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Survival-Based Rejection: Parent-Child Trauma-Coerced Attachment and Alienation

Complexities of Survival-Based Rejection

Survival-Based Rejection: Parent-Child Trauma-Coerced Attachment and Alienation (SBR-PCTCAA) refers to a pattern of coercive control and alienating behaviours employed to undermine the relationship between a child and a parent or other significant family member. These behaviours are not confined to any single gender or family role and can be exhibited by mothers, fathers, stepparents, grandparents, or even non-family members involved in the child’s life.


At EMMM, we recognise the complexity and nuance inherent in these family dynamics. Each case demands individualised assessment and careful consideration of the unique circumstances involved, rather than reliance on polarised or overly simplistic views. We advocate for a trauma-informed approach that prioritises evidence-based evaluation and thorough exploration of the relational context. Our commitment is to  advance research and understanding of these behaviours and their extensive impacts on family systems, moving beyond traditional frameworks.


The effects of this form of abuse extend beyond the immediate parent-child relationship, often impacting siblings, grandparents, stepparents, aunts, uncles, and cousins. This form of trauma-based rejection frequently involves mechanisms such as adultification,  parentification, infantilisation, and learned helplessness. Common tactics include gatekeeping, denigration, programming, and psychological manipulation, which are reinforced through behavioural conditioning processes including classical conditioning, operant conditioning, and observational learning. Non-verbal communications such as negative facial expressions, body language, and tone of voice also serve as powerful tools when used alongside these manipulative strategies.

Legal Considerations

Recognising these dynamics in legal contexts is critical for safeguarding the best interests of the child. It ensures that court interventions are appropriate, informed, and focused on genuine safety concerns. While supervised contact can be a necessary measure in some cases, it must never be used improperly to portray the rejected parent as unsafe without clear evidence. Courts must rely on rigorous, evidence-based clinical expertise and thorough evaluations to make balanced decisions that prioritise the child’s safety, emotional well-being, and the promotion of healthy family relationships.

Survival-Based Rejection: Parent-Child Trauma-Coerced Attachment and Alienation (SBR-PCTCAA) is not currently recognised as a formal clinical diagnosis, similar to how family violence is not classified as a clinical disorder. However, the behaviours involved constitute manipulative and emotionally abusive actions that profoundly impact a child's emotional, psychological, and developmental well-being. These behaviours reflect patterns of coercive control, emotional manipulation, and attachment trauma commonly observed in clinical practice, often resulting in symptoms consistent with complex PTSD, anxiety disorders, and attachment disruptions. The effects on a child’s relationships, emotional regulation, and decision-making can closely resemble trauma responses, impairing their capacity to form healthy attachments and engage appropriately with others.


Recognising and identifying these behaviours is vital for timely intervention and prevention, akin to other forms of child abuse. If these behaviours remain unaddressed, they pose significant risks to the child’s mental health, developmental progress, and future relational functioning. Early detection and intervention, informed by attachment and trauma-sensitive clinical frameworks, are essential to reduce long-term psychological harm and support more positive developmental outcomes.


Below, you can explore the complexities and understand the necessity of a comprehensive, case-specific approach that accounts for the unique dynamics present in each family.

Power & Control

Coercive Control is when someone strategically uses various behaviours to create dependency and control of another person. Through the use of these behaviours, the coercively controlling person creates a false world of confusion, fear and contradiction. Over time, coercively controlling behaviour erodes the other person’s sense of self and confidence. These behaviours are at the heart of Parent-Child Trauma-Coerced Attachment and Alienation. 

Coercive Control in Parent-Child Dynamics

The targeted child is placed in an impossible situation, forced to choose between aligning with the problematic parent or risking the loss of the other parent, a relationship they have often been manipulated into rejecting.


Coercive control, as defined by Harman and Matthewson (2020), involves a range of manipulative tactics aimed at overpowering the victim by controlling their behaviours, emotions, and relationships. Problematic parents using coercive control seek total dominance over their family members, especially the child, through demands for loyalty, emotional manipulation, and controlling actions.


Examples of coercive controlling behaviours the problematic parent uses against the child include:


  • Pressuring the child to pledge loyalty exclusively to them.
  • Using threats, reward, or pressure to make the child reject the other parent.
  • Creating unwarranted fear of the other parent in the child.
  • Forcing the child to act defiantly towards the other parent.
     

