TORONTO -- Note: In May 2019, the World Health Organization adopted the International Classification of Diseases (ICD-11) without "parental alienation." In February 2020, a WHO team clarified in an online database that the phrase is "a judicial term and issue."


An emerging mental health issue in which one parent turns a child against the other parent could be added to the international standard for diagnostics next month.

"Parental alienation" may be among an updated list of diseases and related health problems when the World Health Organization votes to accept the 11th revision of the International Classification of Diseases (ICD-11) in May.

The issue is a kind of psychological manipulation of a child. It occurs when one parent systemically "badmouths" the other parent. In extreme cases of high-conflict divorce and separation, the child may align with one parent and reject the other. Mental health experts and law professionals are lining up to label it as a form of emotional abuse that can damage the mental health of children.

Research in the field has labelled parental alienation an "unacknowledged form of family violence" and has found long-term mental health consequences for children who experience it, including anxiety, lowered self-esteem and general quality of life, as well as a greater risk of depression.

"Some of the stories are heartbreaking," says Barbara Fidler, clinical-developmental psychologist in Toronto who has specialized in high-conflict parenting. She says her caseload is growing. "I actually lose sleep over these families. We are losing sleep because children are suffering."

The issue has faced much debate -- what to call it and how to define it -- within the intersecting fields of health and law as parents and children become embroiled in family courts. An international meeting on the issue will take place in Toronto next month. Fidler is working on a special issue of the Family Court Review due early 2020 with Queens University law professor Nick Bala. They hope the collection of all the latest data on parental alienation will inform family lawyers, judges and therapists around the world.

"This is clearly a big problem," says Bala. "I get emails from people coast, to coast, to coast and internationally, raising concerns about being cut off from their children, being cut off from grandchildren."

Research shows that alienation doesn't happen all at once, says Fidler, but it may develop quickly. Experts should focus on the behaviours being exhibited by the children, she says. These may include:

  • Rejection and denigration of a parent for reasons that are trivial
  • Rigid refusal to consider alternative views or explanations
  • Repetition of the favoured parent's words
  • Rehearsed (or it sounds like rehearsed script)
  • Relatives are included in the rejection (even pets)
  • Little or no regret or guilt regarind behavior towards the parent being rejected.

Parents can:

  • Denigrate the other parent
  • Encouraging child to denigrate parent
  • Arranging conflicting activities
  • Inducing guilt about visits with other parent
  • Portraying other parent as dangerous
  • Involving child in spying

Alienating parents may not speak positively about the other parent, support the child's relationship with them, encourage cooperation or problem solving over conflicts with them, or even have photos of them visible.

A growing body of research is illuminating the effects of parental alienation on children, says Fidler, including:

  • Self-hatred and self-esteem issues
  • Higher rates and risks of depression, relationship difficulties and substance abuse
  • Loss of guidance and support of one parent
  • Loss of relationship with extended family
  • Inability to develop and sustain healthy relationships

Fidler and Bala say there is a need for more research into how to better define alienation in its various forms, since not all cases look the same. It's not just a mental health issue, but a legal issue that should require better training for family lawyers and judges, who can put a stop to alienation early.

"We need to recognize the problem earlier so that we can provide the education and in some cases therapy early on," said Fidler.

In Canada, a proposal to reform the Divorce Act outlines the importance of a child's relationship with each parent. "It is generally important for each parent to support the child's relationship with the other parent," an overview of the objectives of Bill C-78 reads online. "If a parent actively attempts to undermine their child's relationship with the other parent, courts may need to consider this in making a parenting order."

There is at least one high profile case in the U.S. that some experts point to as a case in point for a better understanding of parental alienation: Hollywood A-listers Brad Pitt and Angelina Jolie. In June of 2018, court documents obtained by The Blast showed that a judge in the stars' divorce case said the couple's children "not having a relationship with their father is harmful to them" and that Jolie should help mend their relationship with their father.