Parental Alienation Syndrome (PAS): Definition, humanistic profiles and clinical hypothesis of absorption with “adaptation disorder”. Clinical evidences

Purpose: The present research aims to fi nd clinical evidence for the starting hypothesis: parental alienation is a form of psychological violence that is part of the adjustment disorder fuelled by dysfunctional parental conduct. Methods: Using the Perrotta Integrative Clinical Interview (PICI-1C, for children), a restricted and low sample of patients was selected (21 subjects), all aged between 4 and 10 years, with a clinically relevant behavioural manifestation (and a presumed “label” of parental alienation), with parents in the process of marital separation not yet concluded and in a confl ictual or in any case diffi cult intra-familiar relational context. Anonymity was guaranteed to all. Results: According to the PICI-1C, 100% (21/21) of cases fall into one of the six identifi ed subtypes of adjustment disorder: a) 18,5% (4/21), disruptive mood dysregulation disorder (cat. 8); b) 13,7% (3/21), maladaptive separation disorder (cat. 9); c) 23,4% (5/21), oppositional defi ant disorder (cat. 10); d) 23,4% (5/21), explosiveintermittent disorder (cat. 11); e) 7,3% (1/21), uninhibited social engagement disorder (cat. 12); f) 13,7% (3/21), attachment disorder (cat. 13). Conclusions: It can therefore be concluded, with all the limitations of the selected population sample, which is not representative, that the hypothesis of considering PAS (or PAD) as a variant of the general adaptation disorder, due to parental behaviour that feeds the dysfunctionality of the trauma suffered by the minor, can be substantially correct, also pointing out the correlation between the severity of the symptoms suffered (and the psychopathological condition found) and the prolonged exposure to stressful events. Research Article Parental Alienation Syndrome (PAS): Defi nition, humanistic profi les and clinical hypothesis of absorption with “adaptation disorder”. Clinical evidences Giulio Perrotta* Psychologist sp.ing in Strategic Psychotherapy, Forensic Criminologist, Legal Advisor sp.ed SSPL, Researcher, Essayist, Institute for the study of psychotherapies ISP, Via San Martino della Battaglia no. 31, 00185, Rome, Italy Received: 09 April, 2021 Accepted: 03 July, 2021 Published: 05 July, 2021 *Corresponding author: Dr. Giulio Perrotta, Psychologist sp.ing in Strategic Psychotherapy, Forensic Criminologist, Legal Advisor sp.ed SSPL, Researcher, Essayist, Institute for the study of psychotherapies ISP, Via San Martino della Battaglia no. 31, 00185, Rome, Italy, E-mail: ORCID: https://orcid.org/0000-0003-0229-5562


Introduction
"Parental Alienation Syndrome" (PAS) is a controversial psychological dysfunctional dynamic that, according to the 1985 theories of US physician Richard Gardner, is activated on minor children involved in both parental separation and divorce (defi ned as "confl ictual") and in contexts of alleged intrahousehold and family violence [1]. Gardner  4) The phenomenon of the independent thinker indicates the child's determination to assert that he or she is a person who can reason without infl uence and that he or she has worked out the terms of the denigration campaign on his or her own without input from the "alienating" parent; 5) The automatic support to the "alienating" parent is a stance of the child always and only in favour of the "alienating" parent, whatever kind of confl ict arises; 6) The absence of guilt, whereby all expressions of contempt towards the 'alienated' parent fi nd justifi cation in the fact that they are deserved, a sort of 'just punishment'; 7) The borrowed scenarios, i.e. statements that cannot reasonably come directly from the child, such as the use of phrases, words, expressions or the quotation of situations not normally inherent to a child of that age to describe the faults of the excluded parent 8) The extension of hostilities to the extended family of the rejected parent, involving, in the alienation, the family, friends and new emotional relationships (a partner or companion) of the rejected parent.
Gardner stated that, in his opinion, the uncontrolled instillation of PAS would be a true form of emotional violence, capable of producing signifi cant trauma both in the present and in the future lives of the children involved [6,8,10,[12][13][14][15]. These consequences include severe psychopathological processes such as: altered reality examination; narcissism; weakening of the capacity to feel empathy; lack of respect for authority (even to the point of externalizing typically antisocial traits), extended also to non-parental fi gures; paranoia; psychopathologies linked to gender identity; and, fi nally, a lack of respect for authority [51][52][53][54][55][56][57].
According to Gardner [41][42][43][44] The parenting aspects of separations could be clearly defi ned, if one could fully understand the concept that, in the family, there are two 'couple entities', distinct in their mutual rights, duties and responsibilities: the 'marital couple' and of fear, distrust and hatred towards the "alienated" parent. The children would then ally themselves with the suffering parent, showing themselves to be infected by that suffering, beginning to support the vision of the 'alienating' parent. According to Gardner, such 'programming' would destroy the relationship between the children and the 'alienated' parent, as the former would refuse any contact, even by telephone, with the latter [2].
The following criteria should be checked for the presence of PAS [3][4][5] 1) The denigration campaign, in which the child mimics and mimics the "alienating" parent's messages of contempt towards the "alienated" parent. In a normal situation each parent would not allow the child to show disrespect and slander the other. In PAS, however, the 'alienating' parent does not question such disrespect, but may even go so far as to encourage it; 2) The weak rationalisation of the rancour, whereby the child explains the reasons for his discomfort in the relationship with the alienated parent with illogical, senseless or even merely superfi cial reasons (examples cited, "He always raises his voice when he tells me to brush my teeth", or "He always tells me "Don't interrupt!"); 3) the lack of ambivalence, whereby the rejected parent is described by the child as "completely negative" whereas the other is seen as "completely positive"; the 'parental couple'. A 'marital confl ict', therefore, does not necessarily (or must) also trigger a 'parental confl ict', and any confl icts between the two entities could be addressed with the help of family mediation. In part, the rules governing the 'separation' event may contribute to the problem. In order to govern the world of affection, one sometimes relies on a 'global system of antagonisms', on mechanisms of judicial confl ict, on a 'procedural truth' with a winning party and a losing party. The institution of single-parent custody, so widely used in the past, is an element that reinforces the perspective in terms of "winner and loser". In the judicial context and, more generally, within the "global system of antagonisms",  [45,46]. What emerges clearly is the very scarce number of scientifi c works supporting the research on the validity and reliability of Gardner's theory, including the will of the working group of the fi fth revision of the DSM [47] not to include PAS in the Diagnostic and Statistical Manual of Mental Disorders because of its unscientifi c nature.

