One evening, a mother received an unexpected telephone call from her 13-year-old son. Contact had ceased after the mother filed for divorce and the son relocated with his father. The once-loving, mother-son relationship had transformed. The mother’s frequent telephone calls, gifts, and letters were ignored. The son initiated the conversation: “There is a problem, mom.” After a long pause, the son explained: “Apparently, you don’t want me. You don’t love me anymore. You feel it’s best I live with dad.” The son persisted with an angry tone and apparent lack of guilt: “You’re a bitch, drug abuser, and an alcoholic.” The mother pleaded, “What have I done for you to treat me this way? I have always loved you and always will.” Within seconds, there was a dial tone. The mother immediately returned the call and received the all-too-familiar prerecorded message.
The child’s behavior described in this scenario can be attributed to what is called parental alienation syndrome (PAS). Although PAS can occur in intact or separating families, this article will focus on high-conflict divorce. During parental warfare, a child is used as a weapon by one parent (alienating parent) against the other parent (alienated/targeted parent) to inflict assaults on the targeted parent-child relationship. The relationship that was once encased with unconditional love is transformed to an unrelenting campaign of denigration, criticism, and hatred. Bernet, von Boch-Galhau, Baker, and Morrison (2010) estimated that approximately 740,000 children and adolescents in the United States alone face parental alienation.
PAS behaviors were described 62 years ago by psychoanalyst Wilhelm Reich (1949). Since then, other mental health professionals have observed destructive behaviors by a child toward a once-loved parent (Clawar & Rivlin, 1991; Gardner, 1998; Gardner, Sauber, & Lorandos, 2006). Gardner (1998), a child and adolescent psychiatrist, first coined the term parental alienation syndrome and defined it as follows:
The parental alienation syndrome (PAS) is a disorder that arises primarily in the context of child-custody disputes. Its primary manifestation is the child’s campaign of denigration against a parent, a campaign that has no justification. It results from the combination of a programming (brainwashing) parent’s indoctrinations and the child’s own contributions to the vilification of the target parent. When true parental abuse and/or neglect is present the child’s animosity may be justified, and so the parental alienation syndrome explanation for the child’s hostility is not applicable.
There have been heated debates about the diagnostic reliability and validity of PAS. A literature review revealed an abundance of peer-reviewed journal articles in family therapy, forensic psychiatry, law, psychiatry, psychology, and social work. Books dedicated to PAS have been written by mental health professionals in the United States (Baker, 2007; Darnall, 2008; Warshak, 2010), from around the world (Gardner et al., 2006), by lay people (Jeffries, 2009; Richardson, 2006), and a Hollywood actor (Baldwin, 2008). In addition, several reputable websites are dedicated to this subject (e.g., the Parental Alienation Awareness Organization: http://www.paawareness.org).
A literature review using the search engines CINAHL and PubMed was conducted using the words nursing, parental alienation syndrome, parental alienation disorder, hostile aggressive parenting, and child abuse. During the past 20 years, only two nursing articles have discussed PAS (Morrow, 2005; Price & Pioske, 1994). Psychiatric-mental health nursing textbooks do not address PAS. Therefore, the purpose of this article is to provide introductory information about PAS and increase nursing awareness of this family tragedy. Real-life case examples are provided in this article. All identifying information has been changed to ensure privacy.
The Child Custody Battle and War
The alienating parent perceives divorce as a war to be won at all costs—even if the cost is the child’s emotional health. The war strategy is to sever the targeted parent-child bond, which is the ultimate claim to victory. The weapon of choice is always the child. According to Gardner (1998):
PAS children are basically being used as the puppets of the angry alienating parent. To refer to them as pawns is an understatement. A better analogy is that they are attacking queens, bishops, and rooks—so powerful are they as weapons in the parental conflict.
Other effective weapons in the alienator’s arsenal are time and distance. Elapsed time without the target’s presence solidifies the alienating parent-child relationship. Relocation fosters distance. Lack of time with the child and distance prevent the targeted parent from being able to defend false accusations.
PAS children become victims in a web woven by the alienating parent via hostile, aggressive parenting. This parenting style consists of deliberate and malicious strategies that foster PAS. Examples include interfering in telephone conversations, obstructing the target’s parties and family reunions, prohibiting pictures of the target, sabotaging visitation, and discounting the target’s presence. As one alienating parent stated, “We never talk about you. Your name doesn’t come up in conversation anymore.”
