Is Parental Alienation in the DSM or ICD-11? Bernet et al. (2010), the Proposal, and What Actually Happened
A plain-language summary of the authors' 2010 research in The American Journal of Family Therapy 38(2), 76–187 — Parental Alienation, DSM-V, and ICD-11.
Summarised by Malcolm Smith on behalf of Love Over Exile. Last updated 9 June 2026 .
TL;DR
- The short answer · no, it is not a diagnosis. Parental alienation is not a recognised diagnosis in the DSM-5, the DSM-5-TR, or the ICD-11. It was formally proposed for inclusion in 2010 and was declined by both the American Psychiatric Association and the World Health Organization.
- The proposal · Bernet et al. (2010). William Bernet and three co-authors published a 112-page proposal arguing that 'parental alienation disorder' met the threshold for the DSM-5 and ICD-11. They offered two sets of criteria — one as a disorder, one as a relational problem — and estimated it affects about 1% of US children.
- What the manuals actually contain. Neither manual names parental alienation. The DSM-5 has relational-problem codes — Parent–Child Relational Problem and 'Child Affected by Parental Relationship Distress' (CAPRD) — and the ICD-11 has 'caregiver–child relationship problem' (QE52.0). These are administrative relational codes, not a diagnosis of parental alienation.
- The ICD-11 add-then-remove story. For a short period 'parental alienation' was listed in the ICD-11 only as a search (index) term pointing to the relationship-problem code. After objections, the WHO removed it around 2020, stating that parental alienation 'is not a health care term.'
- Why it was rejected · and the criticism. The DSM task force held that a disorder must be a condition inside an individual, whereas alienation is a relationship problem. Critics (Pepiton et al., 2012) argued the evidence base did not support a diagnosis, and others (Meier, 2020) warned that formal recognition could be misused against abuse allegations.
The Study at a Glance
| Authors | Bernet, W., von Boch-Galhau, W., Baker, A. J. L., & Morrison, S. L. |
|---|---|
| Published | 2010 |
| Journal | The American Journal of Family Therapy 38(2), 76–187 , pp. 76–187 |
| Method | A formal proposal. Bernet and colleagues argued that parental alienation — which they reframed as 'parental alienation disorder' — met the threshold for inclusion in the forthcoming DSM-5 and ICD-11, and supplied two alternative sets of diagnostic criteria (one as a stand-alone disorder, one as a relational problem) so it would qualify whichever bar the manuals applied. The document assembles a large international literature in support. Both manuals ultimately declined to adopt it. |
| Sample | Conceptual proposal document (~112 pages) reviewing the international parental-alienation literature — no single original dataset |
| Full paper | View primary source → |
Love Over Exile is a plain-language research archive on parental alienation, written by Malcolm Smith — an alienated parent and author of the forthcoming book Love Over Exile — for non-specialist readers who want to understand the evidence base without a psychology degree or a journal subscription. This page answers one of the most-searched and most-misstated questions in the field, accurately.
"Is parental alienation in the DSM?" is one of the most common questions people ask — and one of the most often answered wrongly. The honest answer starts with a single word: no. The fuller story, which begins with a 2010 proposal by William Bernet and colleagues, is worth understanding properly.
Definition · Parental alienation and the diagnostic manuals
Parental alienation is the process by which a child is turned against one parent, without legitimate justification, through another person's influence. The two manuals clinicians use to classify conditions are the DSM-5 (the American Psychiatric Association's diagnostic manual) and the ICD-11 (the World Health Organization's international classification). Parental alienation is not a diagnosis in either. It was formally proposed for both in 2010 and declined. Each manual contains broad relational-problem codes that can apply to these families, but a relational-problem code is not a diagnosis of "parental alienation".
Proposal: Bernet et al. (2010); status per the DSM-5-TR and the WHO.
Is parental alienation in the DSM or ICD-11? The short answer
No. Parental alienation is not a recognised diagnosis in the DSM-5 (2013), the DSM-5-TR (2022), or the ICD-11. It was formally proposed for both and was declined by the American Psychiatric Association and the World Health Organization.
