Most psychologists agree the least understood -- and often most destructive -- type of child abuse is emotional. Considered the most difficult abuse to diagnose and prevent, its scars are not physical but invisible, with profound, far-reaching consequences.

There is growing interest in a less-well-known type of emotional child abuse known as Parental Alienation Syndrome (PAS). “PAS is a serious form of child abuse” (Cartwright, 1998) with a general consensus regarding the most prominent behavioral symptoms (Gardner, 1989; Rand, 1997; Darnall, 2001; Kelly and Johnston, 2001; Warshak, 2001; Major, 2004; Andre, 2004) defining the mental illness.

This article seeks to increase awareness of PAS as a mental illness form resulting from emotional abuse, and to suggest PAS' inclusion in The Diagnostic and Statistical Manual of Mental Disorders-V (DSM-V).

PARENTAL ALIENATION SYNDROME (PAS)

History

PAS has been referenced by concept in the literature for at least twenty-five years. Wallerstein and Kelley (1980) first noted a pathological alignment between an angry divorcing parent and his/her child. Gardner (1985) further delineated this problematic alignment as occurring between a brainwashing parent with a contributing child, naming the alignment Parental Alienation Syndrome and articulating its symptoms.

Symptoms and psychological dimensions

In its mildest form, PAS may be observed as a child’s reluctance to visit a parent. In its severest form, PAS children “use extreme oppositional behaviors to reject and denigrate the previously loved parent. ... The children’s perceptions are black and white. The targeted parent …is hated for seemingly small or ridiculous reasons” (Andre, 2004).

PAS alienators lie about their brainwashing while empowering their children to behave irresponsibly toward the other parent. Alienators attempt to mislead evaluators, using deceitful accusation tactics to deflect intervention.

Discerning an alienator's true intent requires a trained professional. Just as child sexual predators “groom” their child victims, so alienators groom children by testing for compliance. Common themes are the other parent is crazy, bad, or to be feared (Clawar and Rivlin, 1991). The child endures scenarios in which “correct” responses are rewarded and “incorrect” responses punished.

Children aligned with alienators are taught to tell half-truths and lies. Bone and Walsh (1999) state PAS childrens’ lies are “survival strategies that they are forced to learn to …avoid emotional attacks from the alienating parent.”

Clawar and Rivlin's (1991) research indicates alienators use persuasive techniques and brainwashing tools to isolate children from other family members. Alienators promote denial of the child’s other parent by deliberately refusing to acknowledge the other parent at social events or in the child’s presence. Alienators also rewrite history, causing the child to doubt his/her perception of reality, making the child more vulnerable to the alienator's distortions.

PAS is emotional abuse

Cartwright (1998) stated, “PAS is a serious form of child abuse.” When an alienator isolates a child from another parent through programming techniques and control, harm and symptoms of mental illness result. Emotional abuse results when an alienator controls a child’s beliefs through rejection and fear.

Bone and Walsh (1999) state “healthy and established parental relationships do not erode naturally of their own accord. They must be attacked.” It is emotional abuse when an alienating parent attacks the other parent-child bond intending to destroy it.

Emotional abuse's consequences

Childhood abuse's emotional effects are well documented. Consequences include perpetuating abuse into the next generation for those who remain unaware, low self-esteem, self-destructive behaviors, anger, aggression, cruelty, depression, anxiety, and post-traumatic stress.

Emotionally abused children affect society's structure. They risk becoming mentally ill adults who hate, fear, lie, and engage in antisocial behavior. Kraizer (2004) writes, “Evidence is mounting that child mistreatment is the precursor to many of the major social problems in this culture.” The U.S. Advisory Board (1990) suggests our society's survival depends on protecting children from harm.

Clawar and Rivlin’s (1991) research indicates even mild PAS cases need intervention and “have significant effects.” Traditional talk psychotherapies are ineffective in severe cases, which require deprogramming therapies for successful intervention.

Occurrence

Conservatively, there are potentially 50,000 new PAS cases annually with half a million new children under age 18 experiencing or being at risk for PAS (Andre, 2004).

Interventions lacking

Despite the large number of divorce program interventions available in the literature, few are PAS-specific. The number of intervention programs tripled between 1994 and 1999 (Arbuthnot, 2002), suggesting rapidly growing interest in PAS.