Coercive control over the targeted parent frequently occurs through gatekeeping behaviours. The problematic parent may present themselves as stable and devoted, all while deliberately  undermining the child’s relationship with the other parent to maintain control and dominance.

A child experiencing parental alienation

Navigating the Transition from Intact to Separated Family Structures

  

The challenge for families after separation is adapting from an intact family dynamic to a separated structure, where shared parental roles and enduring bonds with the child remain central. However, the emotional and psychological responses of one parent to the separation can complicate this transition. Children may unwittingly become witnesses to the ongoing emotional distress—such as anger and sadness—experienced by the parent struggling with separation. Understanding these dynamics is crucial for recognising the origins of this form of relational harm and its potential impact on family relationships.


Children’s reactions to parental separation vary widely but often include complex emotional and behavioural responses. They may experience feelings of sadness, anger, confusion, anxiety, and grief. Younger children sometimes become clingy or regress in behaviours such as bedwetting, while older children and adolescents might display rebellion or aggression. Many children struggle with loyalty conflicts, feeling torn between parents or blaming themselves for the separation. Behavioural changes can also manifest as difficulties at school, sleep disturbances, or social withdrawal. The level of conflict between parents notably impacts the degree of distress children experience. Positive adjustment is more likely when parents maintain respectful communication, provide consistent routines, and reassure children that they are loved by both parents. 

Characteristics

    Problematic Personality Traits

  • Narcissistic Traits: Characterised by patterns of grandiosity, a strong sense of entitlement, need for admiration, and limited empathy. These traits often lead to manipulative behaviours aimed at maintaining control and reinforcing self-importance within relationships.
  • Borderline Traits: Marked by emotional instability, fear of abandonment, and intense interpersonal conflicts.  Individuals often exhibit a tendency to self-identify as victims, which can amplify fears, contribute to emotional volatility, and complicate relationships through heightened sensitivity and blame-shifting.
  • Paranoid Traits: Characterised by pervasive distrust and suspicion of others’ motives, leading to hypervigilance and defensive behaviours. This heightened suspiciousness often results in misinterpretation of benign interactions as threats, impairing communication and fostering relational tension or conflict.
  • Histrionic Traits: Marked by heightened emotional expressiveness, a strong need for attention and approval, and dramatic behaviours. These traits may drive superficial or rapidly shifting relationships, complicate genuine emotional connection, and impede effective problem-solving and decision-making within family contexts.
     

Other Factors

  • High Anxiety and Over Control: Exhibiting high levels of anxiety, often leading to micromanagement or helicopter parenting. Anxious parents may impose excessive control over the child’s activities and relationships, driven by fears of losing the child’s loyalty or attachment.
  • Cognitive Distortions: Engaging in distorted thought patterns that contribute to the manipulation of the parent-child relationship. Learn more...
  • Externalising Unwanted Emotions and Responsibilities: Projecting personal emotions and responsibilities onto the child, potentially affecting their emotional well-being.
  • Inability to Accept Own Problems: Demonstrating difficulty acknowledging and addressing personal challenges.
  • Abnormal Grieving Response: Displaying atypical responses to loss or separation, impacting the ability to navigate family transitions.
  • Problematic Family of Origin: Having a history of familial issues that may contribute to current challenges in parenting.
  • Poor Relationship History: A track record of problematic relationships, which may influence parenting dynamics.
  • Desire for Control: Seeking excessive control in relationships, particularly within the parent-child dynamic.
  • Desire for Vengeance: Harbouring a desire for retribution, which can negatively impact the co-parenting relationship.


For more information about B Cluster personality disorders visit Project Air for Fact Sheets.

Processes and Psychological Conditioning Techniques

  • ADULTIFICATION: Imposing adult responsibilities or concerns onto the child, potentially disrupting their normal developmental path. While not a conditioning technique in itself, it often involves conditioning through:
  • Negative reinforcement:  The child might escape criticism or punishment by acting more mature.
  • Positive reinforcement: The child might receive praise or rewards for fulfilling adult-like roles.
  • Modelling: The child might learn by observing and imitating the adults around them who are struggling or overburdened.