That matters, because the opposite is asserted constantly — in custody disputes, on advocacy sites, and across social media. The confusion is understandable: both manuals do contain relational codes that can apply to families in an alienation situation. But a relational-problem code is not the same thing as recognising "parental alienation" as a disorder, and the difference is the whole point.
What did Bernet and colleagues propose in 2010?
In 2010, the forensic psychiatrist William Bernet and three co-authors — Wilfrid von Boch-Galhau, Amy J. L. Baker and Stephen L. Morrison — published "Parental Alienation, DSM-V, and ICD-11" in The American Journal of Family Therapy. At roughly 112 pages, it was less a journal article than a book-length case for recognition.
Their argument was direct: parental alienation, which they reframed as "parental alienation disorder", is "a serious mental condition" with a predictable course, and it met the threshold for inclusion in the two manuals then being revised. They were strategic about it, offering two alternative sets of diagnostic criteria — one defining it as a stand-alone disorder, one as a relational problem — so that it would qualify whichever bar the committees applied.
They also put a number on it, estimating that parental alienation affects about 1% of US children and adolescents (roughly 200,000 or more). It is important to read that as the authors' estimate, not a measured prevalence — a projection offered in support of the case for recognition.
Figure 1 · From proposal to rejection. The 2010 proposal (developed from a 2008 submission) argued for "parental alienation disorder" in both manuals. The DSM-5 (2013) was published without it, offering only relational-problem codes. Around 2019 "parental alienation" appeared in the ICD-11 solely as a search index term pointing to a relationship-problem code; around 2020 the WHO removed it, stating it "is not a health care term."
Today, parental alienation is not a recognised diagnosis in any major manual. Sources: Bernet et al. (2010); DSM-5-TR (2022); WHO ICD-11 FAQ.
What actually happened: the proposal was not adopted
Neither manual took it up. The DSM-5 (2013) and its text revision, the DSM-5-TR (2022), do not list parental alienation as a diagnosis, and neither does the ICD-11.
The DSM task force's reasoning was definitional rather than political. In the DSM's framework, a mental disorder must be a condition that resides within an individual. Parental alienation describes a disturbance in a relationship between people, so by that definition it is not a disorder at all — at most it is a relational problem, a category the manual already handles with existing codes. That single distinction did most of the work in the decision.
What the manuals actually say now
Because this is the part people get wrong, it is worth laying out exactly. The codes that do exist are easy to mistake for recognition, so the precise wording matters more here than almost anywhere else in the field.
Figure 2 · What the manuals actually say. DSM-5-TR: parental alienation is not a diagnosis; the nearest codes are Parent–Child Relational Problem (V61.20 / Z62.820) and CAPRD — Child Affected by Parental Relationship Distress (V61.29 / Z62.898) — both relational-problem codes, not disorders. ICD-11: not a diagnosis; a caregiver–child relationship-problem code (QE52.0) exists, and "parental alienation" was added as a search index term then removed around 2020. WHO: parental alienation "is not a health care term", it is a judicial matter, and no evidence-based health interventions are specific to it.
A relational-problem code that a clinician can apply is not the same as the manuals recognising parental alienation as a disorder. Sources: DSM-5-TR (2022); WHO ICD-11 FAQ (2020).
In the DSM-5, the relevant relational codes are Parent–Child Relational Problem (V61.20 / Z62.820) and Child Affected by Parental Relationship Distress, known as CAPRD (V61.29 / Z62.898). A clinician can use either for a child caught in an alienation situation. Neither is a diagnosis of parental alienation, and using one does not mean a clinician has diagnosed "PA" as a disorder.
In the ICD-11, the related category is "caregiver–child relationship problem" (QE52.0) — a factor influencing health, not a disease. For a brief period the terms "parental alienation" and "parental estrangement" were added only as search index terms pointing to that code, then the WHO removed them around 2020. Its stated position is blunt: parental alienation "is not a health care term", it is relevant to judicial rather than health contexts, and there are no evidence-based health interventions specific to it.
