Skip to 0 minutes and 9 secondsThank you, Dr. Bernet, for speaking with me and the class about this diagnosis of child affected by parental relationship distress. So I was wondering if you could describe what that is. Sure. Well, as you just stated, that it's a very cumbersome label. It's a very cumbersome term. Child Affected by Parental Relationship Distress-- so we usually just say CAPRD. And we've gotten used to that term, CAPRD. And what's interesting about it it's a brand new label or a brand new diagnosis that was introduced only a couple of years ago in the year 2013, when the Diagnostic and Statistical Manual of Mental Disorders was published by the American Psychiatric Association. So at that time, they added this new term CAPRD.

Skip to 1 minute and 4 secondsAnd then the book, in the DSM, there is only a very tiny definition. I think it's only one sentence. And so what we did-- my colleagues and I tried to-- got together and we tried to understand better how to explain, how we can use CAPRD. And basically, what it means, are the different ways in which children are affected when there is conflict between their parents. Especially if there is serious conflict between mom and dad, how are children affected? And it's been known for many years that that's damaging or it could be damaging to children. But it really depends on the nature of the conflict and the nature of the child's reaction as to how damaging it might be.

Skip to 1 minute and 55 secondsAnd so what are the types of stressors that would make this CAPRD applicable? So what we figured out was that there's at least four different scenarios to think about when there's conflict between a mom and a dad. And one is what's called IPD, which stands for Intimate Partner Distress. And that basically refers to situations where there's arguing, or there's verbal conflict, or there are perhaps verbal putdowns of one parent, or the other, or both parents. In other words, it's when arguing occurs with mom and dad. And a more serious kind of conflict is IPV, which stands for Intimate Partner Violence. And that's when there's actually physical damage, or physical violence, or physical conflict between the mom and the dad.

Skip to 2 minutes and 51 secondsHitting, or slapping, or kicking, or something like that. So both of these terms, IPD and IPV, are what traditionally have been called domestic violence. And you can think of it as intimate partner violence is obviously much more severe than intimate partner distress. But both of these things can cause distress on the children. IPV is more severe and so the chances are that that's going to cause more serious problems with the children. And intimate partner violence, where there's physical violence, might cause post-traumatic stress disorder in the children, or other severe behavior, or psychiatric disturbances. While simply arguing, what we're calling IPD, Intimate Partner Distress, is not likely to cause post-traumatic stress disorder.

Skip to 3 minutes and 50 secondsBut it might cause anxiety, or moodiness, or depression, or perhaps some acting out in children. So those are two scenarios that are related to how serious is the conflict between the mom and the dad. I told you in the beginning that there are four scenarios that we thought about. So those two have to do with the nature of the conflict between the parents. And the other two scenarios have to do with the child's reaction to the conflict. And let me tell you what those two things are. So one is a well-known phenomenon that people have talked about a long time, and I'm sure you and your students have probably heard this, which is simply loyalty conflict.

Skip to 4 minutes and 34 secondsThat when the child is caught between the mom and the dad and there is ongoing fighting and disagreeing, that puts the child in a loyalty conflict. What that means is the child is trying to be on good terms with both the mom and the dad. The child is trying to have affection for the mom and affection for the dad at the same time. And that's hard to do if there's conflict between mom and dad. And that's basically what a loyalty conflict is. The child is trying to be on both sides at the same time, but that's very hard. In fact, there's a term for that that's sometimes used in psychology, which is cognitive dissonance.

Skip to 5 minutes and 18 secondsThat if you're trying to entertain two thoughts-- I love mom, I love dad-- and if there's conflict between those two thoughts, it creates discomfort or anxiety in the person having those two thoughts. And that's called cognitive dissonance. And that's why it's very unpleasant and that's why you get symptoms. That's why you get anxiety symptoms, or depression, or sometimes worse symptoms in children who are experiencing severe loyalty conflict. Well, what's interesting is suppose it's very unpleasant being caught between mom and dad. So one possible solution is to go to one side, is to gravitate to one side and reject the other side. So that's the fourth scenario that we're talking about with CAPRD. And that's called parental alienation.

Skip to 6 minutes and 13 secondsParental alienation is when the child tends to get totally on the side of one parent and reject the other one. And that's caused partly by being in the middle of a conflict. But it's partly because the preferred parent is probably indoctrinating the child or brainwashing the child to be on his side or on her side and to reject the other parent. So it is an interesting difference between a loyalty conflict and parental alienation. Because what's going on in the child's mind is different and that's why we say these two phenomena are qualitatively different. It's not just a matter of degree, but what the child is doing mentally is a different way of defending against the situation.

Skip to 7 minutes and 2 secondsIn a loyalty conflict, the child is saying I'm going to stay true to mom and I'm going to stay true to dad, even if it puts me in a bind and it's difficult. And that's different from alienation, where the child says, I'm going to give up on one parent and not like that parent at all, and I'm going to totally like the other parent. So it's a two different mental mechanisms that the child might use to solve the same problem. That is being caught when your mom and dad are in conflict. Now we think that generally parental alienation is a more severe solution. That it seems to work for the child.

Skip to 7 minutes and 43 secondsIt seems to work for the short-term, because it gets the child out of the conflict. In other words, the child is totally on one side and doesn't have to bother about the second side. So in the short-term that might seem like a good solution. But it really doesn't work in the long-term, because you lose the relationship with the second parent. So those are the different components or the different possible ways that CAPRD might manifest itself. In other words, it partly depends on how severe is the conflict between the two parents, whether it's distress or violence between the two parents.

Skip to 8 minutes and 23 secondsAnd it partly depends on the child's reaction to the conflict, whether the child tries to stay in tune with both the mom and the dad, or whether the child totally goes to one side and gives up on the second side. So we thought that would be good, so we wrote an article about this. We thought it would be good to try to explain to psychologists, and psychiatrists, and social workers, and nurse practitioners, to try to explain what the term means. And that was our take on it. That it can mean at least four different things, all four of which are seen in everyday practice with children and families.

Child Affected by Parental Relationship Distress

Child Affected by Parental Relationship Distress (CAPRD) is a problem identified in the Diagnostic and Statistical Manual (DSM-5) published by the American Psychological Association that describes the effect of parental conflict and problems on children. In this interview, Dr. William Bernet describes what CAPRD is and how it affects children. Dr. William Bernet is a Professor Emeritus at Vanderbilt University School of Medicine. He is a forensic psychiatrist who evaluates adults, children, and families involved in legal situations, both civil and criminal. His expertise includes pretrial competency and insanity evaluations, death penalty mitigation, genotyping of defendants, child custody and visitation disputes, and allegations of child sexual abuse.

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