What Happens to Alienated Children When They Grow Up: The 2022 Mental-Health Study

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 (other alienated parents, family members, therapists, lawyers) who want to understand the evidence base without a psychology degree or a journal subscription. This page is one entry in that archive.

What the Researchers Asked

When parents fear for their child in the middle of alienation, the question that eventually arrives — sometimes in the first week, sometimes in the fifth year — is about the long run. What does this do to my child? What does it do to the adult they become?

The research base for an honest answer to that question has been thinner than a parent would hope. Amy Baker’s foundational work, starting with her 2005 American Journal of Family Therapy paper and the 2007 Norton monograph Adult Children of Parental Alienation Syndrome, interviewed 40 adults who had been alienated as children and produced the first sustained qualitative picture of lasting harm. A decade of smaller studies followed — Verrocchio and colleagues in Italy with quantitative depression and quality-of-life findings; Bentley and Matthewson with ten adults in the 2020 Not-Forgotten Child paper; scattered case reports. The picture was clear in its direction and vague in its specifics.

Suzanne Verhaar, Mandy Matthewson and Caitlin Bentley — all connected to the University of Tasmania’s Family and Interpersonal Relationships Lab, the most productive parental-alienation research group in the Southern Hemisphere — set out in 2022 to tighten the picture. Their question was narrow in scope and precise in intent: what happens, specifically and in detail, to the mental health of adults who were exposed to parental alienating behaviours as children? The answer, published open-access in the peer-reviewed journal Children, is the most detailed qualitative documentation of this population the field currently has.

Three adult-outcome studies compared — Baker (2007), Bentley & Matthewson (2020), Verhaar et al. (2022)

The Verhaar paper is the third generation of qualitative adult-outcome research. Reading the three side by side makes its specific contribution visible.

	Baker (2007)	Bentley & Matthewson (2020)	Verhaar et al. (2022)
Where published	Norton (book)	American Journal of Family Therapy	Children (open access)
Type	Qualitative interviews + book monograph	Qualitative interview study	Qualitative interview study
Sample size	40 adults	10 adults	20 adults — incorporates Bentley’s 10 + 10 new
Gender balance	Heavily female-skewed	Mixed	60% female / 40% male — most balanced
Mean years post-separation	Not specified, broad range	Not specified	~34 years (mean age 41)
Screening instrument	None — self-identification	None — self-identification	Baker Strategies Questionnaire >40
Reunion status	Mixed (not centred)	Mixed	80% fully reunified at interview
Mental-health outcomes	Thematic; depression, attachment, identity	Thematic; loss, trauma	Quantified within sample: 100% impact, 30% suicidal, 55% depression
Substance use	Mentioned	Mentioned	Quantified: 55% alcohol, 35% cannabis, 10% sex/porn (novel)
Intergenerational transmission	Identified as theme	Identified as theme	Quantified at 50%
Clinical framing	Adult Children of PAS framework	Loss/grief framework	Complex PTSD (ICD-11) explicitly argued
Open access	No	Paywall	Yes (CC-BY)

A note on dataset overlap, important for citation hygiene. The Verhaar 2022 sample of 20 was created by retaining Bentley’s original 10 participants and adding 10 newly recruited ones. The two papers are not statistically independent confirmations of each other — they should be cited as the Tasmanian Adult-Outcome Pair: Bentley 2020 = the qualitative theme map; Verhaar 2022 = the doubled-sample expansion that severity-screened the cohort with the Baker Strategies Questionnaire and produced the within-sample percentages.

Behind the question is an implicit argument the paper is transparent about: if the adult outcomes look like what the authors found, the behaviours that produced them deserve to be called what they are — emotional child abuse, with a documented lifespan-long trauma signature. Parents who are being told by anyone that “they will just grow out of it” have, since April 2022, the evidence to say no.

What They Did — Methods in Plain English

The paper is an empirical qualitative study. That phrase does specific work, and it is worth unpacking for a general reader.

Empirical means the authors collected new data — actual interviews, actual transcripts, actual people answering questions. It is not a re-analysis of existing literature.

Qualitative means the data is language, not numbers. The authors interviewed twenty adults who had been alienated from a parent in childhood, recorded and transcribed the conversations, and analysed the transcripts thematically — reading and re-reading, coding passages by theme, cross-checking the coding between three independent researchers, and iterating until the themes stabilised. They used a well-validated methodology (Braun and Clarke’s thematic analysis, supplemented by Forero and colleagues’ four-dimension rigour criteria), software support (NVivo), and explicitly verified that they had reached data saturation — the point at which new interviews stop producing new themes.

