Psychiatry Notes - Stalking

"Stalking" is defined as repeated and persistent unwanted communications and/or approaches that produce fear in the victim. The stalker may use such means as telephone calls, letters, e-mail, graffiti and placing notices in the media.

Dr. J. Reid Meloy, author of Violent Attachments and editor of The Psychology of Stalking, is an expert on stalking behavior. Pathological attachments, he says, most often occur in males and generally start in the fourth decade of their lives. It follows a fairly predictable progression:

1. After initial contact, the stalker develops feelings like infatuation, and therefore places the love object on a pedestal.
2. The stalker then begins to approach the object. It might take a while, but once contact is made, the stalker's behavior sets him up for rejection.
3. Rejection triggers the delusion through which the stalker projects his own feelings onto the object: She loves me, too.
4. The stalker also develops intense anger to mask his shame, which fuels the obsessive pursuit of the object. He now wants to control through harassment or injury.
5. The stalker must restore his narcissistic fantasy.
6. Violence is most likely to occur when the love object is devalued, as through an imagined betrayal.

Several stalker typologies have been developed:

Mullen et al. (1999) proposed a multiaxial classification. The first axis was a typology derived primarily from the stalker's motivation, the second from the prior relationship to the victim, and the third a division into nonpsychotic and psychotic subjects. This attempted to capture the stalker's behavior in terms of both motivation and the needs and desires the stalking itself satisfies. They described five subtypes:
1.The Rejected respond to an unwelcome end to a close relationship by actions intended to lead to reconciliation, an extraction of reparation from the victim or both. For the stalker, the behavior maintains some semblance of continued contact and relationship with the victim. This is thought to be the largest group of stalkers. It is comprised mainly of ex-partners. These stalkers respond to the unwelcome end of a close relationship by actions that are initially intended to achieve reconciliation or retribution. Often, the stalker fluctuates between these goals.The Rejected are more prone to violence than other stalkers but can usually be persuaded to abandon their quest, with the aid of legal sanctions and counselling.

2.The Intimacy Seekers pursue someone they have little, if any, relationship with in the mistaken belief that they are loved, or inevitably will be loved, by the victim. The stalking satisfies needs for contact and closeness while feeding fantasies of an eventual loving relationship.
3.The Incompetent are would-be suitors seeking a partner. Given their ignorance or indifference to the usual courting rituals, they use methods that are, at best, counterproductive and, at worst, terrifying. The stalking provides an approximation of finding a partner.
4.The Resentful respond to a perceived insult or injury by actions aimed not just at revenge but at vindication. The stalking is the act of vengeance.
5.The Predatory pursue their desires for sexual gratification and control. These constitute only a small fraction of stalkers. Their motive is a sexual one, the stalking activities usually being the prelude to a sexual attack. Occasionally, the stalking behaviour is itself the predominant source of sexual gratification The stalking is a rehearsal for the stalker's violent sexual fantasies and a partial satisfaction of voyeuristic and sadistic desires.
6.When the typology, relationship to the victim and psychotic/nonpsychotic dichotomy were combined, the result predicted the duration and nature of the stalking, the risks of threatening and violent behavior, and, to some extent, the response to management strategies (Mullen et al., 1999; Mullen et al., 2000). The rejected used the widest range of behaviors, such as following, repeatedly approaching, telephoning, letter-writing and leaving notes. In contrast, the predatory stalkers concentrated almost exclusively on furtively following and maintaining surveillance. Intimacy seekers were the most prolific letter-writers, and they also sent the most unsolicited gifts and other materials. Duration was longest in the rejected and intimacy seekers and shortest in the predatory. The psychotic subjects were most likely to send unsolicited materials, and the nonpsychotic to follow and maintain surveillance.

The psychotic and nonpsychotic were equally likely to threaten, but the nonpsychotic were twice as likely to proceed to assault. The rejected were the most likely type to assault and the resentful, although often issuing threats, were the least likely to resort to overt violence.

The best predictor of stalking duration was typology. Also best predicted by typology were assaults. When assaults were combined with substance abuse and a history of prior convictions, they accounted for most of the explained variance.

Intimacy seekers were largely impervious to judicial sanctions, and often regarded court appearances and imprisonment as the price to be paid in the pursuit of true love. They often had a treatable psychiatric disorder, however, that when effectively managed, ended the stalking.

In contrast, the rejected, who could usually calculate their own advantage, often responded to the threat or imposition of judicial sanctions by curbing their behavior. The rejected type, however, do have significant levels of psychopathology, particularly connected to personality disorder, and therapeutic interventions can play a role in preventing a relapse.

The incompetent type could usually be persuaded to abandon the pursuit of their current victim with relative ease. The challenge is to prevent them from harassing the next victim who catches their fancy. The predatory were generally paraphilics. Management of their sexual deviance is central to the prevention of stalking recidivism.

The resentful, who all too often were both self-righteous and self-pitying, can be very difficult to engage therapeutically. Unless they have an overt paranoid illness, they rarely benefit from mandated treatment. They will, however, usually abandon their harassment if the cost to them, in terms of judicial sanctions, becomes too high. Contrary to myths perpetrated by the mass media, studies show that most stalkers are men, have high IQ's, advanced degrees, and are middle aged (Meloy and Gothard, 1995; and Morrison, 2001).