  • PARENTIFICATION: The child is given responsibilities typically held by a parent, disrupting their normal developmental role. This can include:
  • Emotional Support: The child acts as a confidant or provides emotional support for the alienating parent.
  • Caregiving Duties: The child takes on caregiving roles, such as looking after the parent, siblings or managing household tasks.
  • Decision-Making: The child is involved in making decisions meant for adults.


  • Impact: Adultification and Parentification can both hinder a child's development, blur role boundaries and cause emotional stress. It can intensify the alienation by aligning the child’s loyalty with the problematic parent.

Infantilization and Learned Helplessness

This is a two-pronged process. 

  • Infantilization involves treating someone as much younger than their actual age, often through excessive control and restriction. This can lead to learned helplessness, where  the individual feels incapable of making decisions or taking control of their own life.
  • Children exposed to abusive behaviours, including coercion and alienating behaviours, may develop learned helplessness, a state often seen in situations where individuals repeatedly encounter stress they cannot control. Over time, they begin to feel that no action will improve their circumstances, leading to a sense of powerlessness. This helplessness can result in chronic feelings of anger and resentment as they struggle to cope with the emotional turmoil.

Learning

Coercive and manipulative dynamics often involve behavioural conditioning to shape the child’s thoughts, feelings, and actions. These techniques can entrench dependency, compliance, and loyalty to the coercive parent or adult.

Classical Conditioning

The child develops automatic responses by associating certain stimuli with specific behaviours. The child may come to associate the targeted parent with fear, guilt, or anxiety through repeated pairing of that parent with negative emotional experiences (e.g. distressing conversations, accusations, or conflict).

Operant Conditioning

The child’s behaviour is shaped through rewards and punishments. They might receive praise or attention for rejecting the targeted parent or face criticism or withdrawal of affection for trying to maintain contact, reinforcing the alienation.

  • Positive Punishment: Attempts at autonomy (e.g. expressing curiosity about the other parent, disagreeing, or asserting preferences) may be met with criticism, guilt-tripping, withdrawal of affection, or even punitive consequences, reducing the likelihood the child will repeat such behaviours.
  • Negative Reinforcement: The child learns that emotional or practical dependency on the coercive adult leads to the removal of distress (e.g. tension, conflict, disapproval). This teaches the child that aligning with the coercive adult brings relief, while asserting independence brings discomfort.
  • Positive Reinforcement: The child is rewarded for alignment and loyalty through:
  • Monetary gifts or material rewards(toys, clothes, trips, phones)
  • Emotional rewards (approval, affection, praise, inclusion, belonging)
  • Privileges or status (being treated as the “favoured” child, given adult-like roles or access)

Programming/Brainwashing

Observational Learning

The child learns by watching and mimicking the alienating parent’s behaviour. If the child observes consistent negative attitudes or actions towards the targeted parent, they are likely to adopt those same attitudes and behaviours, further distancing themselves from that parent.


Programming/Brainwashing

Deliberate efforts to manipulate the child's thoughts, feelings and perceptions, often leading to the rejection of the targeted parent. They can utilise intense forms of psychological conditioning, often involving:


  • Isolation: Limiting contact with outside influences.
  • Coercion and manipulation: Using threats, rewards and emotional appeals to control behaviour.
  • Repetition and indoctrination: Repeatedly exposing the individual to specific beliefs and ideologies.

Important Considerations

Understanding these concepts is crucial for recognising potentially harmful situations and promoting healthy psychological development. Human behaviour is complex and rarely the result of a single conditioning technique. These techniques often interact and overlap in real-life situations. Children respond differently to conditioning techniques based on their personality, experiences and resilience.



Click [Here] for Alienating Tactics

Levels of Alienation and Interventions

You’ll find a comprehensive breakdown of each level (mild, moderate, and severe) along with evidence-based approaches to support the child’s well-being. Our resources are designed to help practitioners and families navigate these complex dynamics with the appropriate guidance and expertise.


For more information about the different levels of alienation and interventions and strategies, please click the below link.


Click [Here] for Levels of Alienation and Interventiones

Silent Sabotage: The Role of Non-Verbal Cues

 Non-verbal cues, encompassing negative facial expressions, body language, and tone of voice, become potent tools in the arsenal of alienating a child from a parent when employed in tandem with other manipulative tactics.


