Dr Childress suggests that the appearance of the following 3 diagnostic indicators are indicative of pathogenic parenting that result in a child rejecting a safe, loving parent and that the pathogenic parent most likely has NPD/BPD. He maintains these symptoms are NOT present in the child where a rejected parent has engaged in child abuse.
1. Attachment System Suppression
The child seeks to stop all contact with the normal range parent. A parent who is assessed on the parenting scale to be using parenting practices widely recognised as acceptable is considered to be normal range (20-80% on the scale). If there was evidence of abusive parenting such as medical reports, pictures, verified witness statements etc. they would not score 20-80% and would not be classed as normal range. If the rejected parent is within the normal parenting range there should be no breakdown of the attachment system. The only time a child has an emotional cutoff is as a result of narcissistic parenting. Therefore, if investigation into any alleged abuse and a clinical assessment indicates that the rejected parent is not a dysfunctional parent then the other parent, who most likely has NPD/BPD, has caused the child’s rejection through coercive and controlling behaviours.
When this is the case Childress suggests courts and therapists need to move away from micro analysing the parenting skills of the normal range parent. Accepting that the parent has the authority to discipline their child and instil family values as they see fit.
2. Personality Disorder Symptoms
Childress identifies a set of 5 NPD/BPD personality traits that rub off from the aligned parent onto the child where AB-PA has been established. He is not suggesting the child has a personality disorder just that they have learned behaviours from the parent to whom they are aligned.
- Grandiosity – the child is elevated in the family hierarchy to a status above the rejected parent. The child then feels entitled to negatively judge the rejected parent.
- Empathy – the child will say and do cruel things to the rejected parent without any compassion for them what so ever.
- Entitlement – if the rejected parent does not meet the child’s every need to the level of satisfaction of the child, the child feels entitled to retaliate against the rejected parent.
- Haughty and arrogant attitude – towards the rejected parent. They show disdain for who that parent is as parent and as a person.
- Splitting – the child sees the rejected parent as all bad and the parent with whom they are aligned as all good. The child is not able to hold a realistic view that there is good and bad in both parents.
Childress also describes an “anxiety variant” where around the age of 4-6 years old the child is terrified of their parent. This is usually the result of the manipulative parent communicating to the child that the other parent is a threat to the child. This can be diagnosed using DSM5 criteria for a Phobic Anxiety.
3. Delusional Belief System
The child believes they are a victim when no real abuse has occurred. Yes, no parent is perfect and a normal range parent may make mistakes in how they handle certain situations but that is normal. This temporary and normal breach of trust needs to be repaired for healthy relationship to be maintained (breach-and-repair sequence identified by Tronick). The difference comes when the child says that they have been abused physically, emotionally or psychologically by the rejected parent when there is no evidence and or when what the child characterises as abuse is not abuse e.g. removal of mobile phone privileges as a punishment for bad behaviour or asking them to do chores like emptying the bin. In having these false beliefs, the child justifies their rejection of the normal range parent. The parent from whom they have emotionally cutoff deserves to be rejected and punished.
Childress views the process of AB-PA by a NPD/BPD parent as a child protection issue which if not tackled properly will lead to psychological damage. This will likely result in the child not being able to have good relationships with future partners and most likely continue the cycle of abuse with their own children in future.
In making a diagnosis in these cases Childress refers to the following sections of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) and the International Classification of Diseases (ICD) 10.
Code: 309.4 Adjustment Disorder with mixed disturbance of emotions and conduct
Description: Relating to the development of emotional or behavioral symptoms in response to an identifiable stressor(s) occurring within 3 months of the onset of the stressor(s). Both emotional symptoms (e.g., depression, anxiety) and a disturbance of conduct are predominant.
Code: V61.20 (Z62.820) Parent-Child Relational Problem
Description: Cognitive problems may include negative attributions of the other’s intentions, hostility toward or scapegoating of the other, and unwarranted feelings of estrangement. Affective problems may include feelings of sadness, apathy, or anger about the other individual in the relationship.
Code: V61.29 (Z62.898) Child Affected by Parental Relationship Distress
Description: This category 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 medical disorders.
Code: V995.51 (Z62.898)Child Psychological Abuse, Confirmed
Description: Child psychological abuse is 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. (Physical and sexual abusive acts are not included in this category.)
Code: F24 Induced delusional disorder. Under section V Mental and behavioural disorders.
Description: A delusional disorder shared by two or more people with close emotional links. Only one of the people suffers from a genuine psychotic disorder; the delusions are induced in the other(s) and usually disappear when the people are separated.