Disappointing to some professionals, I’m sure, is the fact that two disorders didn’t make it into the DSM-5 at all — not even in the chapter “Conditions for Further Study.”
Those two lonely disorders? “Internet addiction” and parental alienation disorder.
This is a nice respite from the hype surrounding both these concerns and reaffirms what we’ve been saying here for years — these are not mental disorders. Do some people have a usually-temporary and almost-always transitory problem with figuring out how much time to spend on the Internet? Sure they do — it’s just not a disorder-level concern.
And the evidence is simply too sparse for “parental alienation disorder,” which I believe has propagated more for legal than clinical reasons.
Nearly since the introduction of the term “Internet addiction” in 1996, I’ve been beating the same drum about this so-called disorder — it doesn’t exist. I wrote a guide to Internet addiction back in 1999, which we keep updated from time to time.
So here we have 17 years’ worth of research, and still the disorder doesn’t even rise to the level of recognition in the DSM of a condition that may need further study. That could be for one of two reasons. One, the working group that looked at the research was biased and decided that such a disorder couldn’t possibly exist (which would require consensus among the entire working group — a pretty unlikely scenario). Two, the research is still so flimsy and based upon the same flawed instruments it’s been using for most of that 17 years, the data are simply not robust or generalizable.
In 2008, I penned this article about why Internet addiction still doesn’t exist. I had to do an update just 8 months ago to rebut the claim by Forbes that Internet addiction was going to be included in the new DSM-5. (A good argument not to get your health information from a website like Forbes.)
The DSM-5 working groups also didn’t much care for parental alienation disorder, a disorder we covered late last year here. The research data for this concern simply doesn’t support its inclusion at this time. Which is exactly what we told our readers last September (just so there are no surprises!):
‘‘The bottom line — it is not a disorder within one individual,” said Dr. Darrel Regier, vice chair of the task force drafting the manual.
‘‘It’s a relationship problem — parent-child or parent-parent. Relationship problems per se are not mental disorders.’
Could you imagine the outcry the American Psychiatric Association — the publishers of the DSM-5 — would receive if they started coding relationship problems as mental illness, on the same level as schizophrenia or clinical depression?
The evidence for both these disorders is so lacking, neither made it into the category “Conditions for Further Study.” That’s saying something — especially for “Internet addiction,” which has had hundreds of peer-reviewed studies published about it.
For all the misplaced angst and media-created melodrama surrounding the publication of the DSM-5, we can be thankful neither of these two disorders made the cut.
20 comments
the DSM is a joke and should be banned
as it just supports the drug industry
Ditto love addiction, porn addiction, and any number of other non-substance addictions not subject to confirmation via the null hypothesis. These are seductive labels that will draw people to therapists’ offices in droves; the therapists can then treat and refer to 12-step programs from which the patients are likely to drop out, which often means the patient will return to therapy. Nice revolving door.
Actually, “Internet Gaming Disorder” DID make it into the Section III of the manual, which are for disorders needing further study. Please review the DSM-5 before making such claims.
I’m sorry, but where in this article or comments did you see anyone talking about “Internet Gaming Disorder?” Perhaps you should actually read the article you’re commenting on before making such claims.
Parental Alienation is not in the DSM-5. Neither is Road Rage. But PA is real and it is Child Abuse.
While the words “parental alienation” do not appear in the DSM-5, a number of new entries address the issue of a parent damaging, and in some cases destroying, the previously normal, healthy relationship between a child and the child’s other parent.
For example, parent-child relational problems now have a discussion in DSM-5, not just a label. The discussion explains that cognitive problems in
parent-child relational problems “may include negative attributions of the other’s intentions, hostility toward or scapegoating of the other, and unwarranted feelings of estrangement.” That is a pretty good description of a child’s view of the alienated parent.
Further, child psychological abuse is a new diagnosis in DSM-5. It is defined as “non-accidental 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.” In many instances, the behavior of the alienating parent constitutes child psychological abuse.
Child affected by parental relationship distress is another new diagnosis in DSM-5. It should be used “when the focus of clinical attention if 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
physical disorders.” That is also a good description of how parental alienation comes about.
So while the words may not appear in the DSM-5, I think the authors made it possible for clinicians to identify and address parental alienation. For alienated parents and children, that’s all that matters.
Sincerely,
mike jeffries
Parental alienation disorder is, as I stated in the article, not in the DSM-5. That was the focus of this article.
