APA Definition of Delusional Disorder
delusional disorder in DSM–IV–TR, any one of a group of psychotic disorders with the essential feature of one or more nonbizarre delusions that persist for at least 1 month but are not due to schizophrenia. The delusions are nonbizarre in that they feature situations that could conceivably occur in real life (e.g., being followed, poisoned, infected, deceived by one’s government). Diagnosis also requires that the effects of substances (e.g., cocaine) or a medical condition be ruled out as causes of the delusions. Seven types of delusional disorder are specified, according to the theme of the delusion: erotomanic, grandiose, jealous, persecutory, somatic, mixed, and unspecified. Criteria changes for delusional disorder in DSM–5 include the following: The delusions may be either nonbizarre or bizarre (i.e., implausible), and their potential presence as a result of an ingested substance, a medical condition, or another mental disorder sometimes associated with firmly held delusional beliefs (e.g., obsessive-compulsive disorder, body dysmorphic disorder) must be ruled out. Formerly called paranoid disorder.
An encapsulated delusion is a belief in one area of life which is fixed and unshakeable even in the face of evidence to the contrary. Encapsulated delusional disorder, is seen in cases of alienation of children, when a child is showing the signs of psychological splitting and is aligned with a parent who has an unshakeable belief that the other is harmful to the child’s wellbeing. Encapsulated delusions are extremely powerful and in their strongest display, will cause the holder to bend all evidence to shape their beliefs. Children in the care of a parent who is suffering from encapsulated delusions, become fearful, anxious and bound into the belief of the parent that the parent who is being rejected, is harmful. When a child suffers a fixed and unshakeable belief that a parent is harmful, where there is clear evidence that the parent is not, the child is considered to be suffering from significant emotional and psychological harm. In such circumstances, removal from the care of the parent who is suffering the delusion is often necessary.
Encapsulated delusions occur in people who in many other areas of life appear to be normal. The fixation of the delusion, which is not accompanied by hallucination, is the key symptom. The person suffering from such delusions, is unusually obsessed by the focus of the delusion, believing that they have discovered something or know something that others do not know. This belief is often accompanied by a grandiosity which is narcissistic in nature and which causes the sufferer to believe that they are better than others, because they know a truth that others don’t. Efforts to dissaude the sufferer are futile and in fact can escalate the fixed nature of the belief. Unfortunately, for children in the care of someone who suffers encapsulated delusion, there is no choice but to enter into the shared persecutory belief that the other parent is harmful.
Children who grow up believing that a healthy parent is dangerous to them when they are not, suffer significant harm. In some cases of encapsulated delusion, the beliefs are so fixed and so harmful, that a parent will demand that a child is medically examined, for example, for signs of sexual abuse. In the absence of evidence that the child has suffered sexual abuse, to make such a demand is, by any measure of responsible and healthy parenting, itself, abuse. Sadly, in too many cases of encapsulated delusional disorder, this is one of the outcomes and this is often the point at which the threshold for significant harm is considered to be crossed and the state in the form of local authority child protection services step in.
Encapsulated or shared persecutory delusions, are uncommon in alienation cases, but they are one of the range of reasons why, children are removed from the care of a parent. Such a persecutory belief arises from behaviours which are defensive in nature and which are usually fear and anxiety based. The belief that the other parent is seeking to do harm, simply by wanting to have a relationship with the child, appears to stem in many cases, from unresolved childhood abuse in the parent suffering the delusion. The projection of the unresolved issues onto the child, especially during the period post divorce or separation, when anxiety is already high, is often the beginning of an episodic reaction in the parent who is suffering the delusion. Over time, the child becomes bound into a process by which, the rejected parent’s love begins to be experienced as persecutory and something to be afraid of. This causes serious emotional and psychological harm.
In my experience of working with families where encapsulated delusional disorder has been present, the suffering parent will bend all incoming evidence which contradicts the delusion they are suffering, to ensure their belief is upheld. So, for example, anyone who presents evidence that the rejected parent is not persecutory, but is healthy and well, becomes aligned in the mind of the sufferer to the rejected parent and becomes persecutory simply by their existence. In such circumstances, where the Court itself is also often experienced as persecutory, the parent binds the child tighter into the sharing of this encapsulated delusion, making it impossible to protect the child without removal from the parent. It must be recognised, that even where a child is removed in such circumstances, every effort is made by the Court to maintain a relationship between the child and the parent they have been removed from, in a way that is safe.
A good example of a shared persecutory delusion is where a parent believes that a child has been abused, during a period of time when the person being accused of abuse, could not have been responsible. A belief that abuse is taking place when a parent is not in the country, for example, which leads to the construction of an explanation of how the supposed abuser returned to the country without others knowing, to abuse the child and then left, again without anyone being aware of it, other than the parent suffering the delusion. When a child echoes the beliefs of the parent, in a situation where there is clear evidence to the contrary, especially when this leads to the parent wanting to have the child medically examined, action has to be taken to protect the child.,
The current climate in the UK, in which there is an almost mantra like repetition, that all allegations of parental alienation are used by abusive men to control protective mothers, is ignorant of the reality of the serious underlying psychological and mental health conditions which cause alienation reactions in children. The idea that a parent can go into Court and claim that a child is being alienated and that this automatically overrides existing evidence of domestic abuse, is simply not upheld by the reality of how cases of alienation in children are managed.
Cases of alienation of children are serious and taken very seriously. A finding of fact of domestic abuse would preclude a case being considered as alienation at the Clinic, as this is considered to be a contributory factor to the child’s rejection. In the absence of any such finding, psychological and psychiatric assessments are sought, in order to determine the presence or absence of mental health problems, ruling in or out serious conditions such as shared encapsulated persecutory delusions, is part of the differentiation process. Only when there has been a long process of observation, clinical assessment and differentiation, where a parent is demonstrating an incapacity to recognise harmful behaviours, does removal of the child on the basis of safeguarding occur and when it does, it is always the Court which makes that decision. The current popular narrative about alienation, which is promulgated by ideological researchers and a group of parents supporters, who are themselves, likely to be on the spectrum of fixed and unshakeable thinking, is a huge distortion of what really happens in Court.
Which is why it is so important to pull apart what we mean by alienation of children in divorce and separation and to recognise and acknowledge that, however unpalatable it may seem, removal of children to protect them from harm, is sometimes necessary. As in all child protection work, careful differentiation takes place before intervention. Believing that someone can simply say a child is being alienated and that overrides everything else, including proven domestic abuse, is, so far from the truth as to represent a shared delusion in itself.
Alienated children are in need of protection because they are being abused. Protecting them is our primary responsibility because of the seriousness of the harm that they are suffering. The Court is the place in which those matters are recognised and addressed. Of course, some will claim alienation when it is nothing of the sort, however, the stringent court processes, ensure that those cases are identified. Alienation is not something which is taken lightly and what lies beneath genuine cases, should be of serious concern to anyone who cares about the wellbeing of children.
Karen Woodall - Psychotherapist, Writer, Supervisor, Trainer 