Proposed versus actual: side by side
| | What Bernet et al. proposed (2010) | The actual status today | |---|---|---| | DSM-5 / DSM-5-TR | Add "parental alienation disorder" | Declined. Not a diagnosis. Nearest: Parent–Child Relational Problem (V61.20 / Z62.820); CAPRD (V61.29 / Z62.898) — relational codes | | ICD-11 | Recognise parental alienation | Not a diagnosis. QE52.0 caregiver–child relationship problem exists; "PA" was an index term, added then removed (~2020) | | WHO position | (Implicit recognition) | "Not a health care term"; a judicial, not a health-statistics, matter | | Prevalence | ~1% of US children (~200,000+) | Their estimate — not a measured figure | | Status of the construct | A valid, diagnosable disorder | Real as a phenomenon, but not a recognised diagnosis |
Why was it rejected? The criticism
The proposal met sustained, substantive opposition — and this is where a fair page has to give the critics room.
The most-cited rebuttal is Pepiton, Alvis, Allen and Logid (2012), pointedly titled "Is Parental Alienation Disorder a Valid Concept? Not According to Scientific Evidence." They argued that the supporting material presented "anecdotal cases and opinion … as research", misused statistical and research terminology, and did not meet the bar for a valid diagnostic concept. Others, including Houchin and colleagues (2012), argued that the parental-alienation debate "belongs in the courtroom, not in DSM-5" — that it is a custody-litigation problem, not a psychiatric one.
There is also an empirical safeguarding concern that bears directly on formalising PA as a diagnosis. Joan Meier's 2020 study found that in US custody cases, when a mother alleges abuse, a father's cross-claim of alienation roughly doubles her risk of losing custody — a gender-specific pattern critics read as alienation being used to defeat genuine abuse allegations. Giving the label the authority of a formal diagnosis, on this view, would raise the stakes of that misuse.
Bernet and Baker's reply
In fairness, the authors did not let the criticism stand unanswered. In 2013, Bernet and Baker published a "Response to Critics" in the Journal of the American Academy of Psychiatry and the Law, rebutting the four main objections — insufficient research, misuse in court, advocates' motives, and Gardner's legacy. It is a genuine, ongoing scholarly disagreement, not a settled rout. But the institutions themselves came down on the side of caution, and that is the fact that governs the answer today.
What does this mean for you?
If you are an alienated parent, the practical lesson is precise. Do not claim that "parental alienation is a diagnosed disorder" — in court, in a report, or to a clinician — because it is not, and being corrected on it can cost you credibility on everything else you say.
The stronger approach is the one the rest of this archive keeps pointing to: describe the specific behaviours and their documented impact on your child, rather than reaching for a diagnostic label the manuals declined to grant. A clinician can still use a relational-problem code such as CAPRD where it genuinely fits — and the underlying phenomenon can be real and serious even though it is not in the manual. "Not a diagnosis" is not the same as "not happening".
What are the honest limitations?
This page describes an advocacy proposal and its rejection, so it inherits the field's open disagreement. Bernet and colleagues are an interested party — the proposal's principal advocates — and their prevalence figure is an estimate, not data. The critics, too, write from positions, and the institutional decisions reflect a definitional judgment (a disorder lives inside a person) as much as a verdict on whether children are ever unfairly turned against a parent.
What is not in dispute is the bottom line readers came for: parental alienation is not a recognised diagnosis in the DSM-5, the DSM-5-TR, or the ICD-11. The manuals offer relational-problem codes, the WHO calls it "not a health care term", and the responsible way to talk about it is as a real relational problem — not a formal disorder it was never granted to be.