Negative Body Language and Facial Expressions

  • Parents may employ disapproving or negative body language, including facial expressions such as frowning, eye-rolling, head shaking and sighing. These subtle cues convey contempt, subtly influencing the child's perception of the other parent.


Impact of Tone of Voice

  • The tone of voice assumed by a parent, particularly when adopting a condescending manner when  discussing the other parent, can significantly shape the child's view. The nuances in vocal expression contribute to the complex web of influences on the child's perceptions and attitudes towards the targeted parent.


Understanding the subtle role of non-verbal cues, body language and tone of voice is imperative in comprehending the complexities of the dynamics.

Types of Alienating Parents


  • Naïve Alienators exhibit passive tendencies regarding their children's relationship with the other parent. While they may inadvertently contribute to alienation through occasional actions or statements, they often respond positively to education about the detrimental impacts of their behaviour.
  • Active Alienators are consciously aware of their actions and intentionally foster alienation out of feelings of hurt and anger. These individuals possess some level of insight and may express remorse once they become aware of the damage inflicted.
  • Vengeful Alienators believe the targeted parent must endure consequences for the termination of their relationship. Driven by a mission to destroy the targeted parent, they lack self-control and insight. Typically associated with narcissistic and borderline personality traits, they experience an abnormal grief reaction known as narcissistic injury upon the relationship's end.
  • Obsessive Alienators incorporate the destruction of the targeted parent into their identity. Characterised by limited self-control and insight, they may exhibit problematic personality traits, such as narcissistic and borderline tendencies. For these individuals, causing harm to the targeted parent becomes a defining aspect of their behaviour. 


Understanding these distinct profiles is pivotal for tailored interventions in cases of parental alienation.

Trauma Bonding

The targeted child forms a detrimental emotional attachment, referred to as a coerced attachment or trauma bond with the problematic parent/person.


This phenomenon draws parallels to observed behaviours in environments such as cults, hostage situations, human trafficking, intimate partner violence and child abuse. Trauma bonding manifests as a consequence of interpersonal trauma within relationships characterised by violence or exploitation, as outlined by Reid et al. (2013).


Understanding this complex psychological dynamic is essential for effectively dealing with the intricate aspect of PCTCAA and implementing effective interventions to mitigate its lasting impact on the child.

Understanding Relationships: Attachment vs. Trauma Bonds and Parental Behaviour

  • Attachment Bond: The emotional connection within this bond is characterised by strength and security, fostering a sense of trust and comfort. This contributes to the promotion of the child's overall well-being and security. The relationship dynamics are nurturing and supportive, encouraging healthy interactions that have a positive impact on the child's growth.
  • Trauma Bond: In contrast, the emotional connection in a trauma bond involves mixed emotions stemming from abusive experiences, potentially compromising the child's well-being and stability. The relationship dynamics are characterised by abusive and manipulative behaviours, leading to conflicted responses and the potential for emotional dependency which can be confusing and may result in emotional dependency.
  • Protective Parent: A protective parent focuses on supporting healthy emotional bonds, prioritising the child's safety and emotional stability. This parent fosters healthy relationships with both parents and encourages positive dynamics within the family. The behaviour towards the child is geared towards supporting relationships with both parents, resulting in a positive impact on the child's overall well-being and development.
  • Problematic Coercive Parent: In the case of an alienating parent, the emotional connection undermines bonds and causes confusion. This parent disregards the child's well-being, prioritising their own agenda. The relationship dynamics involve undermining the relationship with the other parent, and the behaviour towards the child hinders their relationship with the other parent, ultimately resulting in a negative impact that hinders emotional growth.


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Support for Young PeopleAlienating Tactics ListThe Role of Cognitive DistortionsParental Child AbductionShared Parenting ResearchLevels of Alienation Plus InterventionsDiagnostics

The Impact

  

This form of emotional and psychological abuse can have long-lasting effects, extending for years or even a lifetime. It disrupts a child's chance at a normal, conflict-free childhood and deprives them of relationships with both parents. Additionally, it may hinder the child from forming connections with the extended family of the alienated parent. Recognising these consequences emphasises the importance of early intervention and comprehensive support to mitigate the adverse impact on the child's well-being and family relationships.