Can people looking to have their children treated for child abuse get a DSM-5 diagnosis? Absolutely. But that’s not the same as the clearly delineated syndrome that advocates of “parental alienation disorder” have forwarded.
Attempting to “treat the child” is treating the effect, not the cause. The root cause has not been treated if the court does not step in in a TIMELY manner to remove the parent who is instigating the campaign of hate against the formerly loved parent. Once it is obvious a parent refuses to facilitate time sharing,follow court orders,co-parent, it is the Court’s place to deal w/ the out-of-control parent by whatever means necessary.
My husband was obsessed with persuading my children that I never existed in their lives, badmouthing and demeaning me once it was apparent I was divorcing him. I trusted the ‘system’ in Broward Cty, Fl., a huge mistake. After 18 mths of waiting for an initial custody hearing,there were myriad of lies and distortions told by husband, repeated by my children, and even the Guardian. The Judge wrote a report stating I was a substandard mother and awarded my husband 100% custody based on lies that were never checked out.
The only mental health professional involved who observed myself and husband together had a hugely differing opinion on the entire situation. However, this was AFTER the Judge reached her decision.
BTW, I am a Columbia trained L.C.S.W. for 25 years. I stayed home w/ my kids for 7 years and put all of my love into teaching them manners, integrity, honesty, fun, family love and many other things. My children have not talked to me for 4.5 years, I pay 100% child support and they live 6 blocks from me.They were 12 and 13 when this started. They still live with their father.
Your thinking that not including PAS in the DMV because it involves more than 1 person does not make sense to me. Many of the other clinical definitions in the DSM involve more than 1 person.
BOTTOM LINE: The Courts are ineffective,unsophistocated and same w/ lawyers. There needs to be special unit for “high conflict divorces” where real mental health professionals will do evaluations (not the 15K type that psychologists want to do), make a plan and HAVE THEIR OWN JUDGES who have the authority to carry out the recommendations/plan.
Child abuse is real, even if not physical.
It is more than a relationship problem. This is NOT a criticism of any alienated child or adult, but as per http://drcraigchildressblog.com/2014/06/18/diagnosis/ it involves attachment system issues, grandiosity, splitting, false belief systems, and empathy issues. To be clear, this is NOT a criticism of any alienated person.
The evidence is not “sparse”. Refer to Amy Baker’s paper “Parental alienation as a form of psychological maltreatment: Review of theory and research.”
There is an ever increasing number of initial skeptics, that after they get close familiarity with the problem and try to “solve the relationship problem”, eventually grasp the issue, after causing lots of additional harm.
Please contact me. I agree with you totally and I am trying to bring awareness of parental alienation to the national level.I have written an op-ed for a mayor newspaper and I will know later this week if it was accepted.
I have not seen my children in 5 years even though I was the full time mother for 18 years. I was married to a Harvard MBA who fits the common behavior patterns of the perpetrator.
Many thanks
Dr.Grohol is spot-on when he states that parental alienation syndrome has a relational origin. In fact, the same is true of many, many cases of anxiety, depression, adjustment disorders,some personality disorders, etc.
Mental disorders are diagnosed based on the signs and symptoms of the identified patient, as well as the client’s history. For instance, a diagnosis of adjustment disorder requires a preceding event. Parental alienation syndrome displays as very clear symptoms in the child, and these symptoms are preceded by a history of specific behaviors in the parents. If a child is severely beaten by a parent and develops PTSD, is this a relational problem or a mental disorder? I would say both.
When I first encountered parental alienation syndrome, I had never heard of it before and was puzzled by the odd behaviors I was seeing in the (client) children–the combination of which I have not seen in cases of other kinds of abuse. When I researched it, I was surprised at how remarkably the children’s symptoms matched the description of PAS. The adults’ behaviors and even the children’s language was straight out of the book. It has been very helpful to understand the roots and progression of this disorder in managing treatment.
The value of codifying PAS as a mental disorder (if there is value in codifying any of them–but that is another discussion) is that it gives official “backing” to clinicians working with these families. It is sometimes a relief to clients to see that their alarming symptoms fall into a pattern, and that that pattern has a name. With this information, they can learn more about the disorder. With more information,they may be more cooperative with treatment, and thus get better faster.
