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