Diagnosing PA/PAS

This week we at Pychlaw.net will continue to discuss last week’s topic on PA. Future research will likely show that some of the eight criteria are more important than others.  It may be that some criteria will be dropped or modified.  It may be that new criteria will be identified and added.  The criteria for many psychological disorders – including well known conditions such as autism and attention-deficit/hyperactivity disorder – have evolved based on the results of extensive field trials and on-going research.

 The child’s symptoms that define PA – refusal to see one of the parents, a campaign of denigration, hatred that is unjustified and disproportionate to the circumstances, etc. – are usually just the tip of an iceberg of maladaptive attitudes and destructive behaviors.  PA is a powerful psychosocial force that leads the child to develop comorbid emotional problems, troublesome and often deviant behaviors, and impaired interpersonal relationships.  Mental diagnoses often are identified in alienated children including conduct disorders, mood disorders, substance abuse, and personality disturbances.

Johnston, Walters, and Olesen (2005) found that “alienated children had more emotional and behavioral problems of clinically significant proportions compared to their non alienated counterparts.”  Johnston (2005) said that alienated children “are likely to be more troubled – more emotionally dependent, less socially competent, have problematic self-esteem (either low or defensively high), poor reality testing, lack the capacity for ambivalence, and are prone to enmeshment or splitting in relations with others.”  She also noted:

Severely alienated children also are likely to manifest serious conduct disorders and can behave very inappropriately, at least in the presence of the rejected parent. Extreme expressions of hatred, rage, contempt, and hostility can be acted out in rudeness, swearing, and cursing, hanging up the phone, spitting at or striking a parent, sabotaging or destroying property, stealing, lying, and spying on the rejected parent.

                        

Summarizing a great deal of the research, Fidler and Bala (2010) explained that data consistently shows that alienated children are at risk for emotional distress and adjustment difficulties and at much greater risk than children from litigating families who are not alienated.  They reported that clinical observations, case reviews, and both qualitative and empirical studies uniformly indicate that alienated children may exhibit: poor reality testing, illogical cognitive operations, simplistic and rigid information processing, inaccurate or distorted interpersonal perceptions, disturbed and compromised interpersonal functioning, self-hatred, low self-esteem or inflated self-esteem or omnipotence, pseudo-maturity, gender-identity problems, poor differentiation of self or enmeshed relationships, aggression and conduct disorders; disregard for social norms and authority, poor impulse control, emotional constriction, passivity, or dependency, and lack of remorse or guilt. 

 The principle that family-of-origin relations influence future relationships and life adjustment is the foundation of several schools of developmental psychology.  There are many studies that document long-term psychological damage associated with alienation and estrangement.   Wallerstein and Blakeslee (1989) exclaimed that they had “seen a great deal of evidence that Medea-like anger severely injures children at every age.”  They added:

When one or both parents act the Medea role, children are affected for years to come.  Some grow up with warped consciences, having learned how to manipulate people as the result of their parents’ behavior.  Some grow up with enormous rage, having understood that they were used as weapons.  Some grow up guilty, with low self-esteem and recurrent depression. (p. 196)

                                                                                                                        

       Johnston, J. R., Walters, M. G., & Olesen, N. W. (2005). The Psychological Functioning of Alienated Children in Custody Disputing Families: An Exploratory Study. American Journal of Forensic Psychology, 23(3), 39-64. 

Fidler, B. J., & Bala, N. (2010). Children resisting post-separation contact with a parent: Concepts, controversies, and conundrums. Family Court Review, 48(1), 10-47. 

  Wallerstein, J. S., & Blakeslee, S. (1989). Second Chances: Men, Women, and Children a Decade After Divorce. New York, NY: Ticknor & Fields.

Diagnosing PAS

The most widely accepted criteria for the diagnosis of PAS that we at PsychLaw.net have found was originally published by Gardner (1985, 1992), who wrote that children with PAS manifested some or all of eight characteristic behaviors.  We have adapted Gardner’s eight criteria for the diagnosis of PA, as we use the term in this blog.  It is important to emphasize that the diagnosis of PA is based upon the level of symptoms in the child, not on the symptom level of the alienating parent.

         It should be noted that some children are more susceptible than others to the indoctrination promulgated by the alienating parent because of both external and internal factors.  That is, a child may be more vulnerable because of stressful external factors such as: the shared parenting arrangements; a new intimate partner of their parent; changes in the child’s residence, peers, and school system; and economic factors causing the child to adjust to a new home in a less expensive neighborhood and attending a new school.  Also, the intensity and duration of the child’s symptoms depend on internal factors such as the child’s temperament, which affects the child’s susceptibility to influence by others.  A child low in susceptibility may rebuff a parent’s attempt to “poison” the child against the other parent, whereas a highly susceptible child is likely to internalize and believe the false propaganda intentionally programmed by the alienating parent.  (See Chapter 7, “Reunification Planning and Therapy,” for a more detailed discussion of the child’s “vulnerability” due to external circumstances and the child’s “susceptibility” due to personality and temperamental factors, especially in regard to reunification.)

