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The term conveys how a child's relationship with one estranged parent can be poisoned by the other parent, and there's broad agreement that it sometimes occurs in the context of divorces and child-custody disputes.
However, an acrimonious debate has raged for years over whether the phenomenon should be formally classified as a mental health disorder by the psychiatric association as it updates its Diagnostic and Statistical Manual of Mental Disorders for the first time since 1994.
The new manual, known as DSM-5, won't be completed until next year, but the decision against classifying parental alienation as a disorder or syndrome has been made.
"The bottom line — it is not a disorder within one individual," said Dr. Darrel Regier, vice chair of the task force drafting the manual. "It's a relationship problem — parent-child or parent-parent. Relationship problems per se are not mental disorders."
Regier and his APA colleagues have come under intense pressure from individuals and groups who believe parental alienation is a serious mental condition that should be formally recognized in the DSM-5. They say this step would lead to fairer outcomes in family courts and enable more children of divorce to get treatment so they could reconcile with an estranged parent.
Among those on the other side of the debate, which has flared since the 1980s, are feminists and advocates for battered women who consider "parental alienation syndrome" to be an unproven and potentially dangerous concept useful to men trying to deflect attention from their abusive behavior.
Some critics of the concept say it's being promoted by psychologists, consultants and others who could profit if parental alienation had a more formal status in family court disputes.
"At its worst, it lines the pockets of both attorneys and expert witnesses by increasing the number of billable hours in a given case," wrote Dr. Timothy Houchin, a University of Kentucky psychiatrist, and three colleagues in an article earlier this year in the Journal of the American Academy of Psychiatry and the Law.
"It creates an entire new level of debate, in which only qualified experts can engage, adding to the already murky waters of divorce testimony," they wrote, arguing that courts could deal with parent/child estrangement without labeling the child as mentally ill.
Advocates of the concept of parental alienation had been braced for a decision by the APA not to classify it as a syndrome or disorder, but held out hope that it would be specifically cited in an appendix as an example of a parent-child relational problem.
Regier, in an e-mail Friday, said this is "very unlikely," even though the final draft of the DSM-5 remains incomplete.
Dr. William Bernet, a professor emeritus of psychiatry at the Vanderbilt University School of Medicine, is editor of a 2010 book making the case that parental alienation should be recognized in the DSM-5. He contends that about 200,000 children in the U.S. are affected by the condition.
Bernet's proposal to the DSM-5 task force defines parental alienation disorder as "a mental condition in which a child, usually one whose parents are engaged in a high conflict divorce, allies himself or herself strongly with one parent, and rejects a relationship with the other parent, without legitimate justification."
In a telephone interview, Bernet contended that the task force had made up its mind based on factors beyond the scientific evidence.
"I think they're being motivated not by the science, but being driven by friendships, by political forces," he said.
Parental alienation surfaced on the pop-culture scene several years ago as a consequence of the bitter divorce and child custody battle involving actors Alec Baldwin and Kim Basinger. Baldwin was assailed by some feminist groups for citing parental alienation syndrome as a source of his estrangement from his daughter.
"The truth is that parental alienation really is a dangerous and cleverly marketed legal strategy that has caused much harm to victims of abuse," said the National Organization for Women amid the controversy.
Bernet, in his proposal to the DSM-5 task force, said he agreed that "in some instances the concept of parental alienation has been misused by abusive parents to hide their behavior."
"However, we strongly disagree with throwing out the baby with the bathwater," he wrote, arguing that such abuse would be curtailed if diagnostic criteria for parental alienation were established.
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