A qualitative study is a different instrument from a quantitative one. It cannot produce population estimates of the kind Harman’s 2019 prevalence paper did. What it can do — at a level a survey cannot reach — is capture the texture of lived experience: the particular shape of adult grief, the pattern of substance-use difficulty, the way identity confusion actually sounds when someone describes it. Twenty richly-documented cases, read in full, tell you things a thousand survey respondents ticking a depression-scale box cannot.

The sample.

• Size and demographics: 20 adults, aged 26 to 59 (mean 41, SD 10). 60% female, 40% male — unusually strong male representation for this literature.
• Original separation: mean age at separation from the targeted parent was 6.9 years, so most participants were interviewed an average of 34 years after the original loss.
• Alienation pattern: 75% had been alienated by their mother, 25% by their father.
• Reunion status: critically, 80% were fully reunified with the targeted parent at the time of interview and 15% partially reunified — meaning the documented outcomes describe what persists after reunion, not only ongoing separation grief.

The screening gate. Inclusion was not on self-identification alone. Every participant completed the Baker Strategies Questionnaire, a 20-item validated instrument measuring exposure to parental alienating behaviours (the 17 Baker-and-Chambers strategies plus three bracketing items).

Only participants scoring over 40 on the 0–80 scale and endorsing the specific item about limited contact with the other parent were admitted.

That gate matters. It is what separates a study of “adults who feel estranged from a parent” from a study of “adults with clinically meaningful parental-alienation exposure in childhood”.

The interviews. 60–90 minutes each, conducted online via Zoom or Skype, semi-structured — meaning the researchers had a guide of questions they asked everyone, but participants were free to follow threads the researchers had not anticipated. This is the methodological space in which the novel findings of the paper (the sex/pornography addiction theme, the specific coping-strategy sub-categories, the Complex PTSD framing) emerged.

The paper was approved under the Tasmanian Social Sciences Human Research Ethics Committee, reference H0016616, and published open-access in April 2022 under a Creative Commons BY licence — meaning anyone can read the full text without a journal subscription. The open-access choice matters: this is research that exists to be read by professionals, advocates, and alienated parents themselves, not locked behind institutional library credentials.

What the paper is not is also worth naming. It is not a review — it is a primary study. It is not quantitative — the percentages we cite are descriptive rates within a 20-person sample, not population estimates.

It is not longitudinal — participants were interviewed at one point in time. And it does not have a non-alienated comparison group — so the within-sample rates cannot be directly compared to general-population base rates.

These are real limitations, discussed in Section 6. They do not diminish the central contribution: the richest, most methodologically disciplined qualitative picture of this population that the literature currently contains.

The four-theme picture at a glance

The paper organises its findings into four overarching themes, with a fifth cross-cutting transmission finding. The diagram below puts the headline within-sample percentages from the 20-person cohort alongside one another, so the shape of the lasting impact is visible in a single frame.

What They Found — Six Key Findings

The paper organises its findings into four overarching themes — mental-health difficulties, addiction and substance use, emotional pain, and coping and resilience — with a fifth cross-cutting finding on intergenerational transmission. The six sub-sections below track those themes, weighted toward the findings most useful for a reader trying to make sense of their own experience or a family member’s. Every percentage is a within-sample figure from the 20-person cohort; read them as the best available qualitative estimate, not as a population rate.

1. 100% reported mental-health impact; 90% reported specific difficulties

The paper’s first and most striking finding is its uniformity. Across an international, gender-balanced sample of twenty adults interviewed decades after the childhood separation that began their exposure to parental alienating behaviours, every single participant reported that their mental health had been impacted. Not most. All twenty.

Ninety percent reported specific mental-health diagnoses or difficulties — formal clinician-assigned labels, self-assessed patterns, or both. The distribution: 55% depression and anxiety, 40% personality difficulties (most commonly borderline, narcissistic, or perfectionistic traits), 20% eating disorders or body-image difficulties, 15% self-harm, 10% psychosomatic symptoms, 5% formally diagnosed PTSD, 5% ADHD or neurodevelopmental difficulties.

The uniform 100% figure deserves to be read carefully. It does not mean parental alienation causes mental-health harm in every alienated child — this is a self-selected sample of adults who chose to participate in a PA research study, so the finding cannot be generalised to a population-level “every alienated child will have mental-health problems as an adult” claim.

What it does mean is that within a sample rigorously screened for clinically meaningful childhood PA exposure, mental-health impact is not occasional or partial — it is the baseline.

