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Concerned About Unconventional Mental Health Interventions?

Concerned About Unconventional Mental Health Interventions?
Alternative Psychotherapies: Evaluating Unconventional Mental Health Treatments

Tuesday, April 21, 2020

Why No Knowledgeable Person Would Say Avoiding a Divorced Parent Means an Attachment Disorder

Five years ago, I wrote a post on this blog——where I expressed my concern about the attempts of the California psychologist Craig Childress to “explain” in terms of attachment theory why some preteen and teenage children avoid one of their divorced parents.

This parent avoidance phenomenon is sometimes referred to as “parental alienation” (PA), of course, and advocates of PA belief systems attribute the avoidance to skulduggery on the part of one of the parents, who maliciously turns the child against the avoided parent. As there is no adequate research and little theory about parent avoidance, there was a bit of room for Childress to put forth his take on it, which he did in a self-published book, a self-published pamphlet, a blog and a (now private) Facebook page.

Childress’s basic idea is that a child with a normal emotional attachment to a parent can have not only that attachment, but the whole “attachment system”, suppressed by the manipulations of the other parent. Why does that parent do the manipulating? Easy, according to this view; she (usually but not always) has a narcissistic/borderline personality disorder that has developed because she was in a condition of disorganized attachment as a toddler. That condition arose because one or both of the parent’s parents had been traumatized and hence behaved toward the child in ways that were both frightening and frightened.

None of these steps (except the source of disorganized attachment, if any) makes any sense in terms of what we know about attachment and later development. First, early attachment status is by no means a perfect predictor of later personality characteristics. A longitudinal study following individuals from birth to early adulthood showed that (Sroufe, 2005). Second, although there have been many queries about the outcome of disorganized attachment (a state in which toddlers behave strangely in circumstances where you would expect them to go close to a parent for comfort), the evidence seems to be that it does not result in a personality disorder. Third, even if a parent were able to suppress the child’s attachment system, logically this would interfere with all child-caregiver relationships and could not be finetuned to affect attitudes toward one parent and not the other. Fourth—and very important—children who avoid a divorced parent and are said to have PA are usually preteens or teenagers. Their ways of feeling and showing emotional attachment are vastly different from those of toddlers, they thrive without much parental presence unless some adverse circumstances disturb them, and in fact they are beginning to seek peers in friendship or romantic relationships that will soon replace the comfort and security that parents used to offer.

I said a lot of this about Childress’s views, a long time ago. Why bring it up again? The current problem has to do with discussions about the International Classification of Diseases published and periodically revised by the World Health Organization. The eleventh edition of this publication (ICD-11) is presently under construction, and a comment page allows interested people to propose and discuss various concerns. PA advocates, who failed to get PA included in DSM-5 in the United States, are hoping for some inclusion in ICD-11. The argument until just recently has been that PA cannot be listed as a diagnosis, but could be listed as an index term that would take the reader to the topic of “parent-child relationship problem”, obviously a category much broader than, and not necessarily including, PA.

In the last few days, however, it has been proposed that parent avoidance should be classified as an attachment disorder—and a few contributors have cited Childress as a source for this. One proposal lists criteria that are identical with lists of PA characteristics, but does not use the PA term.
So, could it make sense to think of PA as an attachment disorder? No, it could not. There are attachment disorders listed in both DSM-5 (and previous editions) and ICD-10. These are disorders of social relationships that appear to stem from a child’s history of caregiving and separations from caregivers; salient events in that history would have occurred during the period when emotional attachments usually form, about 10 months to 3 years of age. Reactive Attachment Disorder, for example, can only be diagnosed if there is a history of problematic caregiving in early life AND if symptoms begin before age 5 years.

Parent avoidance, on the other hand, is most often seen (and labelled PA) in children in the preteen and teenage years. The avoided parent usually states that the child was normally attached to him (or her) but now refuses contact. The early period when attachment forms is asserted to have been normal, and no problems or changes of caregiver are reported. These children are thus past the age when attachment disorders begin to show symptoms, and they do not have the problematic caregiving history associated with genuine attachment disorders.

What would be the advantage to PA advocates of claiming that attachment problems are the cause of children avoiding parents? One advantage is that there is a huge literature on attachment that authors may reference as supporting their thinking, as Childress frequently cites Bowlby. PA authors can be fairly sure that most of their audience, though they may have heard of Bowlby, actually have no idea what Bowlby said, when he said, to what extent he had an evidence basis, or to what extent he changed his mind. But everybody knows that attachment is good and attachment problems are bad, so this suggests that anyone concerned about a lack of attachment must be fighting the good fight.

Claims about attachment disorders may also win for PA advocates an added concern related to pseudoscientific views of known attachment disorders. Charlatans presenting their perspectives on Reactive Attachment Disorder, for example, have asserted that children with attachment disorders grow up to be antisocial, callous, cruel, even psychopathic. (Narcissistic/borderline, anyone? ) There is no evidence that this is true, but it would certainly be persuasive to a parent who knew no better.

Those who are proposing that PA be presented as an attachment disorder in ICD-11 are presumably hoping that their wolf will be accepted as a real sheep when wearing the attachment disorder disguise.  Fortunately, there are a number of knowledgeable people who want actual “wool and lamb chops” out of ICD-11 categories and are paying attention to these proposals.

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