In cases of PAS, many children get treated for the ensuing depression, eating disorders, etc., with medications and/or individual therapy. These are the wrong responses to parental alienation syndrome, and are perpetuated by a lack of understanding of this problem. How much better it would be to call a spade a spade and treat this disorder with effective relational therapy!
The emotional harm that visits alienated children is far too grave (in extreme cases resulting in homicide or suicide) to be so lightly dismissed.
Mike Jeffries has briefly outlined a more careful reading of the DSM.
It would be of great benefit to all readers if you invited a PA specialist to pen a few words about how to diagnose and treat this kind of disorder, whether used as a DSM code or example within other codes.
I believe PAD should be future studied. At least for prevention of disorders in the children involve.
Internet addiction can be the “top of the iceberg” as a non chemical depended abuse.. but so is gambling.
In our clinic (Sismanogleio-Athens/Greece Hospital Dpt of Child and Adolescence Psychiatry)there is an ongoing research about internet addiction in clinical sample.So far (in a really small sample) one thing comes out for sure… co-morbidity…
It’s interesting that you don’t mention the third “lonely disorder” – sex addiction, nee hypersexual disorder, which also wasn’t included, and was rejected from the appendix as well.
Like Internet Addiction, it is a hype-fueled concept, with lots published aboout it, but very little actual empirical evidence that supports it asa “disorder.” many of the same criticisms you level at IAD are valid for sex addiction as well. PsychCentral has a very strong Sex Addiction treatment voice in its writers – is this why you didn’t include it?
I’m genuinely curious – not trying to be confrontational.
Excellent article, as always John. A couple of years ago neuroscientists in China appeared to find brain changes associated with addiction in individuals who spent hours and hours online. Of course, like the hundreds of other studies on so-called “internet addiction” there were flaws. It appears that the APA has seen through those flaws in those studies and come to the conclusion that this condition does not exist. People should not be too quick to criticise the editors of the DSM. Internet addiction does not feature in the latest World Health Organisation ICD either.
I feel that Internet Addiction does deserved to be recognized, as in the article there are many existing scientific papers published and being researched as we read this article. why wouldn’t the APA/DSM issue some reasons for its rejection? after-all many well known researchers have done works on it. Does it mean that all the researches on IA is futile? As we all know internet is a booming technology which have changed us. our brains are affected, our behaviors are affected. I hope Internet Addiction would receive recognition in the coming editions, although I wish people/users be not addicted to the internet.
Thanks for the wonderful article Sir. I am a regular reader to your site.
I’m not an expert, I just happen to have son who I strongly suspect has a clinical problem with internet addiction, but I have to agree with Constantinos Bletsos above who points to co-morbidity.
I think it’s similar to how alcohol and drug use is often co-morbid and how many treatment centers or groups are geared for treating “dual diagnosis.” Also, in looking back at my son it’s difficult to know which came first. Was it the internet addiction or the depression? And which one fed the other? I suspect another factor could be predisposition to addiction.
Sir, I would have to respectfully disagree with you on whether or not internet addiction is real or not considering that there have been the deaths of children due to neglect from parents who were more interested in their online life than their own children. I agree that maybe they need to substantiate the claims more but the United States is one of the few hold outs. Europe and Asia have already had issues with people dying from neglecting themselves because they were more interested in playing online. Dr. Kimberly Young, while I don’t totally agree with her, has some interesting points and the definition of an addiction is “a condition that results when a person ingests a substance (alcohol, cocaine, nicotine) or engages in an activity (gambling) that can be pleasurable but the continued use of which becomes compulsive and interferes with ordinary life responsibilities, such as work or relationships, or health. Users may not be aware that their behavior is out of control and causing problems for themselves and others.” Killing yourself or a child via neglect or in anger because of the kid (for example, and this happened in S. Korea) because they broke the X-box is a pretty big indicator that someone is addicted. And if GAMING is considered an addiction I don’t see why the use of the Internet as a whole wouldn’t be since it is just as much, if not more so, apt to draw users in to social media/games/information/news. This is the generation of “More and now”.
I cannot believe that this man was even allowed to obtain a Ph.D. 10 years ago there were over 200 peer review articles supporting the psychological abuse of custodial interference, i.e. Parental Alienation. Now 10 years later, the number of peer review articles and stories on the internet from victims themselves, one cannot really ignore this and say it does not exist and is only about legal battles. This man should have his licensed revoked.