If our prevalence work establishes scale, this finding establishes that at the individual level, the harm travels with the person. For an alienated parent worrying about the long run, the paper is evidence that the worry is proportionate.

2. 30% suicidal ideation; 15% self-harm

Six of the twenty participants reported suicidal ideation. Many had attempted. Three had self-harmed.

The finding that most deserves sitting with is the one about protective factors. Of the ten participants who had themselves become targeted parents in adulthood — the intergenerational-transmission subgroup — four specifically reported that thoughts of their own children were the protective factor that stopped completed suicide.

The report reads as understatement; the implication is anything but. A third of this sample experienced suicidal ideation in adulthood as a consequence of childhood alienation.

A subset of those were kept alive by the existence of the children they were then, in turn, alienated from.

This finding is the mental-health headline. It is also the reason the authors’ framing of parental alienating behaviours as emotional child abuse is not rhetorical inflation but a clinically conservative characterisation. Behaviours that produce this kind of adult outcome have, by any reasonable standard, cleared the bar for the label.

3. Substance use across more than half the sample — including novel findings

More than half the sample reported problematic substance use. The exact distribution: 55% alcohol, 35% cannabis (daily, occasional, or past addiction), 20% recreational MDMA, 10% sex or pornography addiction, 5% methamphetamine or hallucinogen use.

The novel finding is the sex/pornography-addiction theme. Verhaar and colleagues are the first group in the parental-alienation literature to explicitly document this pattern and to call for further research on it.

Their framing links it conceptually to the broader CPTSD picture — adults with chronic childhood relational trauma are over-represented across a wide range of process addictions, and the specific experience of a childhood relationship systematically corrupted by the alienating parent may shape the particular form the adult compulsive behaviour takes.

The paper is careful not to overstate; the finding appears in 2 of 20 participants (10%). But its appearance at all, in a carefully-screened sample, is the kind of signal that motivates the next study.

The broader framing matters. The paper positions substance use as a maladaptive coping strategy responding to unresolved chronic trauma — not as a moral failing, not as an independent personality-of-the-alienated-child issue, but as what it typically looks like when the nervous system of an adult carries unprocessed childhood abuse. That framing is consistent with the wider Complex PTSD literature and with trauma-informed clinical practice.

4. Emotional pain themes — grief, anger, shame, self-esteem injury

Across 95% of the sample, the researchers coded 83 references to emotional pain across eight sub-themes. The frequencies: 60% grief and loss (the most frequent theme), 45% anger, 45% shame and guilt, 40% self-esteem injury, 30% loneliness and isolation, 20% helplessness, 15% abandonment, and pervasive trust difficulties without a clean percentage because the theme appeared in almost every transcript.

The distribution is notable for what it foregrounds. Grief — the dominant emotional register for most targeted parents — turns out to be equally dominant for the adult children of alienation, even decades after reunion. The same pattern that the alienated-parent literature describes as ambiguous loss, the adult child ends up carrying in their own form: grief for the childhood relationship that was distorted while it was still being lived, grief for the version of themselves that might have existed had the alienation not happened.

Anger and shame co-occur at 45%. That co-occurrence is diagnostic: the adult child’s anger is often turned inward, experienced as shame, which in turn produces self-esteem injury (40%). This is the emotional architecture the Complex PTSD framework describes, and it is the architecture that the next finding — the push toward CPTSD — is trying to formalise.

5. 50% had become targeted parents themselves

Ten of twenty participants had been alienated from their own children in adulthood because of parental alienating behaviours by their former partners.

This is the intergenerational-transmission finding. Baker’s foundational work had identified the pattern thematically — alienated adults repeatedly described being alienated from their own children as one of the seven major impact areas. What Baker did not do was enumerate it. Verhaar and colleagues quantify the pattern at 50% in a gender-balanced international sample.

The figure should be read with the study’s limits in mind. Twenty participants is appropriate for qualitative thematic saturation, not for precise population-level estimation. The true rate in the wider population of adult children of parental alienation may be higher or lower than 50%. What the finding does establish, with qualitative certainty, is that intergenerational transmission is not rare — it is a feature of the phenomenon at a rate where every clinician and family-law professional working in this space should expect to encounter it.

For readers, the implication cuts two ways. For a currently-alienated parent worried about their child, the finding is a warning that untreated alienation has a tendency to propagate. For an adult child of alienation now struggling with their own custody situation, the finding is validation — the pattern you may recognise in yourself is not a character flaw, it is a well-documented transmission of unhealed relational harm, and the trajectory can be interrupted by professional support and deliberate relational work.

