C. A. CHILDRESS, Psy.D.

LICENSED CLINICAL PSYCHOLOGIST, PSY 18857

547 MARENGO DR., STE. 105 PASADENA, CA 91105 (909) 821-5398

Professional-to-Professional Letter of Diagnostic Concern Dear Mental Health Professional, I am a licensed clinical psychologist in Pasadena, California, specializing in child and family therapy and parent-child relationship conflict. I have provided this letter to parents who believe that they are experiencing a particular type of family relationship dynamic involving significant DSM-IV TR Axis II Personality Disorder psychopathology with a spouse or an ex-spouse that is possibly being transmitted to their children through the significantly problematic pathogenic parenting of the ex-spouse. I have suggested to parents that they provide this diagnostic discussion letter to mental health professionals who become associated with the assessment or treatment of their children, along with the associated handout on DSM-IV TR diagnostic criteria, and to accompany these materials with their request of the mental health professional to specifically assess for these diagnostic features with their children. Parent Psychopathology: Personality Disorder: The particular type of parental psychopathology of concern that may be involved with this family is a mixed Axis II Personality Disorder presentation of the ex-spouse that is organized primarily around Narcissistic traits but includes prominent Borderline features as well. This presentation may also include Paranoid, Histrionic, and occasionally Antisocial features in addition to the primary organizing core of Narcissistic and Borderline traits. Delusional Disorder, persecutory type: The mixed Personality Disorder (i.e., Personality Disorder, NOS or prominent features) of the ex-spouse leads to the development of a false belief system with the ex-spouse regarding the abuse potential and/or fundamental parental inadequacy of the other parent in which the child is supposedly being harmed by the other parent, creating the subsequent belief that the active protection of the child from abuse by the other parent is required of the ex-spouse. This false belief system of the ex-spouse is held despite contrary evidence indicating that the parenting of the other spouse/parent is entirely normal-range, which elevates this false belief system to a Delusional Disorder, persecutory type. Note that DSM-IV TR diagnostic criterion A for a Delusional Disorder requires that the delusion be nonbizarre and criterion C requires that the impact of the delusion be restricted and localized in its focus. Pathogenic Parenting: The primary clinical concern with this family is that the ex-spouse gradually imposes (DSM-IV TR; Shared Psychotic Disorder) the Delusional Disorder onto the child who then shares this delusional false belief and begins to symptomatically expresses the delusion with regard to the other parent. This process would meet the DSM-IV TR diagnostic criteria for a Shared Psychotic (delusional) Disorder. In addition, the childs symptom display will also evidence signs that the Axis II Personality Disorder psychopathology of the ex-spouse is also being transmitted to the child, so that the child will be symptomatically expressing toward the other parent the Axis II Personality Disorder processes of the ex-spouse. The transmission of parental psychopathology to a child who then symptomatically expresses this psychopathology would represent pathogenic parenting (i.e., parenting that is so highly Page 1 of 4