Primary Sources Cited
- Bernet, W., von Boch-Galhau, W., Baker, A. J. L., & Morrison, S. L. (2010) — Parental Alienation, DSM-V, and ICD-11. The American Journal of Family Therapy 38(2), 76–187. DOI 10.1080/01926180903586583.
- Pepiton, M. B., Alvis, L. J., Allen, K., & Logid, G. (2012) — Is Parental Alienation Disorder a Valid Concept? Not According to Scientific Evidence. Journal of Child Sexual Abuse 21(2), 244–253. DOI 10.1080/10538712.2011.628272.
- Bernet, W., & Baker, A. J. L. (2013) — Parental Alienation, DSM-5, and ICD-11: Response to Critics. Journal of the American Academy of Psychiatry and the Law 41(1), 98–104. jaapl.org/content/41/1/98.
- Meier, J. S. (2020) — U.S. child custody outcomes in cases involving parental alienation and abuse allegations. Journal of Social Welfare and Family Law 42(1), 92–105. DOI 10.1080/09649069.2020.1701941.
- World Health Organization (2020) — Frequently asked questions: Parental alienation (ICD-11). who.int.
Last reviewed and updated on 9 June 2026 by Malcolm Smith.
Frequently asked questions
Is parental alienation in the DSM-5?
No. Parental alienation is not a diagnosis in the DSM-5 (2013) or the DSM-5-TR (2022). It was formally proposed for inclusion by Bernet and colleagues in 2010 and the American Psychiatric Association declined to add it. The nearest things the DSM does contain are relational-problem codes — Parent–Child Relational Problem (V61.20 / Z62.820) and 'Child Affected by Parental Relationship Distress' (CAPRD, V61.29 / Z62.898) — but these are administrative codes for a relationship difficulty, not a diagnosis of parental alienation. Anyone telling you 'parental alienation is in the DSM-5' is mistaking a relational-problem code for diagnostic recognition.
Is parental alienation in the ICD-11?
No. The ICD-11 does not recognise parental alienation as a diagnosis. There is a code for 'caregiver–child relationship problem' (QE52.0), which is a factor-influencing-health category rather than a disease. For a short period 'parental alienation' and 'parental estrangement' were added only as index (search) terms pointing to that code, but the World Health Organization removed them around 2020 after objections. The WHO stated plainly that parental alienation 'is not a health care term' and that listing a search term does not signify WHO endorsement.
What did Bernet et al. (2010) actually propose?
They proposed that parental alienation — which they renamed 'parental alienation disorder' — be added to the DSM-5 and ICD-11. In a 112-page document they argued it is a serious, definable mental condition with a predictable course, and they supplied two alternative sets of diagnostic criteria: one treating it as a stand-alone disorder, and one treating it as a relational problem, so it would qualify whichever threshold the manuals used. They estimated it affects about 1% of US children (an estimate, not a measured figure). The proposal was not adopted by either body.
Why was parental alienation rejected from the DSM-5?
The DSM-5 task force's core reason was definitional. A mental disorder, in the DSM's framework, must be a condition that resides within an individual. Parental alienation describes a disturbance in a relationship between people, so it does not fit the definition of a disorder — at most it is a relational problem, which the manual already covers with existing codes. Separately, critics argued the scientific evidence base was not strong enough to support a new diagnosis, and that formalising it could be misused in custody litigation. The combination meant the proposal did not succeed.
Does 'CAPRD' mean parental alienation is recognised?
Not as a diagnosis. CAPRD stands for 'Child Affected by Parental Relationship Distress', a relational-problem code (V61.29 / Z62.898) added in the DSM-5. It describes a child who is affected by conflict or distress in the parents' relationship, and a clinician can use it for a family in an alienation situation. But it is a broad relational code, not a diagnosis of 'parental alienation', and it does not establish PA as a recognised mental disorder. Bernet's own later work (in 2016) worked within this relational-problem framework rather than continuing to seek a new stand-alone disorder.
If it's not a diagnosis, does that mean parental alienation isn't real?