PAS AND THE DSM-V

One reason for few PAS intervention programs may be its lack of inclusion in the Diagnostic and Statistical Manual (DSM-IV), an important diagnostic tool for naming disorders, determining differential diagnosis and diagnostic validity, and providing research uniformity.

Because PAS is not in the DSM-IV, there is no uniform diagnostic criteria or even an agreed-upon name. Rand (1997) pointed out there is a “body of divorce research and clinical writings which, without a name, describe” PAS.

DSM exclusion leads to misunderstanding

PAS' exclusion is sometimes considered evidence of its nonexistence by those lacking understanding of the DSM's evolution. Since its first publication in 1952, the DSM has undergone four major revisions, each attempting to reflect the time's accepted thinking. However, PAS' exclusion from the DSM does not mean it doesn't exist (Warshak, 2003).

Its time has come

Cartwright (2002) stated there were “133 peer reviewed articles, and 66 legal citations from courts of law” recognizing PAS. Articles continue to be added to the professional literature; there may already be a comprehensive database from which to answer a DSM-V workgroup's questions.

Conclusion

PAS is a form of child abuse with potentially severe consequences. A substantial body of peer-reviewed literature indicates PAS is a valid and distinct disorder. Inclusion in the DSM-V would provide the legitimacy PAS warrants, and clarify the conceptual framework, as well as the psychological and behavioral dimensions for diagnosis, research and treatment.

The American Psychiatric Association DSM-V Prelude Project committee has a website, www.dsm5.org/suggestions, for the user community to submit suggestions for the next DSM.

We must ensure our nomenclature systems reflect current understanding of mental illness by asking a workgroup review PAS for inclusion in the DSM-V.

References

Arbuthnot, J. (2002). A call unheeded: Courts’ perceived obstacles to establishing divorce education programs. Family Court Review, 40,371-382.

Andre, K. (2004). Parental alienation syndrome. Annals of The American Psychotherapy Association, 7, 7-11.

Bone, J.M. and Walsh, M.R. (1999). Parental alienation syndrome: How to detect it and what to do about it. The Florida Bar Journal. 73.44-48 [Retrieved electronically; www.fact.on.ca/Info/pas/walsh99.htm].

Cartwright, C. (1998). Brief to the special joint committee on child custody and access. [Retrieved from] www.education.mcgill/ ca/profs/cartwright/papers/pasbrf01.htm.

Cartwright (2002). The changing face of parental alienation. Paper presented at the symposium: the parliamentary report for the sake of the children. Ottawa.

Clawar, S. and Rivlin, B. (1991). Children Held Hostage. Chicago: American Bar Association.

Darnall, D. (1998). Divorce Casualties.Lanham, MD: Taylor Trade Publishing.

Duryee, M. (2003). Expected Controversies: Legacies of Divorce. Journal for the Center for Families, Children and the Courts. 149-160.

Gardner, R. (1985). Recent trends in divorce and custody litigation. Academy Forum. 29, 3-7.

Gardner, R. (1989). Family evaluation in child custody, medication, arbitration, and litigation. Cresskill, N.J.: Creative Therapeutics.

Gardner (2001). The empowerment of children in the development of parental alienation syndrome. [Retrieved electronically; http://rgardner.com/refs/arl4.lml].

Kelly, J. and Johnston, J. (2001). The alienated child: A reformulation of parental alienation syndrome. Family Court Review. 39, 249-266.

Kraizer, Sherryll (2004). Online; www.safechild.org/abuse.htm.

Major, J.A. (2003). Parents who have successfully fought parent alienation. [Retrieved electronically; www.breakthroughparenting.com/PAS.htm.1-15].

Rand, D. (1997). The spectrum of parental alienation syndrome (part I). American Journal of Forensic Psychology. 20,5-29.

Wallerstein, J. and Kelly, J. (1980). Surviving the break-up: How children and parents cope with divorce. NY: Basic Books.

Warshak, R. (2001). Divorce Poison. NY: Regan Books.

Warshak, R. (2003).Bringing sense to parental alienation. Family Law Quarterly, 37, 273-301.

About the author

Dr. Katherine C. Andre is a licensed psychologist in private practice in Lakeport. She chairs the Lake County Mental Health Advisory Board, is a Diplomat in The American Psychotherapy Association and in Division 12 of The American Psychological Association. For 10 years she worked as a Lake County Superior Court family mediator, where she encountered PAS firsthand.