The hidden ACE

Journal of Psychiatry Reform vol. 10 #11, October 2023

Caroline Giroux, MD, FRCPC

Author information:

Professor of Psychiatry, Psychiatrist, University of California, Davis Medical Center, Department of Psychiatry and Behavioral Sciences, Sacramento, California, USA. [email protected]

When I started working at a county clinic with the underserved, I noticed a lot of trauma in the patients’ stories. Among them was a young woman who had to quit law school due to the impact of psychological and physical injuries. As I explored her story more, what I discovered under severe obsessive-compulsive disorder, affect dysregulation and cannabis addiction left a strong impression on me. During her parents’ divorce when she was about 8 or 9, she recalled having been asked by her father to spy on her mom. You don’t need a degree in psychology or the clinical vocabulary of the mental health field to know that what this father had done was damaging to both the mother and their child by creating a skewed representation of the mother.

This is one of the unfortunately many facets of a phenomenon that should be considered adverse childhood experience (ACE) or childhood toxic stress. It is not listed on the original ACE screening questionnaire, therefore I call it “the hidden ACE”. Divorce is one ACE but only the tip of the iceberg. If there was underlying psychopathology in one of the parents, the divorce might lead one parent to retaliate and weaponize the children, forcing them to reject the other parent or view them as flawed, bad or even dangerous, hence the inappropriate fear regime from prescribed scrutiny like the example above. This is parental alienation syndrome (PAS), the silent tragedy of at least 22 to 25 million of parents in the USA, which means that at least as many children are deprived of a decent, caring parental figure. It can happen to anyone. Such tragic narratives from rejected parents who are also professionals (like psychologists, attorneys, physicians etc.) have come to my attention.

Parental alienation is the conscious or unconscious influence of a parent leading a child to denigrate and reject his/her other parent and the parent’s social network. It is a parental exclusion campaign, an appropriation of the child by a parent to the detriment of the other. The alienating attitudes and behaviors lead to an unjustified rupture between a parent and his/her child.

A memoir written to the Minister of Justice in Québec [1] details clearly the complex dynamics of this counter-intuitive phenomenon, often worsened by the family court system.   According to Amy Baker, PhD an expert on the subject, these are the characteristics of PAS:

1.The existence of a good attachment relationship between the rejected parent and the child before the separation;

  1. No history of abuse by the rejected parent;
  2. An alienating parent that aims to exclude the other, by means of denigration and false narratives ;
  3. Eventually, the child comes to play an active role by rejecting his/her other parent.

And it is important to distinguish abuse from normal, occasional impatience or overwhelm associated with the stress from the parenting role, or any hardship such as divorce proceedings.      Abuse is rather a pervasive pattern of damaging behaviors (verbal, emotional, physical etc.) that affects the child’s sense of safety, secure attachment and self-worth. For instance, a dynamic      with occasional occurrences of raised voice does not qualify as abuse. Claims of abuse should therefore be carefully examined and contextualized. A parent who raises their voice might do so due   to fear more than anger or intent to intimidate. The level of expressed emotions in families might also vary depending on culture.

Additionally, PAS often (but not always) occurs in divorced (or divorcing) families. It is a disorder that arises in 11-15% of divorce cases.  It has also been found that 20% to 25% of parents     engage in alienating behavior as long as 6 years after divorce. Alienating parents can be either mothers or fathers [2]. It results from the combination of a programming (brainwashing) of a parent’s indoctrinations and the child’s own contributions to the vilification of the targeted parent [3]. In sum, the erasure of a parent comes from the interplay of an alienator who   discourages the bond between the child and that parent by creating barriers (custody interference, false narratives) and the subsequent rejection of the targeted parent by the child.

Tragically, it is the child who is the main victim. Because trauma affects the whole person, reasons for referral of the child in our clinical settings might include:

Learning disorders

Relationship problems with peers and skewed perceptions of intimate relationships

Poor judgment of reality, illogical reasoning and rigid thinking

Aggressive behaviors, contempt for social norms and authority

Suicidal gestures

Our assessment can also reveal low self-worth versus inflated ego, poor differentiation of self (enmeshment) and the absence of remorse or guilt. Phenomena like Stockholm syndrome  and Munchausen by proxy might be missed if there is an inability to be comprehensive or think with a family systems and trauma lens.

