This is to confirm the information discussed in our consultation on <date>

I indicated the pathology of concern in court-involved custody cases is the following DSM-5 diagnoses:

DSM-5 297.1 Delusional Disorder (shared); persecutory type, with the allied parent as the primary case and the child as the secondary case.

DSM-5 300.19 Factitious Disorder Imposed on Another; a false (factitious; artificially created) attachment pathology imposed on the child by the pathogenic parenting of the allied parent for secondary gain to that parent.

The potential secondary gain to the allied parent for inducing false pathology in the child include:

1) Court Manipulation: to manipulate the court’s decision-making surrounding child custody in favor of the allied parent,

2) Spousal Abuse: the emotional and psychological spousal abuse of the targeted parent by the allied parent using the child, and the child’s induced pathology, as the spousal abuse weapon,

3) Regulatory Object: the allied parent is using the child as a ‘regulatory object’ to meet that parent’s own emotional and psychological needs.

Pathogenic parenting that creates a thought disorder in the child (a persecutory delusion) that then destroys the child’s attachment bond to the other parent represents an additional modifying V-code diagnosis of V995.51 Child Psychological Abuse and warrants a child protection response.

I reminded of professional duty to protect obligations for all mental health professionals relative to three types of dangerous pathology; suicide, homicide, and abuse (child, spousal, and elder abuse).

Based on a referral question involving severe attachment pathology (i.e., a child rejecting a parent), concerns for possible child abuse by one parent or the other are present, duty to protect obligations may be active, and a proper risk assessment for child abuse needs to be conducted to the appropriate diagnoses for each parent.

I discussed the attachment system as a primary motivational system that always motivates the child to form an attachment bond to the parent (because this confers survival advantage – the other motivational direction is death by starvation and predation).

I discussed problematic parenting as creating an insecure attachment that more strongly motivates the child to bond to the parent in particular patterns – anxious-ambivalent, anxious-avoidant, and disorganized.

I discussed that a child rejecting a parent likely represented disorganized attachment – i.e., no organized strategy to bond to the parent. I indicated that disorganized attachment is caused by either abusive-range or psychotic-range parenting (or both together).

I indicated that in court-involved custody conflict, clinical concerns exist for a thought disordered parent (persecutory type) who is psychologically abusing the child by creating false pathology in the child to meet the allied parent’s own emotional and psychological needs.

In court-involved custody cases involving severe attachment pathology, a proper risk assessment for child abuse needs to be conducted to the appropriate differential diagnoses for each parent.

Targeted Parent Abusive: Is the targeted parent abusing the child in some way, thereby creating the attachment pathology toward that parent?

Allied Parent Abusive: Or is the allied parent psychologically abusing the child by creating a shared (induced) persecutory delusion and false (factitious) attachment pathology in the child for secondary gain to the allied parent?

Possible Spousal Abuse

I indicated that a possible second dangerous pathology present in court-involved custody conflict is a modifying DSM-5 V-code diagnosis of V995.82 Spouse or Partner Abuse, Psychological of the targeted parent by the allied parent using the child, and the child’s induced pathology, as the spousal abuse weapon.

This leads to concerns for two possible dangerous pathologies potentially present in court-involved custody conflict,

1) Child Psychological Abuse (V995.51; a shared persecutory delusion and factitious attachment pathology imposed on the child),

2) Spouse or Partner Abuse, Psychological (V995.82) of the targeted parent by the allied parent using the child, and the child’s induced pathology, as the spousal abuse weapon.

Duty to protect obligations may be active on multiple grounds for protection.

I indicated my current role in the family courts as a second-opinion consultant in clinical psychology based on my specialized expertise supported by my vita in 1) the diagnostic assessment of delusional thought disorders, 2) assessment, diagnosis, and treatment of attachment pathology, 3) family systems therapy, 4) child abuse & complex trauma, 5) factious disorder imposed on another, and 6) court-involved custody conflict.

I indicated that in my review of forensic custody evaluations and mental health reports, standard concerns are regularly present and that I have developed these standard domains of clinical concern into a Catalogue of Concerns for my ease in reviewing reports.

I indicated I would attach some of the relevant Domains of Concerns for this consultation. I am attaching the following Domains of Concern:

• Delusional Thought Disorders
• Factitious Disorder Imposed on Another
• Differential Diagnosis
• Risk Assessment
• Dark Personality
• Attachment Pathology
• Family Systems Pathology
• Psychological Control
• Professional Standards of Practice

Assessment Protocol