problematic that it is inducing psychopathology in the child), and the presence of significantly pathogenic parenting that results in the transfer of Axis I and Axis II parental psychopathology to a child would seemingly elevate the level of clinical concern to a consideration of child protection issues. Child Symptom Expression: Primary Borderline Processes: The childs symptom expression in these circumstances will express a prominent rejection-abandonment presentation regarding the targeted parent. Of particular clinical note in this regard will be a prominent Borderline Personality Disorder splitting dynamic (Borderline criterion 2) involving the childs differential relationships with each parent, in which the pathological ex-spouse receives the splitting representation of the entirely all-good idealized parent while the other parent receives the splitting extreme of the entirely all-bad demonized-devalued parent. The childs rejection-abandonment of the other parent as the splitting extreme of the all-bad/devalued parent represents the influence of the pathogenic parenting from the ex-spouse in which the Borderline Personality Disorder dynamics of the core abandonment fears of the ex-spouse (Borderline criterion 1) are being projected onto the other parent, and the child, who is under the psychological influence of the Shared Psychotic Disorder processes with the ex-spouse, stabilizes the psychological expulsion of this core abandonment fear by rejecting-abandoning the other parent. The idealized ex-spouse becomes the extreme of the never-to-be-abandoned parent while the other spouse/parent becomes the other extreme of the entirely-abandoned parent. Shared Delusional Processes: The child displays the persecutory Delusional Disorder of the ex-spouse by symptomatically maintaining an excessive and complete rejection-abandonment of the other parent, which the child proposes is justified by that parents abuse or fundamental parental inadequacy. However, when an independent clinical evaluation of the parenting behavior of the rejected-abandoned parent is conducted, there is no indication of either emotional or physical abuse or parental inadequacy that would warrant and account for the excessive and complete rejection-abandonment of the parent displayed and expressed by the child. Furthermore, the child and ex-spouse share the same false belief system regarding the abusepotential or fundamental parental inadequacy of the other spouse/parent and this false belief system continues to be held despite contrary evidence that the parenting of the rejectedabandoned parent is entirely normal-range. Primary Narcissistic Processes: The childs symptom expression will be notable for a group of Narcissistic Personality Disorder features that includes a prominent lack of empathy for the rejected-abandoned parent (Narcissistic criterion 7). Other Narcissistic Personality Disorder features that are likely to be displayed by the child include a narcissistic sense of entitlement relative to the childs expectations of parenting from the rejected-abandoned parent (Narcissistic criterion 5); a narcissistic self-inflation (grandiosity) in which the child perceives himself or herself as being in a superior status position of elevated authority relative to the rejectedabandoned parent so that the child sits in judgment of the rejected-abandoned parent and judges the parent to be inadequate as a parent, thereby deserving (in the childs view) the childs behavioral and emotional retaliation toward the rejected-abandoned parent (Narcissistic criterion 1); and the potential display by the child of an arrogant and haughty attitude toward the rejectedabandoned parent (Narcissistic criterion 9).

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Additional Borderline Presentation: In the childs rejection-abandonment of the other parent, the child is likely to display episodes of unstable emotional outbursts toward the rejectedabandoned parent (Borderline criterion 6) and prominent problems with anger control relative to the rejected-abandoned parent (Borderline criterion 8). Possible Additional Personality Disorder Features: The child may also display Paranoid Personality Disorder features associated with a belief held without a sufficient basis that the rejected-abandoned parent is exploiting, harming, or deceiving the child (Paranoid criterion 1), and a persistent tendency of the child to hold grudges toward the rejected-abandoned parent and to be unforgiving of insults, injuries, or slights perceived by the child from the rejectedabandoned parent (Paranoid criterion 5). The child may also be overly sensitive to reading hidden demeaning or threatening meanings into benign remarks or events associated with the rejected-abandoned parent (Paranoid criterion 4), and the child may be reluctant to confide everyday sorts of personal child-related information to the rejected-abandoned parent out of an expressed concern that the information will be used maliciously by the rejected-abandoned parent (Paranoid criterion 3). These Paranoid Personality Disorder symptom displays would be consistent with the persecutory delusional beliefs the child shares with the ex-spouse regarding the abuse-potential or fundamental parental inadequacy of the rejected-abandoned parent. The child might also display emerging Antisocial Personality Disorder features involving the childs displayed lack of remorse for the overtly hostile-rejecting treatment of the rejectedabandoned parent (Antisocial criterion 7) and the potential for the childs deceitfulness and repeated lying to the rejected-abandoned parent to achieve the childs own personal pleasure (Antisocial criterion 2; this symptom display could also be interpreted as Narcissistic manipulation criterion 6). The DSM-IV TR prohibits a diagnosis of Antisocial Personality Disorder prior to the age of 18. Earlier displays of features of Antisocial Personality Disorder are associated with Conduct Disorder. Within the current family processes of concern, the child may exhibit Conduct Disorder symptoms associated with the destruction of property belonging to the rejected-abandoned parent (Conduct Disorder criterion 9); runaway from the care of the rejected-abandoned parent (Conduct Disorder criterion 4); lying to the rejected-abandoned parent to obtain goods or favors or to avoid obligations (Conduct Disorder criterion 11). Selective Expression of Personality Disorder Features: Symptom displays of Personality Disorder features during childhood are very rare. The childs selective symptom expression of these Personality Disorder features solely toward the rejected-abandoned parent while in other settings and relationships, particularly with the ex-spouse, the childs behavioral and emotional expressions appears normal-range or perhaps even hyper-good and hyper-mature, is also atypical of Personality Disorder processes if these processes are inherent and authentic to the child. The selective expression of Personality Disorder features by the child is highly suggestive that the Personality Disorder symptom presentation is not an authentic expression of psychopathology that is inherent to the child but is a consequence of the psychological control dynamic associated with the imposition of the Shared Psychotic (delusional) Disorder from the primary case of the ex-spouse. The presence of selectively expressed Axis II Personality Disorder symptoms with the child represents strongly suggestive evidence for the diagnostic potential of a Shared Psychotic Disorder process with a pathological and controlling parent who is the authentic source-origin of the Axis II Personality Disorder psychopathology being expressed by the child. If DSM-IV TR Axis I and Axis II psychopathology is being transferred from the ex-spouse to the child, and is being symptomatically expressed by the child, this would be indicative of severely Page 3 of 4