The Alienating Parent-Child Bond
Although alienators can be fathers, mothers, both parents, step-parents, and grandparents, the focus for this discussion is on one parent. Compounding losses from the disintegrating marital bond, such as a move out of the family home, change in financial status, or imposed child custody/visitation orders, devastate the alienating parent. This parent may also have deep dependency needs and unhealthy object relations, meaning that the alienating parent does not possess a clear and firm sense of self in relation to others. These individuals rely on others to fulfill their good sense of self. In terms of PAS, the child assumes a surrogate role and rescues the alienator. In time, the child’s object relations become unhealthy as the child loses his or her own sense of self. On the basis of a research study of 40 adults who experienced PAS as children, Baker (2007) collated the frequency distribution of 33 strategies used to alienate children from their targeted parent, the most frequent being bad-mouthing (general), limiting contact, and withdrawing love/getting angry.
PAS and Enmeshed Boundaries
The alienating parent and child develop an enmeshed relationship. The words us, we, and our become common. During a telephone conversation between Mr. Allen and his ex-wife, Mr. Allen mentioned that he had scheduled surgery for their daughter. Ms. Allen, who had joint custody with her ex-husband, became irate: “You scheduled surgery and didn’t tell me? I am her mother!” Mr. Allen matter-of-factly stated, “You need to stay out of our business.”
PAS and Cult-Like Thinking
The alienating parent’s programming and brainwashing tactics have been compared to cult-like thinking (Baker, 2007; Warshak, 2010). Factors that foster the alienating environment include keeping the child isolated from the targeted parent and extended family, fostering emotional dependence, and instilling fear. In most cases, at least one of these factors is present (Warshak, 2010).
The alienating parent may accuse the targeted parent of never loving and having a healthy relationship with the child. Assessing the targeted parent-child relationship prior to the marital breakup is essential in detecting PAS. Obtaining collateral information is vital. Bone and Walsh (1999) asserted:
Children do not naturally lose interest in and become distant from their nonresidential parent simply by virtue of the absence of that parent. Also, healthy and established parental relationships do not erode naturally of their own accord. They must be attacked.
During mediation, an alienating mother proudly displayed her son’s perfect report card. The 4.0 grade point average was “proof” that her son successfully transitioned to her household and insisted he reside solely with the mother. The mother conveniently forgot to mention that her son was always stellar in academics and sports. After studying the report card, the mediator stated to the targeted father, “You have to admit, your son is doing very well in school.” Unfortunately, the perfect report card was not a direct reflection of the child’s emotional well-being. A psychological evaluation revealed that this child was exhibiting behaviors associated with severe PAS.
Warshak (2010) elaborated:
Sometimes a parent uses a child’s apparent good adjustment to keep the other parent at arm’s length. The argument goes like this: If the child gets along well with teachers, friends, and one parent; earns good grades, stays out of major trouble; and claims to be happy, why rock the boat? Why require the child to relate to the other parent?.... Too many therapists endorse this misguided thinking. They fail to recognize the devaluation of the parent-child relationship that is inherent in ranking school and friends above family. They take an astonishingly casual attitude toward the child’s loss of a parent, and the parent’s loss of a child.
The Alienated/Targeted Parent
A parent’s worst nightmare is to experience PAS. The grief of marital loss is compounded by the loss of a loving parent-child relationship. The targeted parent is often caught off-guard by the child’s polarized behavior; for example, “I’ve lost my son. How could this have happened?”
The parent wonders how he or she will cope with the pain inflicted by his or her own child. A key to survival is to stay connected with the child as much as possible via telephone messages, letters, cards, text messages, and e-mail. The targeted parent has to provide regular infusions of reality orientation to ignite the child’s recollection of past memorable events. Even in the worst case, when extended periods of time have elapsed, it is essential that the targeted parent remember the child with gifts or telephone calls on birthdays and major holidays. Not to do so only reinforces the alienator’s mantra that the target never loved the child. However, the alienator may intercept the correspondence, and the child may not even be aware of the targeted parent’s attempts to make contact.
Andre and Baker (2009) wrote a book geared toward middle school children to help them from becoming involved with embattled parents during a divorce. Difficult family situations are presented to help the child identify thoughts and feelings while finding solutions. Nurses working with middle school children are encouraged to read this book and disseminate the information to parents. Warshak’s (2010) book about “divorce poison” describes how to implement “poison control.” Additional advice for the targeted parent and treatment strategies for the clinician are described by Ellis (2005).