Just like PAS is preventable, so is its trajectory [4]:

70% have significant depression as adults

35% reported having struggled with substance use

50% of those who were alienated as children are now alienated parents

80% of alienated children would have wanted the alienation to be detected and stopped.

There is a multidimensional impact to this issue. The suffering of a child in a position to reject a parent is underestimated and impossible to fully grasp. A child who “divorces” from a parent is encouraged to hate 50% of himself/herself and denies half of his/her genetic, affective and cultural legacy [1]. The consequences affect all dimensions of a child’s well-being, development (physical, emotional, psychological, interpersonal, spiritual) and future possibilities (including financial due to lower professional achievement and parents’ depletion of assets from the court battle).

Just like any other poison, alienating behaviors from a parent or caregiver can come in various doses, leading to mild, moderate or severe degrees of affliction. But before it gets to a degree of irreversible severity, there are typical manifestations that should alert any mandated reporter to the high likelihood of PAS:

The child has denigrated the excluded parent with derogatory language and severe oppositional behavior.

The child offered illogical, inconsistent or frivolous reasons for his or her anger towards the targeted parent.

The child did not demonstrate normal ambivalence, i.e. mixed feelings of love and hate for the ostracized parent, only hate.

The child supported and felt a need to protect the alienating parent (which may be due various mechanisms, including loyalty, fear of the parent’s retaliation, or because the child feels their survival depends on the bond with the alienator, like in a dynamic analogous to the one occurring in Stockholm syndrome).

The child did not demonstrate guilt  over his or her negative behavior towards the rejected parent.  The child used borrowed scenarios, or vividly described situations that he or she could              not have experienced. This can lead to creation and consolidation of false memories in children about the rejected parent.

Animosity may spread to the friends and/or extended family of the ostracized parent.

But what is behind the child’s “hatred”? Because we have to understand that it is not his/her hatred, but the alienator’s.  Due to the child’s developing brain and dependency on caregivers,     he/she has become the alienator’s emotional conduit or processor. Alienators utilize many kinds of control, manipulation and threats. They expect loyalty from the children, who become   hostages of the parent’s sick possessiveness.

There are countless red flags for this dynamic, including massive rejection of a parent, disproportionate to what would be expected in the average divorce, with the child claiming to hate a      parent without being able to articulate why. Peripherally, this will present as severe psychological splitting by children who side with the alienator (one parent, the alienator, is idealized,      favored, and the other is viewed as “bad”). Due to the alienator’s poor boundaries, and need to win over and control, the child is instrumentalized and used as confidant and might be told      details  of the  legal proceedings, court documents etc. The red flags on the alienator’s side include propensity to triangulation, coercive control and oppression during marriage, and  intensification of abuse  post-separation. Once the child develops emotional or behavioral disturbances due to unbearable tensions, the alienator does not acknowledge even minor mistakes       and might oppose therapy     for the child, claiming it is the other parent who has a problem. The alienating parent uses this narrative to isolate the child and obstruct custodial time of the co-parent (under a façade of overinvolvement, overprotectiveness). It is no surprise that the alienating parent often displays significant narcissistic personality traits (vulnerability to shame, insecurity, envy, rage, poor   insight, lack of empathy) and manipulative behaviors (including gaslighting, threats).

Collateral damage can be significant. The ostracized parent can experience a variety of difficult emotions: constant worry about the alienated children and helplessness, shock, loss of meaning      in life. Post-traumatic manifestations include extreme anxiety, depression, confusing “grief” from constant reminders/triggers, helplessness, shame, guilt, isolation, fracture of identity and    cognitive dysfunction with impact on work performance and resulting financial hardship. As for the extended family or the rejected parent’s family, there can be heightened fear of death in      aging grandparents and sadness in aunts, uncles and confusion in cousins who had  a healthy bond and camaraderie with the child prior to the alienation.

In summary, 13% of parents are erased. And this might even be only an underestimate due to isolation, associated shame or the fear of stigma. Parental alienation syndrome is a manifestation      of severe psychopathology in the alienating parent who sometimes acts with the complicity of their relatives. Ironically, the alienated, ostracized, rejected, erased or targeted parent is often a normal parent, a responsible and caring person who just wants peace and tries to disengage from the conflict. The rejection often affects the extended family on the rejected parent’s side. By   being weaponized, children are robbed of their childhood and a nurturing parent.   They suffer significant trauma.