         Some researchers have studied the frequency with which the eight criteria occur in individual cases of PA or PAS.  For example, Baker and Darnall (2007) collected information from 68 parents whose children were severely alienated from them.  They used a questionnaire to determine how often the eight symptoms of PAS listed by Gardner had been observed by their subjects.  The authors found “general support for the presence of the eight symptoms of PAS.”  In this research, 88% of the target parents said that the alienated child “always” or “often” denigrated, rejected, or belittled them.  Also, 98% of the target parents said that the alienated child “completely” or “mostly” gave weak, frivolous, or absurd reasons for rejecting them.

 

Baker, A. J. L., & Darnall, D. (2007). A construct study of the eight symptoms of severe parental alienation syndrome: A survey of parental experiences. Journal of Divorce & Remarriage 47(1/2):55-75. 

Gardner, R. A. (1985). Recent trends in divorce and custody litigation. Academy Forum, 29(2), 3-7. 

 

Gardner, R. A. (1992). The parental alienation syndrome: A guide for mental health and legal professionals. Cresskill, NJ: Creative Therapeutics. 

 

PA and Brainwashing

After reviewing 700 cases of family counseling, mediation, and forensic evaluation, Clawar and Rivlin (1991) identified and described the following techniques in the PA context they termed brainwashing: denying and not acknowledging the social existence of the other parent; attacking something about the character, life-style, past, present, or future of the target parent; discussing visitation arrangements with the child, thus pressuring the child to make a choice; failing to inform the other parent of educational, social, and religious functions, thus communicating that the other parent lacks importance; creating or exaggerating differences between themselves and the other parent in front of the children; asking the children to ally their sympathies and support with the alienating parent; making moral judgments regarding the target parent’s values, life-style, friends, etc.; implicitly or explicitly threatening to withdraw affection if the child expresses a desire to be with the other parent; creating the belief that the other parent is not sincere in his or her love for the child; creating the belief that the other parent is unable to properly care for the child; and convincing the child to doubt his or her ability to perceive reality (pp. 15-36).

Amy Baker (2007a) studied adults who said they had been alienated as children from one of their parents.  She asked the subjects to describe the strategies that the alienating parent had used to bring about the PA.  Baker said that 40% or more of her adult subjects reported the following alienating strategies when they were children: general bad-mouthing of the target parent by the alienating parent; limiting contact with the target parent; anger and withdrawal of love following visitation with the target parent; telling the child the target parent does not love him or her; forcing the child to choose one parent over the other; bad-mouthing specifically to create the impression that the target parent is dangerous; and confiding in the child about adult relationships (p. 64).

Gulotta and Liberatore (2008) in Italy conducted psycholinguistic analyses of the statements of alienated children and the dialogue between the children and the alienating parents.  They provided many examples of the subtle and not-so-subtle messages that an alienating parent might communicate to a child.

In some cases, one or both parents make false allegations of physical or sexual abuse in order to prevent the other parent from obtaining custody or access to the children. These cases usually involve several reports to child protection authorities and the police about the alleged abuse. In some cases, both parents make allegations of abuse against each other, but more frequently it is only one parent who makes a false claim of sexual or physical abuse of a child. 

Although domestic violence typically includes physical aggression or assault, such as hitting, kicking, shoving, and slapping, it may also involve sexual abuse, emotional abuse, severe neglect, and economic deprivation.  Whatever the manifestation of domestic violence, the underlying theme is that the perpetrator controls and dominates his or her victim.  In addition to controlling the spouse or domestic partner, the perpetrator of domestic violence often endeavors to control their children also.  After the couple separates or divorces, the perpetrator may continue to control the children and alienate them from the former partner as a way to punish him or her.

Peter Jaffe and his colleagues have been most active in pointing out that aspect of PA.  Jaffe, Johnston, Crooks, and Bala (2008) wrote:

Abusive ex-partners are likely to attempt to alienate the children from the other parent’s affection (by asserting blame for the dissolution of the family and telling negative stories), sabotage family plans (by continuing criticism or competitive bribes), and undermine parental authority (by explicitly instructing the children not to listen or obey). 

Also, Warshak (2010b) described a pattern he observed in families that featured coercive control and domination; i.e., a parent continues harassing and controlling the ex-partner by manipulating the children to turn against the victim parent.  