Because of the complex interpersonal dynamics of PAS, nurses should be informed of the outcome of the divorce decree and which parent has what type of custody. For example, a parent may illegally seek treatment for the child, and the targeted parent may have no knowledge of the child receiving medical treatment or being involved in therapy.
Hallmark Behaviors of PAS Children
Gardner (1998) observed PAS children embellish an alienating parent’s derogatory behaviors toward the targeted parent. He identified eight symptoms commonly exhibited by PAS children.
A campaign of denigration. The child’s loving feelings toward the targeted parent are stifled or replaced with intense hate. Bad-mouthing is common. The unrelenting campaign of denigration becomes as reflexive and automatic as breathing. Reminders of past joyful experiences with the targeted parent are counterattacked (i.e., “I don’t remember.”).
Weak, absurd, or frivolous rationalizations for the deprecation toward the targeted parent. The child’s vocabulary is inconsistent with his or her developmental age. A school-age child may say words such as adulterer or slut to describe the targeted parent. However, the child cannot define the words, nor can the child provide examples to substantiate these derogatory claims.
Lack of ambivalence. While no parent is perfect, the alienating parent selectively magnifies the targeted parent’s weaknesses so they outweigh positive attributes. Eventually, the child perceives the targeted parent as the “all bad” parent and the alienating parent as the “all good” parent.
The “independent-thinker” phenomenon. The child displays the “independent thinker” phenomenon when he or she mirrors the alienator’s delusional system. The child displays what is believed to be uninfluenced behavior. For example, the child may resist visitation (based on false, fixed beliefs) while the alienating parent calmly states, “Our son can make his own decisions. I can’t change his mind.” This “autonomous” role empowers the child with more authority over the targeted-parent relationship than any child should hold. To the alienator’s delight, the child’s antagonistic behavior is rationalized as being reflective of the dysfunctional relationship the targeted parent had with the child all along.
Reflexive support of the alienating parent. The child demonstrates reflexive support of the alienating parent in their enmeshed relationship. The child experiences an intense fear of losing a relationship with the only person in the world who seemingly loves him or her and has the child’s best interest in mind. The child is forced into a no-win situation to choose between parents rather than experience unconditional love from both parents. As one child stated to his father, “Mom wants to help me be independent—you don’t.”
Absence of guilt over cruelty to and/or exploitation of the targeted parent. The child exploits the targeted parent’s minor flaws without guilt. One mother who was diagnosed with migraines was labeled a “drug abuser” because she was prescribed a triptan medication.
The presence of borrowed scenarios. The child mirrors the alienating parent’s behaviors to perfection. The child and alienator’s behaviors are synchronous, almost as if they have been reading from the same script in preparation for an audition.
Spread of the animosity to the friends and/or extended family of the targeted parent. Hate and animosity infiltrate into other relationships. Associates of the target, such as grandparents, aunts, uncles, and cousins also become an enemy to defeat.
Emotionally Abused PAS Children
PAS is a form of emotional abuse, and PAS children can display symptoms associated with dissociation or panic disorder (Andre, 2004). Other diagnoses include conduct disorder, antisocial personality disorder, separation anxiety disorder, delusional disorder, narcissistic personality disorder, and gender identity problems (Gardner, 2006). As one child confessed, “Mom, I feel like I’m in the trenches with hand grenades being thrown at me.”
According to Baker (2007):
PAS is child abuse—it is plain and simple as that. The effects on the child simply do not disappear over time. The child does not just “get over it.” Inflicted wounds to the child’s psyche can last a lifetime and impact adulthood. The long-term effects on adult children of PAS include depression, divorce, substance abuse, difficulty trusting oneself and others, in addition to perpetuating alienation from their own children.
The alienator spins a web of twisted truths, which creates confusion. After some time, deciphering the truth becomes an insurmountable task. As one child stated, “I don’t know who I should trust—my mom or my dad.”
In the following individual example, a school-age girl received a telephone call one day from her father: “Your mom has a restraining order against me. I can’t come within 500 feet of you.” The child confronted her mother. The mother clarified this information in the presence of their daughter. The mother then reviewed with her husband the status quo court order that restrained each parent from selling personal assets.