Targeted children: The devastating impact on mental health and life

  • disrupted social-emotional development
  • attachment disorders
  • interpersonal problems
  • emotional dysregulation
  • paranoid thinking 
  • confusion
  • maladaptive coping
  • obsessive-compulsive tendencies
  • loneliness and isolation
  • low self-esteem
  • eating disorders
  • self-harm 
  • resentment
  • shame and guilt
  • helplessness
  • anger
  • abandonment & trust issues
  • depression
  • anxiety
  • somatic symptoms
  • substance related problems
  • suicide ideation and suicide


a) family violence and abuse (children can go on to be in abusive relationships meaning their partners are abusive)

b) trauma related disorders (eg. complex PTSD)

c) persistent complex bereavement (ongoing grief and losses)

d) intergenerational transmission of alienation

Children subjected to these abusive behaviours exhibit unwarranted disdain and an entitled attitude towards the targeted parent. They are indoctrinated to perceive the problematic parent as entirely virtuous and the targeted parent as entirely flawed. Consequently, these children encounter disruptions in their social-emotional development.


Targeted children grapple with a nuanced form of grief for a living parent, a loss manipulated through emotional tactics. This emotionally induced loss leads to psychological complexities, fostering difficulties associated with trauma and abuse. This form of abuse inflicts emotional distress on children, manifesting in enduring consequences such as social isolation, a fragile sense of self, heightened anger, depression and anxiety. Understanding these implications underscores the urgency of addressing these abusive behaviours and intervening to safeguard the mental and emotional well-being of affected children.

Consequences for Targeted Parents

The profound loss of a child is emotionally devastating. Targeted parents grapple with ambiguous loss*, mourning the living but emotionally distant presence of their child. This poignant loss is further exacerbated by the denigration and vilification endured as part of the abusive process. Experiencing despair, helplessness, frustration, anger and confusion, targeted parents navigate a complex emotional landscape.


Many of these dedicated mothers and fathers encounter significant financial and emotional burdens while seeking resolution within legal and mental health systems that may not fully comprehend. Despite being embroiled in parental conflict, targeted parents strive to shield their children from its impact.


*Ambiguous Loss: Arising from traumatic loss, it is externally induced and lacks closure. Characterised by frozen grief and a sense of being stuck in limbo, this individual journey is defined by the circumstances (Boss, 1999, 2009). Understanding the multifaceted challenges faced by targeted parents is crucial for fostering empathy and driving informed interventions to alleviate their burdens.

Impact on Children and Targeted Parents

Individuals, both children and parents, exposed to these abusive behaviours endure trauma reactions comparable to those seen in other  forms of abuse. Psychological challenges arise, mirroring symptoms aligned with complex post-traumatic stress reactions. Manifestations include substance use problems, self-harm behaviours, eating disorders, depression, anxiety and even tendencies towards suicidality.


Family Violence-Related Suicide

Family violence-related suicide is a tragic outcome that can occur in families suffering from severe emotional abuse, coercive control and alienation. Victims, including both targeted parents and children, may become overwhelmed by the emotional trauma within these destructive family dynamics. The persistent psychological harm and sense of hopelessness in such environments can lead to devastating consequences, including suicide.


Recognising the gravity of these consequences is paramount for fostering understanding and promoting targeted interventions to address the enduring impact of this form of abuse on the mental health of affected individuals.

Presentation of the Targeted Child

  • Expression of negative views about the targeted parent
  • Extreme and opposite views about parents
  • Situationally determined changes in the child’s behaviour
  • Denial of positive regard for the targeted parent
  • Distorted views about the targeted parent
  • False memories or accounts of events not experienced
  • Lack of concern about internal inconsistency of information provided
  • A litany of complaints about the targeted parent
  • Fear response towards the targeted parent
  • Dependent or symbiotic relationship with alienating parent
  • Compliant with adults other than targeted parent
  • Believes alienating parent persecuted by targeted parent
  • Lack of empathy for plight of targeted parent
  • Targeted parent holds no important position in child’s life
  • Rigidity of belief system regarding targeted parent
  • Independent thinker phenomenon


Citation: Haines, J., Matthewson, M., & Turnbull, M. (2020). Understanding and Managing Parental Alienation: A Guide to Assessment and Intervention. Routledge.