problematic pathogenic parenting in which a significant degree of psychopathology is being induced in the child through the parenting of the ex-spouse. This would seemingly elevate the level of clinical concern to the consideration of child protection issues. Professional Consideration of these Diagnostic Possibilities I have suggested to parents who believe that they are experiencing this family dynamic involving a significant psychopathology with a spouse or ex-spouse that is being transferred to the child (i.e., pathogenic parenting) that the targeted parents request professional consideration of these potential diagnostic presentations by the child in order to professionally evaluate for the potential of significantly pathogenic parenting by the spouse or ex-spouse as being responsible for the childs symptom display relative to the rejected-abandoned parent. If these diagnostic possibilities are excluded relative to the childs symptom expression, I have also suggested to parents who believe that they are experiencing this family dynamic that they request from evaluating and treating mental health professionals the reasons for the exclusion of these differential diagnostic possibilities so that clarity of the childs diagnosis and treatment needs can be achieved. With regard to the potential shared delusional belief that the child may hold with the ex-spouse involving the abuse-potential or fundamental parental inadequacy of the rejected-abandoned parent, there could be three potential reasons for rejecting this diagnosis: 1) The ex-spouse does not believe that the parenting of the rejected-abandoned parent is abusive or fundamentally inadequate. If this is the case, then the ex-spouse should offer no justification for the childs rejection-abandonment of the other parent and should seemingly be highly concerned and motivated to resolve the aberrant relationship behavior being expressed by the child toward the other parent. 2) The ex-spouse maintains a belief that the rejected-abandoned parent is an abusive or fundamentally inadequate parent, thereby justifying the childs rejection-abandonment of the other parent. However, there is reasonable supportive evidence to suggest that this belief system may be true, which would mean that it does not qualify as a delusion because it is not clearly a false belief. 3) The ex-spouse maintains a belief that the rejected-abandoned parent is an abusive or fundamentally inadequate parent, thereby justifying the childs rejection-abandonment of the other parent. However, this belief system is responsive to change based on the presentation of contrary evidence, therefore it does not qualify as delusional. With regard to the childs potential display of Personality Disorder features, this diagnostic possibility can be rejected if the childs symptoms are not consistent with the criteria for the Personality Disorders features. If, however, these diagnostic possibilities are confirmed, then issues of pathogenic parenting and child protection would seemingly become prominent professional concerns. Thank you for your consideration of these diagnostic and treatment-related possibilities. Craig Childress, Psy.D. Licensed Clinical Psychologist, CA PSY 18857 Consultation: drcraigchildress@gmail.com Page 4 of 4