In this example, the father used the word restraining to meet his own agenda. With repeated situations such as this, the child becomes confused, angry, and depressed while struggling with a no-win situation about loyalty conflicts and parental trust. Over time, exaggerations of the truth, belittling comments, and overall disrespect take their toll on the targeted parent-child relationship. Ellis (2005) reported that a child may cope by rejecting one parent to escape from battling parents.
PAS children are keenly aware that they are on the alienator’s radar screen and all behavior is closely monitored. They dare not mention the target’s name or discuss an enjoyable visit. Any display of positive behavior toward the target within the eyesight and hearing distance of the alienating parent is too high a price to pay for the alienator’s retaliation. However, children displaying mild or moderate PAS can warm up to the targeted parent in the alienator’s absence. For example, during a rare overnight visit, a child named Marshall asked his mother for a hug: “I don’t know when I’ll see you again, mom.” The hug was long and authentic. “The hug felt good,” the mother recalled. “Marshall really wanted to hug me—I could feel it.”
Differentiating PAS from Physical Abuse and Neglect
Allegations of sexual abuse and neglect are very common with PAS and should always be investigated. According to Darnall (2008), children in situations of severe PAS may be difficult to detect because they are often intelligent, do well socially, excel academically, and appear normal. However, the child’s apparent “normalcy” is time limited. Darnall (2008) explained:
Once triggered, they [PAS children] are eager to tell their story to anyone who will listen, especially to the court or someone they perceive as an authority. This reaction can be different than that of children who were physically or sexually abused. While abused children fear telling secrets, the PAS child is eager to malign the parent. Abused children may feel ashamed about themselves and fear the abusive parent, while the PAS child has no shame about attacking or lying about the targeted parent.
In such situations, the clinician should conduct a thorough assessment of the parents’ relationship with the child prior to the family separation/divorce. Interviews should include both parents, the child, siblings, grandparents, teachers, and others who are intimately involved in the child’s life.
PAS and the DSM-IV-TR
Since PAS is not listed in the current Diagnostic and Statistical Manual of Mental Disorders, fourth edition, text revision (DSM-IV-TR; American Psychiatric Association, 2000), its credibility has been questioned by legal and mental health professionals. In the past, it was thought that research into the study of PAS was in its infancy and could not withstand the rigorous evaluation process to be included in the DSM. However, research on the PAS has expanded. Bernet et al. (2010) proposed changing PAS to parental alienation disorder (PAD). In their efforts to incorporate PAD into the DSM, Bernet et al. (2010) proposed diagnostic criteria, described in the Table.
Table: Diagnostic Criteria for Parental Alienation Disorder
The scarcity of nursing literature on PAS is a disservice to families who require treatment. It is imperative that nurses join other professionals in contributing to the current body of knowledge through research. This would heighten awareness in the public and legal community about the emotional abuse of children. Now is the time for psychiatric-mental health nurses to assert themselves and speak up on behalf of emotionally abused children who cannot speak for themselves.
One treatment recommendation for these families includes parenting classes that focus on the family in transition. Classes should provide education on the grieving process and how children at different developmental age levels grieve, and should address PAS, anger management, limit setting, and how to set clear boundaries between parents and children. Learning about the importance of forgiveness and moving forward in life is also essential. An excellent referral resource for families experiencing divorce is Rainbows® ( http://www.rainbows.org), an international program that offers support groups for grieving children from preschool age through adolescence.
Because nurses work in a variety of treatment settings, they are in a prime position to help children and families who are trying to cope with the transitions associated with divorce. However, despite nurses’ presence in the community, only three articles in the nursing literature address PAS. In addition, nursing research on PAS is non-existent. If nurses are to provide the best possible care to divorced/divorcing families, nursing research needs to begin now. Other health care team members have been aware of PAS for many years and have been publishing their research. Nursing is an integral part of the health care team and cannot afford to remain silent on this issue, which affects countless children and families.
Divorce disrupts the integrity of a family. During this period of disequilibrium, each member of the family copes in his or her own way. Parents with healthy coping skills are able to put their differences aside and place the children’s needs first. However, some parents become entwined in a battle, while ignoring the needs of the children. When hostile, aggressive parenting is used to form an alliance between the alienating parent and the child, the groundwork for PAS is laid. The effects are compounded for the child who experiences emotional abuse from PAS and the loss of a relationship with the once loved, now targeted parent.