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List of Detection Factors of Brainwashed Children

  1. Contradictory Statements
  2. Inappropriate and Unnecessary Information
  3. Character Assault
  4. Collusion or One-Sided Alliance
  5. Child Becomes Spy or Conduit of Information
  6. Use of Indirect Statements
  7. Restrictions on Permission to Love or Be Loved
  8. Unchildlike Statements
  9. Good Parent versus Bad Parent
  10. Comparative Martyr Role
  11. Fear of Contact with the Other Parent
  12. Anxiety Arousal
  13. Cohort in Secret-Keeping
  14. Child Appears as Mirror-Image of Programmer
  15. Confusion of a Birth Parent’s Importance
  16. Manifestation of Guilt
  17. Scripted Views
  18. Unmanageability for No Apparent Reason
  19. Radical Changes and Dysfunctional Behaviour Manifested in Other Spheres
  20. Non-verbal Messages
  21. Coaching Behaviour
  22. Brain Twirling
  23. Child Threatens Parent
  24. Child as Parent’s Best Friend
  25. Physical Survival


Reference: Stanley Clawar and Brynne Rivlin (2013) Children Held Hostage: Identifying Brainwashed Children, Presenting a Case, and Crafting Solutions. ABA Publishing.

Adverse Childhood Experiences (ACES)

Childhood experiences, both positive and negative, have a tremendous impact on future violence victimisation and perpetration, and lifelong health and opportunity. 

The CDC-Kaiser Permanente Adverse Childhood Experiences (ACE) Study is one  of the largest investigations of childhood abuse and neglect.

The Science of Social Influence and Its Relevance

Research in psychology and neuroscience demonstrates that human memory and perception are highly susceptible to social and environmental influences. This applies to all ages, from infancy through adulthood, and is even more pronounced when children experience family disruption or relational stress.


In these contexts, social and psychological mechanisms can powerfully shape how children interpret and remember their experiences. This can lead to outcomes that diverge sharply from objective reality, with implications for wellbeing, relationships, and interventions.


How Influence and Memory Distortion Occur


  • Memory is suggestible: Empirical research shows that repeated suggestions, leading questions, and emotionally charged prompts can distort children’s recall, sometimes creating false or altered memories.
  • Perceptions are socially shaped: Children construct their understanding of events by attuning to the behaviours, language, and emotional signals of those around them, including parents, siblings, caregivers, and authority figures.
  • Convincing influence: Persistent narratives and pressured situations can shift what feels “true” for children, even if it conflicts with previous or lived experiences. This is exacerbated when children are seeking safety, approval, or belonging.


Key mechanisms of social influence and family context


  • Social pressure: The desire to conform or appease significant adults may alter how children report, interpret, or remember experiences.
  • Visualisation and imagery: Encouraging children to imagine or visualise events can increase certainty in memories of things that never occurred.
  • Suggestive questioning: The way questions are framed profoundly impacts children's responses and the accuracy of their memories.
  • Repetition: Repeated discussion or retelling of events strengthens and sometimes distorts memory, especially in stressful contexts.
  • Compliance and fear-driven agreement: Children may agree with adults’ narratives under emotional or relational stress, even if it contradicts their own experience.
  • Pattern-making (patternicity): Children seek patterns and coherence, sometimes weaving together separate or unrelated events into a new “story”.
  • Confirmation bias: Once a belief forms, children may remember information that supports it, and discount information that contradicts it.


Neuroscience and Trauma-Informed Practice


  • Impact of trauma: Chronic stress, family conflict, and relational trauma can disrupt neural pathways involved in memory, attention, and emotional regulation. This heightens vulnerability to suggestion, makes it harder for children to distinguish real from imagined, and amplifies social influence.


Understanding these processes is essential for practitioners, educators, and families aiming to protect children in high-stress environments. Trauma-informed, evidence-based interventions should carefully assess the impact of social influence and memory distortion. Creating safe, supportive, and non-leading opportunities for children to share their stories can foster resilience and authentic connection, supporting reunification and healthy relationships.