Working hypothese and methodologies
If we try to analyse PAS and its possible redefi nition as PAD from a technical point of view, a number of elements emerge which, in the writer's opinion, merit attention:

1)
The hypotheses in which PAS would apply would not include the hypotheses of actual abuse, violence and neglect. This is because PAS is a perpetrated and continuous condition of psychological violence, from which future psychopathologies would spring.
Even if one were to admit the psychological nature of PAS, one would still have to consider, for the purposes of its objective existence and effective manifestation, variability factors that could condition its origin and course. Reference should be made to aspects such as age, gender, the degree of communication and cognition reached by the child, as well as the possibility that the alienating parent accepts to take charge in order to reestablish a functional communication between the child and his/her spouse, in order to neutralise the effects of the previous harmful behaviour towards the alienated person.

2)
The symptomatology described in subjects aff ected by PAS falls perfectly within other nosographies already contained in the DSM-V. In particular we are talking about "adjustment disorder", which occurs when an individual has signifi cant diffi culty in adapting to or coping with a signifi cant psychosocial stressor. The maladaptive response usually involves otherwise normal emotional and behavioural reactions that occur more intensely than usual (taking into account contextual and cultural factors), causing severe distress, preoccupation with the stressor and its consequences, and functional impairment. It is thought that the more chronic or recurrent the stressor is, the more likely it is to produce a disorder. The objective nature of the stressor is of secondary importance. The most crucial link of stressors with their pathogenic potential is their perception by the patient as stressful. The presence of a causal stressor is essential before a diagnosis of adjustment disorder can be made. There are some stressors that are more common in different age groups; in adulthood these are marital confl ict, fi nancial confl ict, health problems for oneself, one's partner or dependent children, personal tragedies such as death or personal loss and job loss or unstable working conditions, e.g. takeover or dismissal of a company; in childhood and adolescence these are family confl ict or separation of parents, school problems or changing schools, sexuality problems, death, illness or trauma in the family. In time this condition may evolve into other more structured and marked disorders [10,48]. In any case, a targeted psychotherapeutic intervention is necessary [49,50].

Results
Trying to support this hypothesis, the writer administered the PICI-1 (version C) [58][59][60][61][62]   The limits of this research are: 1) The use of a population sample that is not suffi ciently representative, although the result of 100% suggests a good reliability of the psychodiagnostic instrument if applied to a larger sample of the population.
2) PICI-1 consists of two clinical interviews, based on the age of the interviewed subject; however, the one referring to the child and pre-adolescent age cannot be used in relation to MMPI-II because the theoretical assumption, the reference model and the nosography used are different.

Working hypothese and methodologies
It can therefore be concluded, with all the limitations of the selected population sample, which is not representative, that the hypothesis of considering PAS (or PAD) a variant of the general adaptation disorder, due to parental behaviour that feeds the dysfunctionality of the trauma suffered by the minor, can be substantially correct, also pointing out the correlation between the severity of the symptoms suffered (and the psychopathological condition found) and the prolonged exposure to stressful events.