Nurses need to become informed about PAS and contribute to the current body of knowledge via nursing research. With a proposal for PAD to be included in the next edition of the DSM, there is no better time than now to assist families in crisis and support this proposal.
- American Psychiatric Association. (2000). Diagnostic and statistical manual of mental disorders (4th ed., text rev.). Washington, DC: Author.
- Andre, K. (2004). Parent alienation syndrome. Annals of the American Psychotherapy Association, 7(4), 7–11.
- Andre, K. & Baker, A.J.L. (2009). I don’t want to choose: How middle school kids can avoid choosing one parent over the other. New York: Kindred Spirits.
- Baker, A.J.L. (2007). Adult children of parental alienation syndrome: Breaking the ties that bind. New York: Norton.
- Baldwin, A. & Tabb, M. (with ). (2008). A promise to ourselves: A journey through fatherhood and divorce. New York: St. Martin’s Press.
- Bernet, W., von Boch-Galhau, W., Baker, A.J.L. & Morrison, S.L. (2010). Parental alienation, DSM-V, and ICD-11. American Journal of Family Therapy, 38, 76–187. doi:10.1080/01926180903586583 [CrossRef]
- Bone, J.M. & Walsh, M.R. (1999). Parental alienation syndrome: How to detect it and what to do about it. The Florida Bar Journal, 73(3), 44–48.
- Clawar, S.S. & Rivlin, B.V. (1991). Children held hostage: Dealing with programmed and brainwashed children. Chicago: American Bar Association.
- Darnall, D. (2008). Divorce casualties: Understanding parental alienation (2nd ed.). Lanham, MD: Taylor Trade.
- Ellis, E. (2005). Help for the alienated parent. American Journal of Family Therapy, 33, 415–426. doi:10.1080/01926180500274518 [CrossRef]
- Gardner, R.A. (1998). The parental alienation syndrome: A guide for mental health and legal professionals (2nd ed.). Cresskill, NJ: Creative Therapeutics.
- Gardner, R.A. (2006). Future predictions on the fate of PAS children: What hath alienators wrought? In Gardner, R.A., Sauber, S.R. & Lorandos, D. (Eds.), The international handbook of parental alienation syndrome: Conceptual, clinical and legal considerations (pp. 179–194). Springfield, IL: Charles C. Thomas.
- Gardner, R.A., Sauber, S.R. & Lorandos, D. (Eds.). (2006). The international handbook of parental alienation syndrome: Conceptual, clinical and legal considerations. Springfield, IL: Charles C. Thomas.
- Jeffries, M. & Davies, J., (with ). (2009). A family’s heartbreak: A parent’s introduction to parental alienation. Stamford, CT: A Family’s Heartbreak, LLC.
- Morrow, S. (2005, August29). Words and actions that hurt. Nursing Spectrum. Retrieved from http://news.nurse.com/apps/pbcs.dll/article?AID=2005508290309
- Price, J.L. & Pioske, K.S. (1994). Parental alienation syndrome: A developmental analysis of a vulnerable population. Journal of Psychosocial Nursing and Mental Health Services, 32(11), 9–12.
- Reich, W. (1949). Character analysis (3rd ed.). New York: Farrar, Straus & Giroux.
- Richardson, P. (2006). A kidnapped mind: A mother’s heartbreaking story of parental alienation syndrome. Toronto: Dundurn Press.
- Warshak, R.A. (2010). Divorce poison: How to protect your family from bad-mouthing and brainwashing. New York: Harper.
Diagnostic Criteria for Parental Alienation Disorder
The 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, alienated parent without legitimate justification. The child resists or refuses contact or parenting time with the alienated parent.
The child manifests the following behaviors:
a persistent rejection or denigration of a parent that reaches the level of a campaign.
weak, frivolous, and absurd rationalizations for the child’s persistent criticism of the rejected parent.
The child manifests two or more of the following six attitudes and behaviors:
lack of ambivalence.
reflexive support of one parent against the other.
absence of guilt over exploitation of the rejected parent.
presence of borrowed scenarios.
spread of the animosity to the extended family of the rejected parent.
The duration of the disturbance is at least 2 months.
The disturbance causes clinically significant distress or impairment in social, academic (occupational), or other important areas of functioning.
The child’s refusal to have contact with the rejected parent is without legitimate justification. That is, parental alienation disorder is not diagnosed if the rejected parent maltreated the child.