The World Health Organization (WHO) refuses to include parental alienation in the International Classification of Diseases (ICD-11)
In a recent statement (December 2022), the WHO explains the reasons why parental alienation was removed from the index terms of the category titled “Caregiver-Child Relationship Problems” of the International Statistical Classification of Diseases and Related Health Problems (ICD), despite the persistent efforts of supporters of the unscientific theory of “parental alienation” to have it included as a term. According to the WHO, parental alienation is a term used primarily in legal disputes over custody and is not a term related to health services or health conditions. Taking into account the multitude of comments and questions regarding the misuse of the term parental alienation, on the one hand with the aim of undermining the credibility of a parent who reports abuse, and on the other hand with the aim of criminalizing this behavior, the WHO, after thoroughly reviewing all the material provided to it, decided not to include the term parental alienation and its related terms in the ICD-11.
The relevant statement follows:
What is the ICD?
The International Statistical Classification of Diseases and Related Health Problems (ICD) serves to record and inform on health matters and health-related conditions at a global level. The ICD ensures the interoperability of digital health data and their comparability. The ICD includes diseases, disorders, health problems, and much more. In order for a specific category to be included in the ICD, it must demonstrate some usefulness for the purposes of the ICD and, of course, there must be evidence proving its existence as a health condition.
Parental alienation
The purpose of the ICD-11 is to provide an internationally standardized classification of health diagnoses, and to record incidents related to health and contact with healthcare for statistical purposes. Chapter 24, titled "Factors influencing health status or contact with health services", provides for the recording of circumstances or problems that affect a person's health status but do not themselves constitute a disease or injury. This chapter includes the category titled "Caregiver-Child Relationship Problems".
During the development of the ICD-11, it was decided not to include the concept and terminology of "parental alienation" in the classification, because it is not a term related to healthcare. The term is used primarily in a legal context, in court disputes over custody in cases of divorce or other types of dissolution of partner relationships.
The broader category titled "Caregiver-Child Relationship Problems" was considered to adequately cover the aspects of this phenomenon that could be the focus of health services.
Recently, proposals were submitted and initially approved for the inclusion of the term "parental alienation" as an index term for the category titled "Caregiver-Child Relationship Problems". As a result of the related online commentary that followed the initial approval, the WHO-FIC Medical and Scientific Advisory Committee promptly clarified that the inclusion of a term for search purposes does not automatically mean that the WHO endorses that term and its use. Following this clarification, the comments and questions remained undiminished regarding the misuse of the term, on the one hand with the aim of undermining the credibility of a parent who reports abuse and therefore refuses contact, and on the other hand with the aim of criminalizing this behavior.
Review
Taking the above into account, the WHO thoroughly reviewed all the material provided to it and considers that:
- Parental alienation is an issue that pertains to specific legal contexts.
- The inclusion of the term in the ICD-11 does not contribute to health statistics.
- There are no documented healthcare interventions specifically for parental alienation.
In cases where an individual characterized by this term seeks healthcare, there is other content in the ICD-11 that is sufficient to guide coding. Users can classify cases under the category titled "Caregiver-Child Relationship Problems".
Therefore, the index term "parental alienation" and its related terms have been removed.