I recieved the question in an email from Denmark:
Q: I am located in Denmark, where it appears that we are using the icd-10. Where can the “ab-pa” “child psychological abuse” fit in that system?
Just so everyone knows the difference of the ICD to the DSM diagnostic systems, let me explain.
The DSM is published by the American Psychiatric Association. This is the psychiatrists (the MD people) NOT th psychologists (the PhD psychology people). Psychologists (and MFTs) use the DSM, but it’s now “ours” – it’s the psychatrists’ MD people, and it helps them make medication decisions for their patients.
So one of the first things to understand, is that psychology people (PhD an MFT) use the DSM diagnostic system, we hve an addtional, non-formal “diagnosis” that is our clinical diagnosis – what’s going on – using our psychology knowledge. So this would be where I describe the pathology as a “cross-generational coalition” or an “emptional cutoff. those are psychology non-formal “diagnoses” using family systems constructs from psychology.
But you won’t find “cross-generational coalition” in the DSM, because that is a psychology “diagnosis” made on psychology information, not a formal “DSM psychiatric” diagnosis in the MD psychiatrist system.
The DSM system is an American diagnostic system because it is our psychiatrists who made it up. By the way, something to understand is that it is made up. We’re trying to understand stuff, but a lot of our understanding is incomplete or problematic – so people who know diagnosis are aware and make allowance for the problems in diagnosis and diagnostic systems.
In earlly childhoood we broke entirely with the DSM and we have our own diagnostic system, the DC:0-3 (Diagnostic Criteria ages 0-3) because the diagnoses of the DSM weren’t applicable to children ages 0-5.
The rest of the world developed their own parallel diagnostic system to the DSM, the ICD (International Classification of Diagoses) developed by the World Health Organization, Intially, fifty years ago or whatever, the two diagnostic system, the DSM and ICD had minor differences, but over the years they’ve gotten together so they’re basically interchangeable (with one really minor difference, that’s really huge for you – your diagnosis is NOT in the DSM (so we’re shifting to another diagonosis that IS in the DSM, Child Psychological Abuse.
But the actual psychiatric diagnosis for your pathology (a diagnosis that was in the DSM-IV but is “hidden” and unavailable in the DSM-5) is a Shared Delusional Disorder (the technical name is a Shared Psychotic Disorder).
In the ICD diagnostic systems, the diagnosis would be F24 Shared Psychotic Disorder. This is the shared delusion of Diagnostic Indicator 3 on the Diagnostic Checklist for Pathogenic Parenting.
A delusion can be caused by psychosis (like schizophrenia) or by trauma. You’re family’s type of delusion is trauma-created delusion; the trauma dream called the “trauma reenactment”.
As we first introduce people to the word “delusion”, most people, even mental health people, make the mistake of thinking we’re talking about delusions caused by a schizoprehnia-type pathology and they say, “the child doesn’t have a psychotic disorder like schizophrenia.” We will need to correct and re-orient them that this is a trauma-related delusion, not a psychotic-schizophrenia type delusion.
Delusions in trauma (the trauma dream of the “the trauma reenactment (also called “the transference” because the patient’s childhood trauma patterns are “transferred” to the therapist and what’s going on in therapy.
Sometimes the therapist becomes the “abusive” therapist in the mind of the patient, sometime the therapist is the “protective” therapist, but the words in quotes are the addition of the childhood trauma, not reality (which is what makes them delusional-psychotic; they those descriptive adjectives are added by trauma and are not true. This form of trauma recovery therapy that uses the “transference” of the trauma to wake the patient to the trauma dream they’re living, is called psychoanalysis. It’s the couch people.
Because this symptom, Diagnostic Indicator 3, the encapsulated delusion is the core of the pathology, identifying the trauma reenactment narrative of the supposedly “abusive” parent, the supposedly “victimized” child, and the supposedly “protective” parent, this is the symptom to focus on. None of this is trauma reenactment narrative is true, it is all a reenactment pattern of the childhood attachment trauma of the allied parent (that created their personality pathology).
Remember what I talk about, trauma is repetition of pattern? This is it… the repetition (in their not-reality mind) is of “abusive.” “victimized,” and “protective” from their childhood trauma.
The childhood trauma of the allied parent is adding the adjectives in quotes to the family relationships – “abusive” parent (you) – “victimized” child – “protective” parent (them). If you take out the words in quotes, that is reality – parent-child-parent. The adjectives in quotes are additions of the childhood attachment trauma (the trauma dream) of the allied parent.
The allied parent doesn’t realize that their childhood trauma is adding these adjective descriptors to reality, and they believe their constructed story of abuse, victimization, and protection. That’s the delusion – the false belief. The idea that you are “abusive” is delusional – translating this into common-speak, take your pick – the idea that you are “abusive” is crazy – the idea that you are “abusive” is a lie.
Doesn’t that fit? Isn’t that an accurate diagnosis – shared crazy between your child and ex- caused by the crazy in your ex- OR… a shared lie between your child and your ex-, told to your child by your ex-.
Sounds about right to me. So what is that diagnosis? In the ICD system it is F-24 Shared Psychotic Disorder. That’s the diagnosis in the ICD that fits your families – a shared lie told to our child by your ex-; or a shared crazy created in your child by the crazy in your ex.
The allied-parent transfers (the transference) their childhood their false trauma-related beliefs, the trauma additions of “abusive”, “victimized, and “protective”, to child’s beliefs and interpretations of relationship, thereby creating the shared delusion with the child (F24 Shared Psychotic Disorder).
Because the delusion symptom – Diagnostic Indicator 3 – is the trauma-related symptom identifying the trauma-reenactment narrative, an AB-PA assessment would be considered a “trauma-informed assessment” of your family, it is specifically knowledgeable about the possible role of trauma in your families – trauma-informed practice..
If the assessment does not include an assessment of the possible trauma-related delusional pathology in the family (the addition of the trauma-descriptive words to actual reality) then the assessment is NOT trauma-informed.
Craig Childress, Psy.D.
Cinical Psychologist, PSY 8857