Authors in many countries have explained how a person who induces a child to experience PA is perpetrating child abuse.  For example, Gardner (1998) wrote: “Whether such parents are aware of the negative impact on the child, these behaviors of the aligned parent (and his or her supporters) constitute emotional abuse of the child.” Janet Johnston and Joan Kelly (2004) agreed on the issue of alienation as abuse, referring to PA as “an insidious form of emotional abuse of children that can be inflicted by divorced parents.”

A professional organization of child neurologists and psychiatrists in Italy offered:

Psychological abuse includes: acts of rejection, psychological terrorism, exploitation, isolation and removal of the child from the social context…. A further form of psychological abuse may be the alienation of a parent figure by the other parent…in “Parental Alienation Syndrome.” (Società Italiana di Neuropsichiatria dell’Infanzia e dell’Adolescenza, 2007, p. 10)

A psychologist in the Republic of South Africa wrote:

Involvement of mental health professionals who have no insight into PAS may exacerbate matters. The longer the time spent with the alienating parent, the more likely the process of alienation will be consolidated.  It is suggested that PAS be recognized as a form of child abuse; accordingly custody may be awarded to the innocent party, with sanctions potentially applied against the alienating party. (Szabo, 2002). 

 Baker, A. J. L. (2007a). Adult children of parental alienation syndrome: Breaking the ties that bind. New York: W.W. Norton & Co. 

Clawar, S. S., & Rivlin, B. V. (1991). Children held hostage: Dealing with programmed and brainwashed children. Washington, DC: American Bar Association Section of Family Law. 

Gardner, R. A. (1998). The parental alienation syndrome: A guide for mental health and legal professionals (2nd ed.). Cresskill, NJ: Creative Therapeutics, Inc. 

Gulotta, G., Cavedon, A., & Liberatore, M. (2008). La Sindrome di Alienazione Parentale (PAS): Lavaggio del cervello e programmazione dei figli in danno dell’altro genitore. [The Parental Alienation Syndrome (PAS): Brainwashing and Programming of Children to the Detriment of the Other Parent] [Italian]. Milan: Giuffrè

Jaffe, P. G., Johnston, J.R., Crooks, C.V. & Bala, N. (2008). Custody disputes involving allegations of domestic violence: Toward a differential approach to parenting plans. Family Court Review 46(3):500-23.

Szabo, C. P. (2002).  Parental alienation syndrome.South African Psychiatry Review, 5(3):1. 

Warshak, R. A. (2010b). Family Bridges: Using Insights from Social Science to Reconnect Parents and Alienated Children. Family Court Review, 48, 48-80. 

Anxiety in PA

We at PsychLaw.net are aware that many alienating parents have demonstrable difficulties in their psychosocial functioning. As long ago as 1985, Benedek and Schetky reported that in high conflict custody cases, overly anxious parents tended to act out their mistrust for their former spouses. They wrote that anxious parents may transmit their anxiety to their child, causing the child to feel that he or she will not be safe visiting the other parent. Writing in 1987, Blush and Ross described cases of PA in which the personality of the alienating parent served as the force driving the alienation. In some of those situations, Blush and Ross described a pattern they termed the “justified vindicator.” They wrote:
In this instance, a hostile, emotionally expansive, and dominant female has directly appealed to “experts” in both the mental health and legal communities. She frequently becomes insistent that formal, punitive legal measures be taken via prosecution before reasonable proofs have been demonstrated. One of the accompanying phenomena with this type of female parent is that she frequently has concurrent criminal action pending with her domestic legal action.

Many researchers explain that alienating parents tend to be rigidly defended and moralistic. These alienators perceive themselves to be flawless, virtuous, and they externalize responsibility onto others. They lack insight into their own behavior and the impact their behavior has on others (Bagby, Nicholson, Buis, Radovanovic, & Fidler, 1999; Bathurst, Gottfried, & Gottfried, 1997; Siegel, 1996). Research literature consistently documents that psychopathology and personality disorders are present in a significant proportion of high-conflict parents litigating over custody or access (Friedman, 2004; Siegel & Langford, 1998). Psychological disturbance – including histrionic, paranoid, borderline, and narcissistic personality disorders or characteristics as well as psychosis, suicidal behavior, and substance abuse – are common among alienating parents (Johnston, Walters, & Olesen, 2005; Rand, 1997a, 1997b; Turkat 1999; Warshak, 2010a).

Two groups of researchers found that the maladaptive personality traits of alienating parents were consistently identified through objective psychological evaluation materials. Concerning the MMPI-2, Siegel and Langford (1998) wrote: “The present study is an attempt to gain understanding of parents who engage in alienating tactics through a statistical examination of their MMPI-2 validity scales.” They tested 16 female subjects who met the criteria for classification as PAS parents; 18 female subjects were considered non-PAS parents. The authors concluded:
The hypothesis was confirmed for K and F scales, indicating that PAS parents are more likely to complete MMPI-2 questions in a defensive manner, striving to appear as flawless as possible. It was concluded that parents who engage in alienating behaviors are more likely than other parents to use the psychological defenses of denial and projection, which are associated with this validity scale pattern.

