You’ll hear me talk a lot about the persecutory delusion, the child’s false belief in “victimization,” created by the allied parent, and how that’s the encapsulated (limited-scope) persecutory delusion of the allied parent, your ex- toward you, that is then being imposed on the child – a shared persecutory delusion with the parent as the “primary case.”
A shared persecutory delusion is an ICD-10 diagnosis of F24 Shared Psychotic Disorder, that’s what a shared delusional disorder is called, a Shared Psychotic Disorder.
The ICD-10 diagnostic system is used throughout the world, it’s a coding system for all medical and psychiatric disorders, it’s used in the U.S. for all insurance billing, medical and psychological, the ICD-10 code is what’s used for billing insurance.
The ICD-10 diagnosis for a shared persecutory delusion between a parent and child, with the parent as the “primary case” is an ICD-10 diagnosis of F24 Shared Psychotic Disorder.
The descriptions for the disorders listed in the ICD-10, like cancer, or depression, or any medical or psychiatric disorder, are pretty brief. It’s mostly just the category system for ALL medical and psychiatric diagnoses, it doesn’t go into a lot of depth explaining each medical and psychiatric disorder.
For psychiatric disorders, the American Psychiatric Association is who you want to turn to for a description of the pathology. The American Psychiatric Association offers a pretty full description of a Shared Psychotic Disorder, let me run through it for a second.
From the American Psychiatric Association:
“The essential features of Shared Psychotic Disorder (Folie a Deux) is a delusion that develops in an individual who is involved in a close relationship with another person (sometimes termed the “inducer” or “the primary case”) who already has a Psychotic Disorder with prominent delusions (Criteria A).” (p. 332)
Dr. Childress: note the two terms for the allied parent, the “inducer” of the child’s delusion (the child’s rigidly held and false belief in supposed “victimization”) and the “primary case” of the shared persecutory delusion, you’ll hear me use those two interchangeably.
“Usually the primary case in Shared Psychotic Disorder is dominant in the relationship and gradually imposes the delusional system on the more passive and initially healthy second person.”
Dr. Childress Comment: This contains two key elements, the first is the power, domination, and influence the allied parent has on the child, and then gradually “imposing the delusional system” on the child, “the more passive and initially healthy second person.”
“Individuals who come to share delusional beliefs are often related by blood or marriage and have lived together for a long time, sometimes in relative isolation.”
Dr. Childress Comment: The parent and child are related by blood, this feature definitely applies.
“If the relationship with the primary case is interrupted, the delusional beliefs of the other individual usually diminish or disappear.”
Dr. Childress: Here, the APA gives direct treatment guidance, i.e., interrupt the relationship with the “primary case” – the “inducer” of the child’s persecutory delusions.
“Although most commonly seen in relationships of only two people, Shared Psychotic Disorder can occur in larger number of individuals, especially in family situations in which the parent is the primary case and the children, sometimes to varying degrees, adopt the parent’s delusional beliefs.”
Dr. Childress Comment: The final part of that description is EXACTLY this pathology, it is a family situation in which the “parent is the primary case” and the children, to varying degrees, “adopt the parent’s delusional beliefs.”
Exactly. An encapsulated persecutory delusion imposed on the child by the “primary case” – the “inducer” – of the persecutory delusion. Here is the definition of a persecutory delusion from the American Psychiatric Association:
“Persecutory Type: delusions that the person (or someone to whom the person is close) is being malevolently treated in some way.”
The American Psychiatric Association also describes additional features of a Shared Psychotic Disorder.
Associated Features and Disorders
“Aside from the delusional beliefs, behavior is usually not otherwise odd or unusual in Shared Psychotic Disorder. Impairment is often less severe in individuals with Shared Psychotic Disorder than in the primary case.”
Dr. Childress Comment: the child goes to school, the allied parent goes to work, “aside from the delusional beliefs,” the shared persecutory delusion relative to the targeted parent, their “behavior is not otherwise odd or unusual.”
“Little systematic information about the prevalence of Shared Psychotic Disorder is available. This disorder is rare in clinical settings, although it has been argued that some cases go unrecognized.”
Dr. Childress Comment: Yes, like here, it is going “unrecognized” here.
“Without intervention, the course is usually chronic, because this disorder most commonly occurs in relationships that are long-standing and resistant to change. With separation from the primary case, the individual’s delusional beliefs disappear, sometimes quickly and sometimes quite slowly.”
Dr. Childress Comment: These are two incredibly important points. If we do not “interrupt the relationship with the primary case” then the situation continues to get worse, it’s chronic, it does not self-improve over time, it keeps getting worse and worse as long as the child is in contact with the “primary case” – the “inducer” – of the child’s persecutory delusion.
Dr. Childress, Comment: If, however, we separate the child from the primary case of the persecutory delusion, the allied parent, then the child’s “delusional beliefs will disappear,” “sometimes quickly” (High Road workshop augmented recovery), “sometimes quite slowly” (psychotherapy or no treatment).
That is my diagnosis for this pathology, an encapsulated shared persecutory delusion, with the parent as the primary case – the “inducer” – who “gradually imposes the delusional system” on the child, “the more passive and initially healthy second person.” American Psychiatric Association; ICD-10 F24 Shared Psychotic Disorder.
Go argue with the American Psychiatric Association and the ICD-10, it’s them that says it, not me. If it fits, I sits.
Craig Childress, Psy.D.
Clinical Psychologist, PSY 18857