Parental alienation (PA) is a term that stirs up a mix of recognition and controversy. For many parents and adult children, it describes a deeply painful experience of estrangement facilitated by manipulation and coercion. However, the term itself is not recognized as a standalone diagnosis in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), the primary tool used by mental health professionals in the United States—like psychologists, psychiatrists, counselors, and social workers—for diagnosing mental health disorders. Globally, many countries rely on the International Classification of Diseases, 11th Revision (ICD-11), published by the World Health Organization (WHO). The ICD-11 is used by medical doctors, psychiatrists, and mental health providers worldwide to classify and diagnose diseases, including mental and behavioral disorders. This article will explore why parental alienation is not included as a formal diagnosis in either system and what that means for therapy and mental health support.
Why Parental Alienation Isn’t in the DSM-5
The DSM-5, a cornerstone in diagnosing mental health conditions, focuses on specific disorders and symptoms rather than broader relational or family dynamics. That’s one reason “parental alienation” isn’t included—it’s not a mental health diagnosis, but rather a description of a pattern of behavior often seen in high-conflict custody situations.
Here’s the twist: while not a clinical diagnosis, Parental Alienation is often used as a legal term. In family court, it typically refers to a parent violating custody agreements by withholding a child from the other parent without any legitimate reason—like documented abuse or neglect. The legal system may address this as custodial interference or contempt of court, especially when the withholding parent can’t provide substantiated evidence for their actions.
The only reason I know this is because I’ve lived it. This isn’t something I picked up through professional training or textbooks—it’s what I’ve learned by being knee-deep in the chaos of the court system. And here’s what’s extra confusing: both therapists and legal professionals sometimes side-eye the term “parental alienation,” even though the behaviors it describes are very real. It’s controversial, often misunderstood, and weirdly politicized—but that doesn’t make the harm any less legitimate.
Critics of PA as a standalone diagnosis argue that it lacks consistent, evidence-based criteria and could be weaponized in custody battles. Instead of focusing on “parental alienation” as a label, mental health professionals are encouraged to anchor their assessments in validated diagnoses and constructs. This approach ensures objectivity and adherence to established clinical standards.
Clinical Constructs That Describe PA
While “parental alienation” isn’t a recognized diagnosis, the behaviors and emotional harm it encompasses are described in clinical terms using established constructs. Here are three key examples:
1. Child Psychological Abuse (DSM-5)
Child psychological abuse is defined as emotional maltreatment that can include:
Manipulating a child to reject a parent without justification.
Undermining the child’s attachment system through fear, guilt, or loyalty conflicts.
This diagnosis captures many of the harmful behaviors seen in cases of PA. Labeling these behaviors as psychological abuse anchors them in a well-established framework, allowing therapists to address the emotional and developmental impact on the child.
2. Factitious Disorder Imposed on Another (FDIA)
Previously known as Munchausen by proxy, FDIA is a clinical disorder recognized in the DSM-5. It occurs when a caregiver fabricates or induces symptoms in another person, often to gain sympathy, maintain control, or manipulate third parties (e.g., courts or medical professionals).
In high-conflict custody cases, this may include presenting a child as emotionally damaged by the other parent without evidence. This tactic, occasionally seen in PA cases, aligns with the manipulative behaviors described under FDIA.
3. Spousal Psychological Abuse (Coercive Control)
Coercive control is documented in the ICD-11 and legal systems worldwide. In the context of family dynamics, it includes:
Manipulating the child as a weapon against the other parent.
Controlling the child’s perception of the other parent through fear, guilt, or misinformation.
This construct overlaps with emotional abuse and highlights how alienating behaviors can affect both the child and the ex-partner.
Why Many Therapists Haven’t Heard of PA
Since PA is not included in the DSM-5 or ICD-11, it’s not commonly addressed in clinical training. Most therapists haven’t been formally educated on it and may not even realize it’s a real and pressing problem. When they do encounter it, they’re often unprepared to recognize the signs—especially because alienating parents can be incredibly convincing.
In many cases, the alienating parent is the first to engage with professionals, and they often use clinical buzzwords like “abuse,” “trauma,” or “safety concerns” to justify the child’s rejection of the other parent. These terms are emotionally loaded and can trigger a strong empathetic response from clinicians—understandably so. But the reality is: therapists are not investigators. They aren’t there to determine who’s lying or what actually happened. Their job is to assess what’s presented to them and support the emotional well-being of their clients. And unfortunately, they can be lied to—sometimes skillfully.
When a therapist only hears one side of the story (especially early in the process), they may unknowingly reinforce the alienation by validating the narrative presented to them without seeing the full picture. This doesn’t come from malice or incompetence—it’s a limitation of the role and the nature of therapeutic work itself. It’s one reason why PA is so hard to untangle: it thrives in the gray area between emotional claims and legal realities.
Implications for Therapy
Therapy can be a lifeline for those impacted by parental alienation, but let’s be real — it’s not a magic wand. The damage caused by PA is often deep, layered, and ongoing. The emotional fallout doesn’t just stop because someone walks into a therapist’s office. Still, therapy offers a critical space for making sense of the chaos and beginning to rebuild.
For targeted parents, therapy can provide validation, coping strategies, and emotional support. Many report feelings of helplessness, grief, rage, and profound confusion. A skilled therapist can help them hold those emotions without letting them spiral — and work through the identity-shifting experience of being cast as “the bad guy” in their own child’s eyes. Therapy can also support parents who are dealing with legal proceedings by helping them manage the stress, confusion, and emotional toll of the process. While therapists don’t give legal advice, they can help clients process court outcomes, prepare emotionally for hearings or custody evaluations, and develop healthy coping tools to stay grounded through what is often a dehumanizing and overwhelming experience.
Children who have been manipulated into rejecting a parent may need help unpacking that dynamic carefully and slowly — especially since they may not even see the alienation for what it is. Therapists must tread lightly: confronting a child too soon can lead to shutdown or resistance, but ignoring the signs altogether only deepens the harm. Good therapy in these situations is patient, trauma-informed, and deeply attuned to the child’s internal world — not just their external behaviors.
For adult children of PA, therapy can be the first time they put the puzzle pieces together and realize their feelings toward one parent were never truly their own. That realization can be world-shaking. Therapy helps them process that betrayal, navigate grief for the time and relationship they lost, and begin to develop their own views and values — separate from the influence of the alienating parent.
It’s also important to acknowledge that therapists must constantly check their own biases when working with families in high-conflict custody situations. That means staying aware of how easy it is to be pulled into one parent’s narrative, especially when that story is told with conviction and clinical-sounding language. Ethical, reflective practice is crucial here — and that includes knowing when to consult, when to refer, and when to admit that more information is needed.
Therapy may not fix everything — especially when the alienation is ongoing and reinforced by legal decisions, misinformation, or continued manipulation — but it can be a powerful source of insight, support, and healing. It’s a place where people can speak the truth of their experience without being gaslit, minimized, or dismissed. And for many, that’s where the real work of healing begins.
The Bottom Line
Parental alienation may not be a formal diagnosis, but the emotional and relational harm it describes is real and significant. Therapists use established constructs like child psychological abuse, FDIA, and coercive control to address the behaviors and support those affected. By focusing on evidence-based approaches, clinicians can ensure that their work remains objective and effective, helping individuals and families heal from the pain of alienation.
If you’re struggling with the effects of parental alienation, therapy can offer a path toward understanding, healing, and hope.