Differential Diagnosis of the Three Types of
Parental Alienation Syndrome

PRIMARY SYMPTOMATIC MANIFESTATION	MILD	MODERATE	SEVERE
The Campaign of Denigration	Minimal	Moderate	Formidable
Weak, Frivolous, or Absud Rationalizations for the Depreciation	Minimal	Moderate	Multiple absurd rationalizations
Lack of Ambivalence	Normal ambivalence	No ambivalence	No ambivalence
The Independent-Thinker Phenomenon	Usually absent	Present	Present
Reflexive Support of the Alienating Parent in the Parental Conflict	Minimal	Present	Present
Absence of Guilt	Normal guilt	Minimal to no guilt	No guilt
Borrowed Scenarios	Minimal	Present	Present
Spread of the Animosity to the Extended Family of the Alienated Parent	Minimal	Present	Formidable, often fanatic
Transitional Difficulties at the Time of Visitation	Usually absent	Moderate	Formidable or visit not possible
Behavior During Visitation	Good	Intermittently antagonistic and provocative	No visit, or destructive and continually provocative behavior throughout visit
Bonding with the Alienator	Strong, healthy	Strong, mildly to moderately pathological	Severely pathological, often paranoid bonding
Bonding with the Alienated Parent	Strong, healthy, or minimally pathological	Strong, healthy, or minimally pathological	Strong, healthy, or minimally pathological

Richard A. Gardner, M.D.