Key Research

  • Loftus (2005)
    Planting misinformation in the human mind: A 30-year investigation of the malleability of memory.
  • Ceci & Bruck (1993)
    Suggestibility of the child witness: A historical review and synthesis.
  • Garry et al. (1996)
    Imagination inflation: Imagining a childhood event inflates confidence that it occurred.
  • Nash, Wade & Lindsay, 2009 Effects of doctored videos and imagination in distorting beliefs and memories.
  • Howe & Knott (2015)
    The fallibility of memory in judicial processes: Lessons from the past and their modern consequences.
  • Lyons & Ghetti (2011)
    The development of uncertainty monitoring in early childhood: Evidence from decision-making tasks with and without feedback.
  • Main, Kaplan & Cassidy (1985)
    Security in infancy, childhood, and adulthood: A move to the level of representation.
  • De Bellis & Zisk (2014)
    The biological effects of childhood trauma.
  • Teicher & Samson (2016)
    Enduring neurobiological effects of childhood abuse and neglect.
  • Cruz et al. (2022)
    Developmental trauma: Conceptual framework, associated risks and comorbidities, and evaluation and treatment.
  • Berliner et al. (2003)
    Children’s memory for trauma and positive experiences.

Relational Harm Assessment: Evidence-Based Instruments

Understanding Diagnoses Related to Child-Parent Relationship and Trauma

Children's psychological and emotional well-being can be deeply affected by complex and sometimes harmful family dynamics, including conflict, neglect, rejection, and manipulative or abusive behaviours by caregivers or parents. Internationally recognised diagnostic codes help clinicians understand, identify, and respond to these varied impacts from a trauma-informed perspective.


However, it is essential to recognise that standard assessments, such as those routinely used by family courts, are often insufficient and do not meet ethical or clinical best practice standards when dealing with the complexities of parental abuse and child trauma. Meaningful identification and intervention require a thorough, case-by-case methodology that goes beyond standard checklists.


To properly determine the nature and cause of relational harm, full psychological evaluations of both the child and parents are needed. Comprehensive assessment of each parent must look beyond surface observations to explore underlying personality traits, emotional functioning, cognitive distortions, and the broader historical and relational context. For more details on the factors to consider, including problematic personality traits and dysfunctional coping styles, please refer to the above dedicated "Characteristics" section of our website.


In addition, assessment should carefully consider signs of survival behaviours and maladaptive coping, which may emerge in both children and parents as responses to chronic relational harm or trauma. These patterns, such as emotional numbing, compulsive compliance, hypervigilance, withdrawal, or externalising behaviours, are crucial for understanding the full impact of the relational environment and for informing targeted, compassionate interventions.


A trauma-informed and ethical approach ensures that interventions are centred on the child and responsive to the complex interplay of individual, relational, and systemic factors present in families experiencing distress or abuse.


Disclaimer:
The assessment tools described here are not exhaustive and should be tailored to the unique needs of each case. A comprehensive evaluation may require additional measures, particularly when assessing the parent or caregiver. 

Research

Research consistently shows that unhealthy caregiver-child relationships, characterised by coercive control, conflict, neglect, or insensitive and unresponsive parenting, are linked with insecure attachment, emotional and behavioural difficulties, and poor social and mental health outcomes in children. Both caregiver and child behaviours contribute to the relationship quality, highlighting the importance of thorough assessment and early, trauma-informed intervention.

Current Research

995.51 – Child Psychological Abuse

DSM-5 code V995.51 identifies Child Psychological Abuse   

as non-accidental verbal or symbolic acts by a parent or caregiver that cause, or have the potential to cause, significant psychological harm to the child. This can include belittling, humiliation, persistent criticism, and verbal attacks that erode a child’s self-worth. It may also involve threats or terrorising behaviours that make the child fearful of harm, abandonment, or punishment. Manipulative and coercive practices, such as pressuring the child to reject a parent, take sides in adult conflicts, or assume adult responsibilities, are also recognised forms of psychological abuse. In addition, emotional exploitation, using the child to meet the caregiver’s emotional needs or to act out adult grievances, further compromises the child’s development. Harm can also occur when a parent withholds care, attention, or affection, leaving the child emotionally neglected. In some cases, indoctrination and enmeshment lead the child to adopt distorted beliefs or identities imposed by the caregiver.


Severe and ongoing psychological abuse can profoundly disrupt healthy attachment, create trauma bonds, and impair the child’s emotional, social, and cognitive development. Cases of this nature may require protective intervention because of the risk of long-term harm. Importantly, this diagnostic category recognises the damaging impact of harmful psychological parenting practices without pathologising the child. Instead, it directs attention to the abusive behaviours of the parent or caregiver and distinguishes psychological abuse from other mental or developmental disorders.