This is a multidimensional and multilayered issue with cultural, societal, transgenerational, legal and financial components (women are more impacted than men by a divorce). Therefore,   barriers should be addressed systematically, changed, or removed. A binary and adversarial judicial system where there is a winner and a loser [1] is a fertile ground for false claims from an alienator who uses the legal battlefield as show time. Family court becomes a lucrative system where the attorneys are the only true winners. In addition to being clunky and tedious, the cogwheel of the legal system in the USA is known for the delays in proceedings, exacerbating the deleterious effects on children’s wellbeing as they remain separated from an excluded parent for extended periods during critical developmental stages in childhood and adolescence.

Additionally, divorcing a domineering and abusive spouse  can take considerably longer than an average divorce proceeding. Depletion of financial assets is almost inevitable, and many alienated parents have to file for bankruptcy or give up the battle altogether.

In such an endless litigation, judges might appoint a minor’s counsel, which ends up putting an unfair burden on minors to choose who they should live with. Children are not allowed to drive, drink or vote, and there is a reason for that. Why would they be considered more developmentally competent to make an informed decision around who should parent them?

There is an astounding gap of knowledge and lack of training that leads to the risk of manipulation of mental health professionals by alienators. Education is necessary to challenge cognitive  biases like “it takes two to tango”, while in reality, it takes one pathological parent to create chaos. Such misconceptions perpetuate the nonchalance of those who are entrusted to protect    children. Training could also help prevent the lack of sophisticated clinical reasoning which results in over-reliance on first impressions or decontextualized elements.  This can lead to   erroneously misidentifying a “healthy” bond between the alienating parent and the child, and difficulty discerning between a child who was abused (who may cling to the  abuser) and an   alienated child  (who rejects a non-abusive parent without ambivalence) [1].

How do we “de-erase”? From erased to RAISE.

Therefore, our field’s mission should aim to offer support to:

Raise awareness about PAS to increase detection and prevention by encouraging adult survivors to share their stories and provide direct insights and guidance to empower and heal current victims;

Empower the targeted parent through education and support of the reunification (the ostracized parents need extra support in their attempts to advocate for their children since they have        often been discredited by the system or mislabeled “reactive”, “crazy” or even abusive from fight-flight responses even though these were proportionate to the tragic, urgent situation);

Collaborate with qualified resources (attorneys, psychologists, social workers, organizations supporting families etc.) and educate them;

Hold alienators accountable: psychological abuse is abuse.

It takes a village to fight for children’s right to preserve a healthy bond with BOTH parents. We all need to encourage children to think for themselves, which will help them raise self-awareness and trust their own feelings and intuition to shield themselves from the external influence of distorted narratives. Maintaining the representation of a rejected but healthy parent alive in the affective landscape of the child and encouraging contact with the erased parent or any supportive figure in their network is also essential as the child will need guidance and a more balanced perspective from this healthier parent. Therapists should be curious and ask details about an absent parent who allegedly “abandoned” their patient and engage in Socratic questioning regarding the false narrative about the absent parent who might have been erased or interfered with rather than “abandoning”. Consistent therapy will foster discernment, integration of polarities and broadening of perspective.

Early on, we need to give explicit permission to children to love both parents and we must validate their pain from having been put in the middle. For the parents who have been ostracized, we must help them reconceptualize themselves as the “healthier parents”.

In conclusion, parental alienation is an insidious, often missed, ignored or misunderstood form of psychological abuse. It affects many people in many supposedly progressive parts of the world, and the central victims are children and adolescents. The traumatic effect might last into adulthood. Resources should be allocated to education, training and prevention. De-erasing parents  might start by raising awareness about this issue and make the protection of the healthy parent-child bond a collective responsibility and priority.





3. Gardner, R.A. (1998). The Parental Alienation Syndrome, Second Edition, Cresskill, NJ: Creative Therapeutics, Inc.

4. L Baker AJ. The long-term effects of parental alienation on adult children: A qualitative research study. The American Journal of Family Therapy. 2005 Jul 1;33(4):2



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