Not being in the DSM is not the same as not existing. Plenty of real human difficulties are not formal diagnoses. The careful position is to separate two questions: 'is the phenomenon real?' (a child being unfairly turned against a loved parent — widely accepted) and 'is it a recognised psychiatric disorder?' (no, both the DSM and ICD declined). What the rejection does mean is that you cannot accurately claim in court or to a clinician that 'parental alienation is a diagnosed disorder' — and that the more defensible approach is to describe the specific behaviours and their impact on the child rather than to lean on a diagnostic label that the manuals rejected.
Who was behind the proposal, and did critics respond?
The lead author was William Bernet, a forensic psychiatrist at Vanderbilt University and the founder of the Parental Alienation Study Group; his co-authors were Wilfrid von Boch-Galhau, Amy J. L. Baker and Stephen L. Morrison. The proposal drew strong criticism: Pepiton and colleagues (2012) argued the evidence did not support a valid diagnosis, and others argued the issue belonged in family court, not the DSM. Bernet and Baker published a 'Response to Critics' in 2013 rebutting the main objections. The exchange is a good example of the field's genuine, unresolved disagreement — and the institutions ultimately sided with caution.
References
- Bernet, W., von Boch-Galhau, W., Baker, A. J. L., & Morrison, S. L. (2010). Parental Alienation, DSM-V, and ICD-11 . The American Journal of Family Therapy 38(2), 76–187 , 76–187. · Primary study summarised on this page.
- Pepiton, M. B., Alvis, L. J., Allen, K., & Logid, G. (2012). Is Parental Alienation Disorder a Valid Concept? Not According to Scientific Evidence . Journal of Child Sexual Abuse 21(2), 244–253. Source
- Bernet, W., & Baker, A. J. L. (2013). Parental Alienation, DSM-5, and ICD-11: Response to Critics . Journal of the American Academy of Psychiatry and the Law 41(1), 98–104. Source
- Meier, J. S. (2020). U.S. child custody outcomes in cases involving parental alienation and abuse allegations: what do the data show? . Journal of Social Welfare and Family Law 42(1), 92–105. Source
- World Health Organization (2020). Frequently asked questions: Parental alienation (ICD-11) . WHO Classifications. Source
See the full curated bibliography on the research page.
How to cite this summary
APA 7th edition
Smith, M. (2026). Is Parental Alienation in the DSM or ICD-11? Bernet et al. (2010), the Proposal, and What Actually Happened [Summary of Bernet, W., von Boch-Galhau, W., Baker, A. J. L., & Morrison, S. L. (2010)]. Love Over Exile. https://loveoverexile.com/parental-alienation-research/bernet-2010-parental-alienation-dsm-icd/
When citing the underlying research, please cite the primary study (entry 1 above) directly.
About the researchers
Parental Alienation, DSM-V, and ICD-11 (2010) was authored by 2 researchers:
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William Bernet, MD · Lead author; founder of the Parental Alienation Study Group
Professor Emeritus, Department of Psychiatry & Behavioral Sciences, Vanderbilt University School of Medicine (Nashville, Tennessee)
William Bernet is an American child and forensic psychiatrist and Professor Emeritus at Vanderbilt University. He is the founder and first president of the Parental Alienation Study Group (PASG), the international professional body for parental-alienation research and advocacy, and one of the most prolific authors in the field. He led this 2010 proposal and co-authored the 2013 'Response to Critics'. His position is explicitly pro-construct, and as the proposal's principal advocate his work here is best read alongside the independent critics — a stance noted on this page for balance.
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Amy J. L. Baker, PhD · Co-author
Developmental psychologist and parental-alienation researcher (New York)
Amy J. L. Baker is an American developmental psychologist and one of the most cited researchers on parental alienation, best known for her work on the long-term effects of alienation on adult children and for cataloguing the strategies alienating parents use. At the time of this proposal she was affiliated with the Vincent J. Fontana Center for Child Protection in New York. She co-authored both the 2010 proposal and the 2013 reply to critics.
