I recently had an interesting discussion at one of the courthouses about Parental Alienation. The issue for the moment was whether PA was considered “real” from a clinical point of view, and whether the DSM had a diagnostic category for Parental Alienation. As these matters go, the discussion was spirited, and my mind went to the efforts of those like Dr. Bernet and Amy Baker, who made efforts to include diagnostic codes for PA in the newest DSM updates. Here is a summary, below:
PA : It is a term used by mental health and legal professionals to describe both a complex form of child psychological abuse (i.e., isolating, exploiting/corrupting, terrorizing) and a diagnostic label for identifying a pathologically disturbed parent-child relationship between an alienating parent and a child victim.
- CHILD PSYCHOLOGICAL ABUSE: Parental alienation meets the standard definitions for child psychological and emotional abuse including those of: The Diagnostic and Statistical Manual of Mental Disorders Fifth Edition (DSM-5) and The American Professional Society on the Abuse of Children (APSAC) Handbook of Child Maltreatment Fourth Edition:
- The DSM-5 defines “child psychological abuse” as any “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.”
- DIAGNOSTIC LABEL: The DSM-5 (2013) has two diagnostic codes which can be used for the diagnosis of parental alienation:
- On page 715 of the DSM-5, the code V61.20 (Z62.820) can be used in settings where a child presents with “unwarranted feelings of estrangement” toward the target parent which is primarily due to the alienating parent’s use of “excessive parental pressure” or “parental overprotection” or “hostility toward” [the target parent] or “scapegoating” [of the target parent] in front of the child.The label for this code is “Parent-Child Relational Problem.” Z62.820 “is a billable/specific ICD-10-CM code that can be used to indicate a diagnosis for reimbursement purposes.” It is important to note that “unwarranted feelings of estrangement” due to “excessive parental pressure” are specific diagnostic indicators of parental alienation.
- On page 716 of the DSM-5 manual, the code V61.29 (Z62.898) can be used to help mental health professionals identify, treat, and prevent parental alienation symptoms and its sequelae in cases where “the negative effects of parental relationship discord (e.g., high levels of conflict, distress, or disparagement)” involved a concerted effort by one parent to harm or destroy the children’s relationship with the other parent. The label for this code is: “Child Affected by Relationship Distress.” Z62.898 is a billable/specific ICD-10-CM code that can be used to indicate a diagnosis for reimbursement purposes. It is important to note that when children are negatively affected by parental relationship distress “the reactions of the child may include the onset or exacerbation of psychological symptoms, somatic complaints, an internal loyalty conflict, and, in the extreme, parental alienation, leading to loss of a parent-child relationship.” Typically, “a child affected by parental relationship distress displays impaired functioning in behavioral, cognitive, affective, and / or physical domains. Examples of behavioral problems include oppositionality and the child’s reluctance or refusal to have a relationship with a parent without a good reason (parental alienation).”
[American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders fifth edition. Washington, DC: