Dr. William Bernet is a professor of psychiatry at and his research is in forensic psychiatry, in particular effects of divorce, child custody disputes, child maltreatment, and methodology of distinguishing true vs. false allegations of child sexual abuse. Dr. Bernet is the author of is the author of Parental Alienation, DSM-5, and ICD-11 and other books.
Welcome, Dr. Bernet. We’ve been receiving conflicting information over the past few weeks. Is parental alienation (PA) listed as a disorder in the DSM-5?
The actual words, “parental alienation,” are not in DSM-5. We were told about three years ago that the leadership of the DSM-5 Task Force did not consider PA to be a mental disorder because the condition “is not located in the child.”
They said that PA should be considered a type of relational problem and they pointed out that DSM already had a condition called parent-child relational problem. They thought that PA was simply a type of parent-child relational problem. We responded that the Task Force should state that explicitly in the discussion of parent-child relational problem in DSM-5.
In DSM-5, the description of parent-child relational problem does allude to PA, but unfortunately does not include those actual words. 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. That is, the child attributes negative intentions to almost everything the alienated parent does; the child scapegoats the alienated parent by persistently blaming him or her for every bad happenstance that occurs; and the child experiences unwarranted negative feelings and attitudes toward the alienated parent.
The authors of DSM-5 clearly were describing PA in the discussion of parent-child relational problem, but they went out of their way to avoid using the actual words, “parental alienation.”
The DSM-5 has two important new diagnoses that can also be used by clinical and forensic practitioners in cases involving PA. There is a new diagnosis called child affected by parental relationship distress, which should be used “when the focus of clinical attention is 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 a good description of how PA comes about, in that it describes how children are injured during high-conflict separation and divorce, especially when the parents experience distress and persistently disparage the other parent.
The second new diagnosis in DSM-5 is child psychological abuse, which 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. When these three diagnoses are considered, it is clear that DSM-5 is a great improvement over the previous editions of DSM when it comes to identifying, classifying, and diagnosing PA.
The plan is for DSM to be revised and updated on a continual basis, not just every 20 years, which is why this edition is called DSM-5 rather than DSM-V. In future years, we will see DSM-5.1, DSM-5.2, and so on. As time goes on, we hope that the leadership of DSM-5 will lose some of their resistance to the words “parental alienation.” They are unlikely to adopt a diagnosis of PA with its own separate coding number, but they could easily say that parent-child relational problem or child affected by parental relationship distress sometimes takes the form of PA, and then give a brief definition of PA.
Please explain why it important for PA to be recognized in the DSM.
Why does this matter? (1) To improve clinical care of families affected by PA. Most of the textbooks that are used to teach the next generation of mental health professionals are based on the most recent edition of DSM. If PA is present in DSM – either the concept or the actual words – it is much more likely that mental health students and trainees will learn the causes, manifestations, and treatment for PA. (2) To improve research regarding PA. We need to have consistent definitions of PA, which have proven validity and reliability, in order for research personnel to study the causes, manifestations, and treatment for PA. (3) For legal purposes. We need to move past the era of repeatedly debating in court whether PA really exists. If PA is in DSM, it will usually be accepted in court as a real problem that needs to be addressed.
More about Parental Alienation with Dr. William Bernet, soon.
William Bernet, M.D., a graduate of Harvard Medical School, has lived in Tennessee since 1988. He is a professor emeritus in the Department of Psychiatry at Vanderbilt University School of Medicine. Dr. Bernet is board certified in general psychiatry, child psychiatry, and forensic psychiatry. As an expert in forensic psychiatry, Dr. Bernet has testified in 34 counties in Tennessee and in 18 other states.
Dr. Bernet has published on a variety of subjects, including: group and individ¬ual therapy with children and adolescents; humor in psychother¬apy; forensic child psychiatry; parental alienation; child maltreatment; true and false allegations of abuse; satanic ritual abuse; reincarnation; child custody and visitation; testimony regarding behavioral genomics; and risk management.
In 2001, Dr. Bernet and Dr. John Meeks published The Fragile Alliance: An Orientation to the Psychiatric Treatment of the Adolescent, 5th edition. In 2007, Dr. Bernet and Judge Don R. Ash published Children of Divorce: A Practical Guide for Parents, Therapists, Attorneys, and Judges. In 2010, Dr. Bernet published Parental Alienation, DSM-5, and ICD-11. His next book will be Parental Alienation: The Handbook for Mental Health and Legal Professionals (2013), edited by Demosthenes Lorandos, William Bernet, and Richard Sauber.
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Last reviewed: 17 Jun 2013