6. Meaning-making and the case for Complex PTSD

Two findings sit at the paper’s end, and they work together.

The first is that 100% of participants engaged in meaning-making as a coping strategy — 154 coded references in total across the twenty transcripts. Eighty percent reported broader adaptive coping patterns: therapy, self-education about parental alienation, cognitive reframing, acceptance work, forgiveness work. Fifty percent also reported maladaptive coping — avoidance, stoicism, vengeful thinking, withdrawal — usually in combination with adaptive strategies, not instead of them. The human picture the percentages hint at is that adult children of alienation are overwhelmingly working on their own recovery, and that the work uses a specific cluster of approaches the paper documents in detail.

The second is the Complex PTSD argument. The authors invoke CPTSD — the chronic, developmentally-embedded, relationally-anchored trauma diagnosis formalised in ICD-11 — as a more accurate clinical framework than borderline personality disorder for this population.

The argument is both conceptual and ethical. Conceptually, CPTSD better captures what the transcripts describe: chronic exposure to a relational trauma during developmentally critical years, with the cluster of adult outcomes (emotional dysregulation, interpersonal difficulties, disturbed self-concept) that the CPTSD formulation predicts.

Ethically, the borderline-personality label carries significant stigma and locates the “problem” in the adult’s personality; the CPTSD label locates it in the childhood trauma exposure that actually caused it. For adult children of alienation who have been assessed as having borderline traits, the paper is an invitation to have the re-framing conversation with their clinician.

Why This Matters

Every parental-alienation paper has to answer the question of what it adds to what we already knew. In this paper’s case, the answer has three parts.

First, it replaces “probably harmful” with specified harm. Before 2022, a parent asking what will this do to my child when they are 40 got an answer that was directionally clear but specifically vague — depression is more likely, substance-use risk is higher, attachment is harder.

After 2022, the answer has numbers on it, taken from detailed interviews with actual 40-year-olds. Fifty-five percent depression or anxiety. Thirty percent suicidal ideation. Fifty percent go on to lose contact with their own children.

Those figures are indicative, not definitive. But they are the most specific answer the literature currently provides, and they changed what a responsible clinician can and cannot say about the long run.

Second, it moves the clinical framing toward Complex PTSD and away from personality-disorder labels. This matters for adult children of alienation who are in clinical contact now. The borderline-personality-disorder label has, for decades, been applied to patients whose presentation is consistent with what this paper describes as CPTSD — and the label has carried stigma, shortened therapeutic engagement, and led to the clinical community treating these patients as “difficult” rather than as carrying an identifiable trauma pattern. The paper is not the first to argue for CPTSD as the better frame for this population, but it is one of the first to argue it specifically for adults with documented parental-alienation exposure, and that specificity gives clinicians a clear pathway: assess for PA history; if present, consider CPTSD as the working formulation; treat accordingly.

Third, it closes the loop between prevalence and outcome. Our Harman et al. 2019 article establishes that 22 million US parents are targeted and 1.3% of the US population has a moderately-to-severely alienated child. Verhaar et al. documents what happens at the individual level in 100% of a carefully-screened sample.

The two papers together are the empirical floor under the argument that parental alienation is a public-health issue — something happening at scale, with documented serious harm, requiring a systemic response.

Either paper alone is incomplete. Read together, they produce a claim that is difficult to dismiss: a known proportion of the population is exposed; of those exposed, the harm travels with them into middle age in every case the research has rigorously documented.

The paper’s influence has begun to show. The downstream systematic-review work of Miralles, Godoy and Hidalgo (2023) covered the long-term-outcome literature through December 2019, before Verhaar 2022 was published; a future updated review would include Verhaar 2022 as one of the most-cited single qualitative studies of adult outcomes. Clinical training materials on parental alienation from PASG and from several Global North professional bodies now include Verhaar’s findings as reference points. UK Family Justice Council guidance draws on adult-outcome evidence of this kind to support the case for earlier intervention in suspected alienation, rather than waiting for a court-ordered formal assessment that arrives too late to prevent the chronic exposure the paper documents.

For readers of this site, the reason the paper matters is narrower and sharper. If you are a targeted parent whose child is currently refusing contact, this is the paper that tells you what you are trying to protect them from — not in theory, but in numbers. If you are an adult child of alienation reading this, it is the paper that says the things you have been carrying are documented, common among people like you, and have names.

