Clinical review
Child Affected by Parental Relationship Distress

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Objective

A new condition, “child affected by parental relationship distress” (CAPRD), was introduced in the DSM-5. A relational problem, CAPRD is defined in the chapter of the DSM-5 under “Other Conditions That May Be a Focus of Clinical Attention.” The purpose of this article is to explain the usefulness of this new terminology.

Method

A brief review of the literature establishing that children are affected by parental relationship distress is presented. To elaborate on the clinical presentations of CAPRD, four common scenarios are described in more detail: children may react to parental intimate partner distress; to parental intimate partner violence; to acrimonious divorce; and to unfair disparagement of one parent by another. Reactions of the child may include the onset or exacerbation of psychological symptoms, somatic complaints, an internal loyalty conflict, and, in the extreme, parental alienation, leading to loss of a parent–child relationship.

Results

Since the definition of CAPRD in the DSM-5 consists of only one sentence, the authors propose an expanded explanation, clarifying that children may develop behavioral, cognitive, affective, and physical symptoms when they experience varying degrees of parental relationship distress, that is, intimate partner distress and intimate partner violence, which are defined with more specificity and reliability in the DSM-5.

Conclusion

CAPRD, like other relational problems, provides a way to define key relationship patterns that appear to lead to or exacerbate adverse mental health outcomes. It deserves the attention of clinicians who work with youth, as well as researchers assessing environmental inputs to common mental health problems.

Section snippets

Proposed Definition for CAPRD

When clinicians are initially exposed to the terminology of CAPRD, it may seem like a fuzzy concept. As the one-sentence definition in the DSM-5 is not detailed enough to clarify the concept, we propose the following expanded definition for CAPRD: This category should be used when the focus of clinical attention is the negative effects of parental relationship distress on a child in the family, including effects on the child’s mental or medical disorders. For this category, “parental

Measuring Parental Relationship Distress

Family researchers have successfully operationalized the assessment of marital or intimate partner relational problems (for example, with the Marital Satisfaction Inventory–Revised [MSI-R]).10 There is a short form of the MSI-R that can be used as a screening tool, which consists of only 10 questions.11 The interviewer asks questions such as: “Does your partner often fail to understand your point of view on things?” “Do minor disagreements with your partner often end up in big arguments?” “Is

Scope of CAPRD

Children, of course, are influenced for better or worse by events that occur in their family, which include the opinions, moods, and actions of the parents and also the interactions between the parents and among all of the family members. Depending on the circumstances of his or her family, a child may be adversely affected to a significant degree when there is persistent or substantial conflict between the parents. Several large studies of psychosocial risk factors for the development of

Differentiating Maladaptive Family Patterns

Although the 4 maladaptive patterns of family interaction that illustrate the CAPRD diagnosis may overlap in features and may co-occur in some families, it is important to understand how they differ from each other.

Discussion

CAPRD is a concept that clinicians and research personnel will find useful once they become familiar with its meaning, scope, and implications. For research in this area to proceed, use of the more stringent definitions for intimate partner maltreatment and intimate partner relationship distress, found in the DSM-5, may be helpful in ascertaining whether either of those problems are occurring in the parents of children presenting with health complaints. The World Health Organization is

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    This article is discussed in an editorial by Drs. Robert R. Althoff and Andrés Martin on page 542.

    An interview with the author is available by podcast at www.jaacap.org or by scanning the QR code to the right.

    Clinical guidance is available at the end of this article.

    Disclosure: Dr. Bernet has received royalties from Charles C Thomas Publisher and Krieger Publishing Co. He has received an honorarium for presenting at the 12th Annual Seminar in Forensic Sciences, South Padre Island, Texas. He has been paid for testifying as an expert witness in child forensic psychiatry. Dr. Wamboldt has received royalties from APA Press and Springer Press. She has received funding from a research grant from Pfizer, Inc. Dr. Narrow reports no biomedical financial interests or potential conflicts of interest.

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