Future Considerations for PA and PAS
Proposed Classification of Parental Alienation for the DSM-V

by Dr. Douglas Darnall
Copyright Jan. 2011

Dr. William Bernet (2010) has done an exemplary job compiling research and writing his book, Parental Alienation, DSM-V and ICD-11¹, arguing for the inclusion of parental alienation disorder in the upcoming DSM-V². Dr. Bernet rightfully takes the position that parental alienation disorder is a relationship problem that involves both parents and the child. He advocates that as a relational problem, parental alienation should be a stand alone diagnosis or, at minimum, be specifically defined as a severe parent-child relational problem. 

However, his proposal for the diagnosis is different than what I have described in my book, Beyond Divorce Casualties: Reunifying the Alienated Family³, where I make a distinction between parental alienation and parental alienation syndrome. The argument to support this distinction is that the treatment for the victimized child and the parents differs, though both have to be involved in the treatment or reunification. 

Regarding the terminology for the DSM-V⁴, Dr. Bernet concludes that parental alienation can be conceptualized as either a “mental disorder” or a “relational problem” (a V-code). If parental alienation were adopted as a mental disorder, it might be placed in the DSM-V appendix called “Criteria Sets and Axis for Further Study”. If parental alienation were adopted as a relational problem, it would be included in the DSM-V chapter, “Other Conditions That May Be a Focus of Clinical Attention”. A parent-child relational problem already exists in the DSM-IV-TR (2000)⁵.


Although no decision has been made, Dr. Bernet’s arguments and documentation are very compelling. If accepted by the DSM-V task force⁶, Dr. Bernet’s position that parental alienation constitutes a severe parent-child relational problem that may merit becoming a stand alone diagnosis would not negate the contribution of Beyond Divorce Casualties⁷, which outlines various approaches for reunification. 


Dr. Bernet and I agree that for treatment options to move forward, the phrase “parental alienation” must be published in the DSM-V⁸ to receive the recognition the diagnosis deserves and to quiet many of the critics that have politicized the concept. First, critics often state that making parental alienation a diagnosis within the DSM⁹ would pathologize¹⁰ children unnecessarily, making their behaviors then be labeled a “mental illness”. As well, critics from some women’s groups have stated their fears that fathers will use “parental alienation” as a false accusation against the mothers, while fathers argue that mothers would make false allegations to keep the fathers away from their children. However correct each of these opposing viewpoints may seem, counselors can attest that it is the children involved in parental alienation situations who “suffer tremendously”, according to Reena Sommer^11,12, an authority on PAS. While the issues involved in parental alienation are often split along the sexes, PA and PAS damage the current, ongoing, and future relationships children have with both of their parents, the extended family, and significant others that may enter their lives.

Mental health professionals and the legal community must get beyond the politics and get on with helping children and families. The only way this can happen in the future is for parental alienation to be included in the DSM-V¹³. 

Dr. Bernet states, “Parental alienation disorder should be the diagnosis if the child’s symptoms are persistent enough and severe enough to meet the criteria for that disorder.”¹⁴  Dr. Bernet has taken Dr. Gardner’s (1998)^15,16 criteria for parental alienation syndrome and adapted them to his proposed diagnosis. The strength of the proposed criteria is that the diagnosis takes into account that there will be various severities of the disorder. Although Dr. Gardner did not make this point clear in his writings, not all the criteria are needed to make the diagnosis of parental alienation syndrome.

DIAGNOSTIC CRITERIA FOR PARENTAL ALIENATION DISORDER 
(Dr. Bernet's proposed criteria adapted from Gr. Gardner's list.)

A. The child – usually one whose parents are engaged in a high-conflict divorce – allies himself or herself strongly with one parent and rejects a relationship with the other, alienated parent without legitimate justification. The child resists or refuses contact or parenting time with the alienated parent.

B. The child manifests the following behaviors:

(1) a persistent rejection or denigration of a parent that reaches the level of a campaign
(2) weak, frivolous, and absurd rationalizations for the child’s persistent criticism of the rejected parent

C. The child manifests two or more of the following six attitudes and behaviors: 

(1) lack of ambivalence
(2) independent-thinker phenomenon
(3) reflexive support of one parent against the other
(4) absence of guilt over exploitation of the rejected parent
(5) presence of borrowed scenarios
(6) spread of the animosity toward the rejected parent onto the extended family. 

D. The duration of the disturbance is at least 2 months.

E. The disturbance causes clinically significant distress or impairment in social, academic (occupational), or other important areas of functioning.

F. The child’s refusal to have contact with the rejected parent is without legitimate justification. That is, parental alienation disorder would not be diagnosed if the rejected parent maltreated the child.