of Parental Replacement is present, it is nearly 100% diagnostic of AB-PA.

ACS 5:  The “Unforgivable Event”

A negative past event is used as justification for all current and future rejection of the targeted parent.

This is a feature of the symptom of splitting:

From Linehan: “It is not uncommon for such individuals to believe that the smallest fault makes it impossible for the person to be “good” inside. Things once defined do not change.  Once a person is “flawed,” for instance, that person will remain flawed forever.” (Linehan, 1993, p. 35)

ACS 6:  Liar– “Fake”

The child claims that the targeted parent is “fake” or that the targeted parent is a liar, often said when responding to the parent’s sadness or love.

This symptom arises from the child’s efforts to cope with the child’s guilt for rejecting a beloved and loving parent. The child seeks to discount the authenticity of the parent’s sadness and loss (and the authenticity of the child’s own sadness and loss).

ACS 7:  Themes for rejection

A characteristic set of reasons are offered for the rejection of the parent:

    • Too controlling
    • Too angry – anger management problems
    • Targeted parent doesn’t take responsibility – doesn’t apologize
    • New romantic relationship neglects the child
    • Prior neglect of the child by the parent
    • Vague personhood
    • Non-forgivable grudge
    • Not adequately feeding the child

ACS 8:   Unwarranted Use of the Word “Abuse”

The allied parent (or child) uses the word “abuse” to describe the normal-range parenting practices of the targeted parent. Borderline personalities frequently characterize other people’s normal-range actions using the term “abusive.”  Normal-range people typically use less inflammatory words to characterize disagreements with others.

    • Using the word “abuse” has two differential diagnostic possibilities: 1) authentic abuse, 2) borderline personality pathology.

The unwarranted use of the word “abuse” originates in the unresolved childhood of the pathological parent that currently distorts perceptions of current interactions.

ACS 9:   Excessive texting

The child and the allied parent maintain almost continual contact while the child is with the targeted parent.

The child acts as a “regulatory object” for the fragile personality structure of the narcissistic/(borderline) parent, who becomes excessively anxious when separated from the child (because the child might bond with the targeted parent). Intrusion into the other parent’s time prevents bonding to this parent and regulates the anxiety of the narcissistic/(borderline) parent.

ACS 10:  Role-reversal use of the child

The allied parent abdicates parental decision making to the child, placing the child out front as supposedly wanting what the allied parent wants.

    • “It’s not me, it’s the child who wants…”

The narcissistic/(borderline) parent first manipulates the child’s desire and then hides their manipulation behind the child’s supposed “independent” decision (“It’s not me, it’s the child who…”).

ACS 11:  The parent “deserves” to be rejected

The child and the allied narcissistic/(borderline) parent both maintain the theme that the targeted parent “deserves” to be rejected.

This represents a classic spousal abuse theme (“of course I hit her, my dinner was cold, she deserved to be hit”). When challenged on the cruelty done to the targeted parent by the child’s angry-hostile rejection, the response of the child and targeted parent is that the targeted parent “deserves” to be rejected (the narcissistic value of justifying abuse and cruelty toward another person).

Note: the healthy value we teach is that we are not nice to other people because of who they are, we are nice because of who we are. This is the healthy counter-value to the narcissistic value that it is okay to be cruel as long as the target of our “deserves” it for some justification.

ACS 12:  Disregard of court orders

The narcissistic personality does not recognize the construct of “authority” – for the narcissistic personality “authority” is synonymous with “power.”

This symptom represents narcissistic entitlement, i.e., that they are exempt from rules that govern other ‘ordinary’ people (i.e., they’re ‘special’).

From Beck et al: “Narcissistic individuals also use power and entitlement as evidence of superiority… As a means of demonstrating their power, narcissists may alter boundaries, make unilateral decisions, control others, and determine exceptions to rules that apply to other, ordinary people.” (Beck, et al., 2004, p. 251)


The 12 ACS offer additional supporting symptoms for the diagnosis when the three Diagnostic Indicators of AB-PA are present. A general interpretation for the degree of support offered by the Associated Clinical Signs identified for the family would be:

2-3 ACS: Mild Support

4-5 ACS: Moderate Degree of Support

6-8 ACS: High Degree of Support

9-12 ACS: Extremely High Degree of Support

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

One thought on “Diagnostic Indicators & Associated Clinical Signs for an Attachment-Based Model of “Parental Alienation” (AB-PA)”

  1. Excellent article. Children are young adults now and have experienced all of the above. Also therapist but not much help when they do not understand ABPA. People in power know but refuse to think of it as abuse. So it goes on and on. Children become adults controlled maybe forever by allied parent. Too bad .
    Nice to hear from you! Best Wishes!

Leave a Reply

Fill in your details below or click an icon to log in:

WordPress.com Logo

You are commenting using your WordPress.com account. Log Out /  Change )

Facebook photo

You are commenting using your Facebook account. Log Out /  Change )

Connecting to %s