What This Means for You

If you are a targeted parent. The paper is both a warning and a motivator. The warning is that untreated alienation has consequences that travel with your child for decades — decades.

The motivator is that 80% of the Verhaar sample had fully reunified with their targeted parent, which means reunion does happen, and 100% engaged in meaning-making even when the outcomes were hardest. The adult your child becomes retains agency the alienation did not destroy.

The practical implication is to keep the door open. Every pattern documented in When Adult Children Wake Up — the Sleeper Effect, the gradual re-evaluation of the alienator’s narrative, the arrival of the moment the child is ready to re-engage — is the real-world counterpart to the 80% reunion rate. Your job between now and then is to be findable, non-reactive, and alive.

If you are an adult child of alienation yourself. You are within a documented pattern. What you experience as depression, anxiety, identity confusion, substance-use difficulty, relationship instability, or parenting dynamics that echo your own childhood — these are the specific outcomes this paper documents in people with your history.

None of them is a character flaw. All of them are understood, in the clinical literature, as the lasting signature of childhood emotional abuse.

The single most actionable step you can take is to have the Complex PTSD conversation with a trauma-informed therapist. If your clinician is unfamiliar with parental alienation as a source of childhood trauma, this paper — open access at the DOI above — is the one to send them.

If you are a clinician working with separated or post-separated families. The paper’s findings are a caseload warning. Adults presenting in your practice with the Verhaar cluster — early-thirties-to-late-fifties, depression or anxiety, interpersonal difficulties, substance-use patterns, identity confusion — should routinely be screened for childhood parental-alienation exposure using the Baker Strategies Questionnaire or equivalent. If exposure is present, the CPTSD formulation is worth considering, and the treatment pathway differs meaningfully from what a default borderline-personality-disorder formulation would recommend. The paper also argues, implicitly, for systemic competence on parental alienation in adult mental-health services — not only in family-court-adjacent specialist work.

If you are a family member, friend, or colleague of an adult child of alienation. The relationship difficulties, the reactive patterns, the substance-use episodes, the identity confusion that you may have encountered in the adult child of alienation you care about — these are not who they are.

They are what the research says happens to 100% of adults with their history. That framing is not an excuse; it is an orientation. It changes what the appropriate posture is.

Patient support for their own recovery work, including professional support, is far more productive than pressuring them to “move past it” or treating the patterns as personal failings.

What the Paper Doesn’t Tell Us — Limitations

Four honest limitations, named plainly so the paper can be cited responsibly.

First, it is self-report. Participants described both their childhood exposure and their adult mental health without independent verification. The other parent was not interviewed.

Medical records, formal diagnoses, and childhood corroboration were not obtained. The paper’s percentages are what the participants reported they were experiencing.

Self-report is a legitimate and common research method in this field, but it is not the same as clinician-assessed, record-verified measurement, and the numbers should be read with that caveat.

Second, there is no non-alienated comparison group. All twenty participants had clinically meaningful PA exposure (BSQ >40). There is no comparison sample of adults without that exposure from the same recruitment stream.

This means the within-sample rates — 55% depression, 30% suicidal ideation, 50% intergenerational transmission — cannot be directly compared to general-population base rates.

The percentages describe what adults with this specific history look like; they do not prove those rates are elevated relative to population norms. The elevation is almost certainly there — Verrocchio’s Italian quantitative work and the broader adult-outcome literature support the inference — but this specific paper does not establish it.

Third, the sample is self-selected. Participants were recruited through social media and parental-alienation support groups. People who actively engage with the PA concept as a framework for their own experience are over-represented by design. Adults who experienced the same childhood behaviours but never came across the parental-alienation literature — who interpret their difficulties through different frames, or who have not identified their difficulties as linked to the childhood dynamic — are not in the sample. The true adult-outcome distribution in the wider population of people alienated as children could differ.

Fourth, the sample is small. Twenty participants is appropriate for qualitative thematic saturation — the point at which new interviews stop producing new themes — and Forero-style rigour criteria were met. What it is not appropriate for is precise population-level estimation. The percentages are the best qualitative indicators the field currently has, not definitive rates. A quantitative replication with a larger sample is the natural next study; until it exists, this paper remains the richest qualitative source and should be cited as such.

None of these limitations is a reason to dismiss the paper. They are reasons to cite it with care — with the specific findings attributed to the specific study, with the qualitative-nature framing preserved, and without casual overstatements that promote within-sample rates to population claims the authors themselves do not make. The aim of a good article about a paper is to leave the reader able to cite it well. That is the aim of this one.