What is the ICD?

The International Classification serves to record and report health and health-related conditions globally. ICD ensures interoperability of digital health data, and their comparability. The ICD contains diseases, disorders, health conditions and much more. The inclusion of a specific category into ICD depends on utility to the different uses of ICD and sufficient evidence that a health condition exists.   

Parental alienation and parental estrangement

The purpose of ICD-11 is to provide an internationally standardized classification for health diagnoses, to count health events and episodes of contact with healthcare for statistical purposes. Chapter 24 ’Factors influencing health status or contact with health services’ allows for the recording of circumstances or problems which influence an individual person's health status, but which are not in themselves an illness or injury.  This chapter includes the category 'caregiver-child relationship problem’.

During the development of ICD-11, a decision was made not to include the concept and terminology of ‘parental alienation’ in the classification, because it is not a health care term. The term is rather used in legal contexts, generally in the context of custody disputes in divorce or other partnership dissolution.

The broader category of 'caregiver-child relationship problem' was seen as adequately covering aspects of this phenomenon that could be the focus of health services.

More recently, proposals to include the terms ‘parental alienation’ and ‘parental estrangement’ as index terms for 'caregiver-child relationship problem' were submitted and initially approved. Following online commentary, the WHO-FIC Medical and Scientific Advisory Committee recommended clarification that inclusion of a term for search purposes does not signify endorsement by WHO of the term or its use. Following that clarification, comments and questions have persisted about the misuse of the term to undermine the credibility of one parent alleging abuse as a reason for contact refusal and even to criminalize their behaviour.

Review

Considering the above, WHO has thoroughly reviewed all materials provided and considers that:

• Parental alienation is an issue relevant to specific judicial contexts.
• Inclusion of the term in the ICD-11 will not contribute to health statistics.
• There are no evidence-based health care interventions specifically for parental alienation.

In situations in which an individual labelled with this term presents for health care, other ICD-11 content is sufficient to guide coding. Users may classify cases to ‘caregiver-child relationship problem’

Therefore, the index term ‘parental alienation’ has been removed, as has the parallel index term ‘parental estrangement’.