Reader’s Question

I live in the U.S. and found this forum when reading through “The Loser” series of articles and hope you might be able to help with my problem.

My son is 16 and was diagnosed with Reactive Attachment Disorder (RAD) and Intermittent Explosive Disorder (IED). He feels abandoned by his mother because she moved away when he was 18 months old. She has been in and out of his life since then. She also has failed to assist in his healing. She will often aggravate the situation by either casting him away when he blows up or by undermining my attempts to give him consistant boundaries.

We have been in cognitive-behavioral therapy for three years, but he still exhibits most of the symptoms of RAD. The symptoms causing us the most concern are: rages during which he blacks-out, hording/stealing food, uncontrollable impulses when it comes to gaining pleasure (inappropriate sexual contact, stealing candy, viewing porn, etc.), and an obsessive need to be valued and loved by opposite-sex peers. He admits that there are no consequences great enough to deter him as long as he gets what he wants at that moment. He’s unremorseful for the hurt his actions cause and only shows remorse for getting caught. He manipulates to get what he wants, and he lies compulsively.

My main question is: As a father of a minor with these disorders and symptoms, what is my legal responsibility to inform or protect the people he attempts to have relationships with?

Our Clinical Psychologist’s Reply

Certain professionals are obligated under the law to warn potential victims of imminent danger to another posed by their clients. For example, if your son were to tell his therapist that he has secured a weapon and plans to use it to take the life of a particular person, the therapist would have a “duty to warn” that person and can therefore breach the normal client-therapist confidentiality to do so.

In the case of realistic imminent serious danger, you have no legal duty to warn, although you might sense a moral obligation. Short of a true imminent serious threat to someone, you have no such obligation. Of course, in the case of a serious credible threat of danger to self or others, as the legal guardian of a minor you also have the ability to seek restrictive care (possibly even temporary placement in a locked hospital ward) for your son. Every state has laws and guidelines for involuntary commitment.

In the situation you describe, it sounds like there is no imminent danger being posed, but you are feeling some sort of moral obligation with regard to your son’s capacity to engage in acts that might harm others in some way. One of the problems that occurs in families in which one person is very conscientious is that the other members of the family who lack conscientiousness are “enabled” not to develop it. It appears that your son has several problems. Some of the “symptoms” you describe appear more than merely the manifestations of RAD or IED. And cognitive-behavioral therapy would appear to be a suitable treatment of choice for many of his difficulties. However, it’s really important that the “behavioral” component of CBT be given adequate attention in treatment planning. Many of the destructive “behavior chains” you have mentioned can be addressed and “interrupted” before they escalate into full blown problems. Medications can also sometimes be helpful in improving impulse control. But ultimately, behaviors persist when they are reinforced and when alternative responses have not been reinforced enough. So, address these concerns with your son’s therapist.