Hello PASG Colleagues
Finally, DSM-5 was published today. The DSM-5 Task Force told us 2 or 3 years ago that they did not want parental alienation to be a separate diagnosis in DSM-5, but they thought that parental alienation could be considered an example of other diagnoses that are in DSM-5.
The actual words "parental alienation" are not in DSM-5, but there are several diagnoses that can be used in these cases. I would say the "spirit" of parental alienation is in DSM-5, even if the words are not.
Parent-child relational problem now has a discussion in DSM-5, not just a label. The discussion explains that cognitive problems in parent-child relational problem "may include negative attributions of the other's intentions, hostility toward or scapegoating of the other, and unwarranted feelings of estrangement." That is a pretty good description of a child's view of the alienated parent, although it is an unfortunate use of the word "estrangement."
Child psychological abuse is a new diagnosis in DSM-5. It is defined as "nonaccidental verbal or symbolic acts by a child's parent or caregiver that result, or have reasonable potential to result, in significant psychological harm to the child." In many instances, the behavior of the alienating parent constitutes child psychological abuse.
Child affected by parental relationship distress is another new diagnosis in DSM-5. It should be used "when the focus of clinical attention if the negative effects of parental relationship discord (e.g., high levels of conflict, distress, or disparagement) on a child in the family, including effects on the child's mental or other physical disorders." That is also a good description of how parental alienation comes about.
Factitious disorder imposed on another is the DSM-5 terminology for factitious disorder by proxy or Munchausen disorder by proxy. Its definition is "falsification of physical or psychological signs or symptoms, or induction of injury or disease, in another, associated with identified deception." In some cases, that would describe the behavior of the alienating parent.
Delusional symptoms in partner of individual with delusional disorder is the DSM-5 terminology for shared psychotic disorder or folie a deux. The definition is: "In the context of a relationship, the delusional material from the dominant partner provides content for delusional belief by the individual who may not otherwise entirely meet criteria for delusional disorder."
In discussing this topic, I would say that the concept of parental alienation is clearly in DSM-5, although the actual words are not. This is a great improvement over DSM-IV-TR, especially with the addition of the new diagnoses, child psychological abuse and child affected by parental relationship distress.
Best wishes, Bill
William Bernet, M.D.
Professor Emeritus, Department of Psychiatry
Vanderbilt University School of Medicine
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