Posted in Parental Alienation PA, PAS & THE DSM

Child Affected by Parental Relationship Distress

A new condition, “child affected by parental relationship distress” (CAPRD), was introduced in the DSM-5. A relational problem, CAPRD is defined in the chapter of theDSM-5 under “Other Conditions That May Be a Focus of Clinical Attention.” The purpose of this article is to explain the usefulness of this new terminology.


A brief review of the literature establishing that children are affected by parental relationship distress is presented. In order to elaborate on the clinical presentations of CAPRD, four common scenarios are described in more detail: children may react to parental intimate partner distress; to parental intimate partner violence; to acrimonious divorce; and to unfair disparagement of one parent by another. Reactions of the child may include onset or exacerbation of psychological symptoms, somatic complaints, an internal loyalty conflict, and, in the extreme, parental alienation, leading to loss of a parent–child relationship.


Since the definition of CAPRD in the DSM-5 consists of only one sentence, the authors propose an expanded explanation, clarifying that children may develop behavioral, cognitive, affective, and physical symptoms when they experience varying degrees of parental relationship distress, i.e., intimate partner distress and intimate partner violence, which are defined with more specificity and reliability in the DSM-5.


CAPRD, like other relational problems, provides a way to define key relationship patterns that appear to lead to or exacerbate adverse mental health outcomes. It deserves the attention of clinicians who work with youth, as well as researchers assessing environmental inputs to common mental health problems.

Child Affected by Parental Relationship Distress

Posted in PAS & THE DSM


According to the literature, Parental Alienation, like narcissism is well recog-
nized within the mental health field and among many experienced profes-
sionals, Parental Alienation Syndrome (PAS) is accepted as well. The DSM-IV

does not currently include PAS because the term was introduced as the DSM-
IV was being written for publication. It takes years of data before it can be

introduced, considered and accepted. A syndrome is a pattern or cluster of

symptoms indicative of some disease.

At this point, DSM-V is scheduled for publication around 2011 and it

appears promising that it will acknowledge PAS because of the extensive

professional literature and clinical findings now available. DSM requirements

420 D. M. Summers & C. C. Summers

are quite stringent, and justifiably so. In his article, “Denial of the Parental

Alienation Syndrome, Also Harms Women,” Richard Gardner explains why

PAS has not made the pages of the DSM-IV at this time.

Gille de la Tourette first described his syndrome in 1885. It was not until

1980, 95 years later, that the disorder found its way into the DSM. It is im-
portant to note that at that point, ‘Tourette’s Syndrome’ became ‘Tourette’s

Disorder.’ Asperger first described his syndrome in 1957. It was not until

1994 (37 years later) that it was accepted into DSM-IV and ‘Asperger’s Syn-
drome’ became ‘Asperger’s Disorder.’ . . . DSM-IV states specifically that all

disorders contained in the volume are syndromes, and they would not be

there if they were not syndromes . . . Once accepted, the name syndrome

becomes changed to disorder. However; this is not automatically the pat-
tern for non-psychiatric disorders . . . Often the term syndrome becomes

locked into the name and becomes so well known that changing the

word syndrome to disorder may seem awkward. For example, Down’s

syndrome, although well recognized, has never become Down’s disorder.

Similarly, AIDS (Autoimmune Deficiency Syndrome) is a well-recognized

disease, but still retains the syndrome term. (Gardner, 2002a, pp. 191–202)

comfort zone