Gordon, Stoffey, and Bottinelli (2008) examined the MMPI-2 data of 76 cases where PA was found and 82 custody cases (controls) where PA did not operate. They found that mothers and fathers who were alienators had much higher scores on measures of psychological dysfunction; that is, test scores that indicated primitive defenses such as “splitting” and “projective identification.” Two different MMPI-2 indexes were used to measure these primitive defenses: L + K – F and (L + Pa + Sc) – (Hy + Pt). The first index (L + K – F) identifies persistent defensiveness. Elevations on this index would be expected in those cases of parents viewing themselves as an “all good parent” while condemning the former spouse as an “all bad parent.” The second index ([L + Pa + Sc] – [Hy + Pt]) is the Goldberg Index (1965). The Goldberg Index is a regression equation score which is the T score of (Lie + Paranoia + Schizophrenia) – (Hysteria + Psychasthenia). Those high “pathology scores” were much more prevalent in the alienator group; the scores for the target parents were most like the scores of the control parents. Gordon and his colleagues concluded that their overall study strongly supported the definitions Gardner put forward with respect to PAS.

Many authors have described the specific behaviors that an alienating parent might use to induce PA in the child. Gardner (1992) gave many examples of alienating strategies he had observed in conducting child custody evaluations. Gardner said that mothers alienated children against their fathers by: repeatedly vilifying the father with derogatory names; destroying every item in the house that might remind the children of the father’s existence; frequently complaining about how little money the father provided; exaggerating the father’s minor psychological problems; and interfering with the father’s visitation schedule (pp. 83-91). Gardner said that fathers alienated children against their mothers by: failing to encourage the children to spend time with the mother; physically protecting the child from the imagined dangers associated with the mother; concocting a sex-abuse allegation against the mother’s live-in boyfriend; seductive maneuvers, such as frequently cuddling and hugging the children; criticizing the mother for “never working a day in her life”; and developing secret codes with the children that were used in the service of hurting the mother (pp. 107-112).

Bagby, R. M., Nicholson, R. A., Buis, T., Radovanovic, H., & Fidler, B. J. (1999). Defensive responding on the MMPI-2 in family custody and access evaluations. Psychological Assessment, 11, 24-28.
Bathurst, K., Gottfried, A. W., & Gottfried, A. E. (1997). Normative data for the MMPI-2 in child custody litigation. Psychological Assessment, 9, 205-211.

Benedek, E. P., & Schetky, D. H. (1985). Custody and visitation: Problems and perspectives. Psychiatric Clinics of North America, 8(4), 857-873.

Blush, G. J., & Ross, K. L. (1987). Sexual allegations in divorce: The SAID syndrome. Conciliation Courts Review, 25(1), 1-11.

Friedman, M. (2004). The so-called high-conflict couple: A closer look. American Journal of Family Therapy, 32(2), 101-117.

Gardner, R. A. (1992). The parental alienation syndrome: A guide for mental health and legal professionals. Cresskill, NJ: Creative Therapeutics.

Goldberg, L.R. (1965). Diagnosticians vs. diagnostic signs: The diagnosis of psychosis vs neurosis from the MMPI. Psychological Monographs: General and Applied, 79(9), 1-28.

Gordon, R. M., Stoffey, R., & Bottinelli, J. (2008). MMPI-2 Findings of Primitive Defenses in Alienating Parents. American Journal of Family Therapy, 36(3), 211-228.

Johnston, J. R., Walters, M. G., & Olesen, N. W. (2005). The Psychological Functioning of Alienated Children in Custody Disputing Families: An Exploratory Study. American Journal of Forensic Psychology, 23(3), 39-64.

Rand, D. (1997a). The Spectrum of Parental Alienation Syndrome, Part I. American Journal of Forensic Psychology, 15(3), 23-52.

Rand, D. (1997b). The Spectrum of Parental Alienation Syndrome, Part II. American Journal of Forensic Psychology, 15(4), 39-92.

Siegel, J. (1996). Traditional MMPI-2 Validity Indicators and Initial Presentation in Custody Evaluations. American Journal of Forensic Psychology, 13(3), 55-63.

Siegel, J., & Langford, J. (1998).MMPI-2 Validity Scales and Suspected Parental Alienation Syndrome.American Journal of Forensic Psychology, 16(4), 5-14.

Turkat, I. D. (1999). Divorce-Related Malicious Parent Syndrome.Journal of Family Violence, 14, 95-97.

Warshak, R. A. (2010a). Alienating Audiences from Innovation: The Perils of Polemics, Ideology, and Innuendo. Family Court Review, 48(1), 153-163.