American Psychiatric Association. (2013). Diagnostic and Statistical Manual of Mental Disorders, 5th Edition (DSM-5), V995.51.
 

Child Affected by Parental Relationship Distress (CAPRD)

CAPRD is a relational problem included in the DSM-5 under the category "Other Conditions That May Be a Focus of Clinical Attention" (V61.29). It describes the psychological impact on children who experience significant distress due to parental relationship conflicts such as intimate partner distress, intimate partner violence,  acrimonious divorce, or unfair disparagement of one parent by the other. Children affected by CAPRD may exhibit a range of symptoms, including psychological distress, somatic complaints, internal loyalty conflicts,  and, in severe cases, disrupted or lost relationships with one parent.


CAPRD emphasises the child’s experience of parental conflict rather than a disorder within the child. It helps clinicians identify relational patterns that exacerbate mental health issues in children. The child’s responses can be behavioural, cognitive, affective, or physical. CAPRD is not a standalone disorder but a relational pattern warranting clinical attention.


Bernet, W., Wamboldt, M., & Narrow, W. (2016). Child Affected by Parental Relationship Distress. Journal of the American Academy of Child and Adolescent Psychiatry. PubMed Article

Caregiver-Child Relationship Problem (ICD-11 Code: QE52.0)

The ICD-11 code QE52.0 defines the "Caregiver-child relationship problem," which describes significant and lasting dissatisfaction within the caregiver-child relationship, including parental relationships. This relational problem manifests as disturbances in functioning due to relationship conflict, lack of appropriate caregiving, or harmful relational dynamics that negatively affect the child’s well-being.

This issue typically involves dysfunction within the caregiving relationship rather than a disorder within the child. Symptoms reflect a breakdown or disturbance in interactions and attachment between child and caregiver. It covers a range of issues from neglect to harmful relational disengagement. The term is broad, intended to capture relational disruptions affecting child development and mental health.
 

World Health Organization, ICD-11 online: Caregiver-child relationship problem QE52.0

Find-A-Code (ICD-11 MMS): QE52.0 Caregiver-child relationship problem
 

Loss of Love Relationship in Childhood (ICD-11 QE52.1)

Children who are forcibly or coercively cut off from a loving parent or other family member experience a profound psychological loss that is captured by the ICD-11 diagnosis QE52.1 Loss of Love Relationship in Childhood. This code applies when a child loses access to an emotionally close caregiver through rejection, estrangement, or permanent separation, even if the parent is physically present.


This "living loss" represents a form of psychological bereavement with significant trauma, distinct from ongoing relational conflict or dysfunction. Addressing this loss is critical to supporting the child’s emotional healing and restoring healthy connections where possible.


At EMMM, we recognise this diagnosis as essential for understanding the impact of forced relational severance on children’s wellbeing and guiding trauma-informed interventions.


ICD-11: QE52.1 Loss of Love Relationship in Childhood

Minimum Key Areas of Expertise

EMMM considers that the minimum key areas of expertise required include:  


  • Coercive control
  • Family violence
  • Child maltreatment
  • Sexual abuse
  • Attachment theory
  • Personality disorders
  • Anxieties, fears and phobias
  • Family systems
  • Complex trauma
  • Alienating behaviours
  • Brainwashing and learning
  • Child development
  • Cognitive distortions
  • False confessions
  • False memories
  • Repressed memories
  • Cults and human trafficking 
  • Assessment and diagnosis
  • Trauma-informed practice 
  • Risk assessments (risk of harm to self, others and child safety risk)
  • Interviewing children (see note)


Note: It must be determined whether the interviewing, questioning and counselling techniques used with the child were so suggestive that they had the capacity to substantially alter the child's recollections of events and thus compromise the reliability of the child's personal knowledge. 

  

Parent-Child Trauma-Coerced Attachment and Alienation cases are counterintuitive and can externally look very similar. Identifying and presenting a case to the family court is not a one size fits all.

Children's Rights Litigation

Trauma Caused by Separation of Children from Parents

Trauma Caused by Separation of Children from Parents

A Tool to Help Lawyers

Reference: Stanley Clawar and Brynne Rivlin (2013) Children Held Hostage: Identifying Brainwashed Children, Presenting a Case, and Crafting Solutions. ABA Publishing.

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