Q & A – What are the different levels of PA?

The three levels of PAS are mild, moderate, and severe. Differential diagnosis is the process of distinguishing one disorder from another based on the presenting symptoms. The differential diagnosis for each level of PAS is as follows:

1. Mild PAS: In mild cases, the child may show some reluctance or resistance to spending time with the targeted parent. However, the child’s behavior is not severe enough to interfere with the relationship. The following conditions may be considered in the differential diagnosis:

• Normal developmental stages: Children may go through phases where they prefer one parent over the other, especially during the early stages of divorce or separation.
• Anxiety or depression: Children with anxiety or depression may show some avoidance behavior, which may be misinterpreted as alienation.
• Parent-child conflict: Children may resist spending time with a parent with whom they have had recent conflict.

2. Moderate PAS: In moderate cases, the child’s behavior is more severe and may start to interfere with the targeted parent’s relationship with the child. The following conditions may be considered in the differential diagnosis:

• Attachment disorder: Children with attachment disorders may show a lack of interest in forming relationships with others, including parents.
• Personality disorders: Personality disorders in the alienating parent or child may contribute to the child’s rejection of the targeted parent.
• Child abuse: In some cases, allegations of abuse may be made against the targeted parent as a means of justifying the child’s rejection.

3. Severe PAS: In severe cases, the child’s rejection of the targeted parent is absolute, and the child may engage in extreme behaviors to avoid contact with the parent. The following conditions may be considered in the differential diagnosis:

• Cult involvement: Children who have been indoctrinated into a cult may show similar behaviors to those with severe PAS, including absolute rejection of the targeted parent.
• Parental kidnapping: In some cases, the alienating parent may abduct the child to prevent contact with the targeted parent.
• Psychosis: In rare cases, severe mental illness such as psychosis may cause the child to reject the targeted parent.

It is essential to conduct a thorough evaluation to differentiate between these conditions and PAS, and to develop an appropriate treatment plan for each case. A trained mental health professional with experience in family therapy can assist in the differential diagnosis and treatment of PAS.