CLINICAL STUDY OF 100 STALKING VICTIMS

• 83% were female
• Stalking duration ranged from one month to 20 years
• Prior relationship with stalker:
• ex-partner 29%
• professional 25%
• work-related 9%
• casual acquaintances 21%
• strangers 16%
• Impact of stalking:
• major lifestyle changes 94%
• social activities curtailed 70%
• changed or ceased employment 53%
• moved home 39%
• change in daily routine, avoidance of reminders of the stalker
• Emotional responses to stalking:
• increased anxiety levels 83%
• increased alcohol, tobacco consumption 25%
• suicidal rumination 24%
• post-traumatic stress disorder 37%

source: Drs. Pathe and Mullens

According to Dr. Michael Zona and his colleagues from the University of Southern California School of Medicine, stalkers appear to come in three basic varieties, with a perverse twist on stalking that adds a fourth important category:

1. Simple obsessional
   The most common form is male with a female with whom he was once sexually intimate.
2. Love obsessional
   A love-obsessed stalker tends to idealize a celebrity or someone he has seen from afar and he develops an unrealistic belief that the target person will agree to a relationship.
3. Erotomania
   Someone suffering from this more extreme obsession believes that the victim loves him or her.
4. False victimization
   Claiming harassment and stalking when none exists, this behavior is usually carried on by people with histrionic personality disorders.

Another method of categorizing stalkers comes from the team who wrote the FBI's Crime Classification Manual:

1. Non-domestic stalker, who has no personal relationship with the victim
2. Organized (based in a calculated, controlled aggression)
3. Delusional (based in a fixation like erotomania)
4. Domestic stalker, who has had a prior relationship with the victim and feels motivated to continue the relationship; this constitutes around 60 percent of stalkers and the aggression often culminates in violence.

Stalkers tend to be unemployed or underemployed, but are smarter than other criminals. They often have a history of failed intimate relationships. They tend to devalue their victims and to sexualize them. They also idealize certain people, minimize what they are doing to resist, project onto people motives and actions that have no basis in truth, and rationalize that the target person deserves to be harassed and violated.

While many stalkers view their actions within a delusional framework and therefore see no need to get help, a few do actually approach professionals. One case resulted in a landmark decision that shifted certain responsibilities onto the shoulders of therapiWhile many stalkers only threaten harm, a small percentage carry out their threats, damaging property or harming pets. With the rise in popularity of the Internet, cyber-stalking has become yet another avenue of danger. Many stalkers have a prior criminal record and show evidence of substance abuse, a mood disorder, a personality disorder, or psychosis. At least half of all stalkers threaten their victims, which increases the possibility of violence. Frequency of violence averages 25 to 35 percent, with most violence occurring between people who have been romantically involved in the past.

CYBER STALKING with the advent of the Internet, a new type of anonymous stalking is creating many new dangers that are difficult, if not impossible, to prevent.

The most perilous areas are chat groups, message boards, and personal e-mail boxes, and the most common form of harassment online is done through threatening e-mail and live chats. Cyber-stalkers can spread rumors, post information about you, send a virus, or even draw you out for an offline (f2f) encounter.

Stalking takes a psychological toll no matter who the target is, Saunders says. And even when jailed, the stalkers find ways to continue to threaten and frighten. Since they eventually get out, the victim must always worry about the stalker showing up again. According to what she learned about the disorder, the typical person suffering from this delusion:

• is single
• is immature
• is unable to sustain close relationships
• has a history of obsessive attachments
• gets attached to unattainable objects
• attains these objects through fantasy
• needs the fantasy in order to survive
• mistakes feelings in the self for feelings in the other
• has delusions that can last for years
• will go to great lengths to rationalize why the object ignores them
• may become predatory
• seeks any acknowledgment, even negative, that makes them feel connected
• has delusions that often develop after the loss of a meaningful connection
• is devious about collecting information
• usually requires forced separation from the object

Not all stalkers are erotomaniacs—only about 10 percent---but most erotomaniacs participate in some form of stalking.

The impact on the victim's psychological and social well-being is considerable. Pathé and Mullen (1997) studied 100 victims of persistent stalking. The majority had to severely restrict their lives by changing or abandoning work, curtailing all social activities, and becoming virtual recluses. Over 80% developed significant anxiety symptoms. Sleep disturbance was common, and many resorted to substance abuse. Over half had symptoms of posttraumatic stress disorder. Feelings of powerlessness and depression were common, and nearly a quarter of the victims were actively considering suicide as a means of escape. Similar levels of distress and disturbance were reported in Hall's study (1998).

California passed the first anti-stalking statute in 1990, followed shortly by the rest of the United States as well as Canada, Australia, the United Kingdom and now some European countries. It was only after stalking became a specific form of offensive behavior that behavioral scientists and health care professionals began to systematically study stalkers and, equally important, the impact of their conduct on the victims.

In the late 1960s, Prosenjit Poddar, a native of India, attended the University of California at Berkeley and met Tatiana Tarasoff at a dance. He developed a strong romantic interest in her. When they shared a quick New Year's Eve kiss, he believed it was a sign that they were engaged. Yet Tatiana's disinterest confused Poddar, so he persisted in believing that she in fact had feelings for him.

He went to Tatiana's house, armed with a knife and a pellet gun. She ran from him and he shot her and then stabbed her 14 times, killing her. Then he turned himself in. He was convicted of second-degree murder and was released after serving five years.

Yet this case had an impact on the relationship of psychiatry to stalking and violent obsessions. Where once what was said between doctor and patient was privileged, that was about to change.

The Tarasoffs instigated a civil case of negligence against the Regents of the University of California. In 1974, the California Supreme Court found that, despite confidentiality, a duty to warn exists when the therapist determines that a warning is essential to avert a danger rising from the patient's condition.

Most jurisdictions now recognize a Tarasoff-type duty, but some limit it to situations in which the patient communicates a serious threat of physical violence against an identifiable victim. Standards vary from state to state. However, there is no automatic duty to warn a potential victim, and in fact, issuing a warning has proven ineffective, because more violence has been shown to result after a warning than if no warning is issued. In any event, there are alternatives.

Among the signals to beware of when a potential stalker approaches, according to de Becker are:

1. Forced teaming: He will try to get you to be a "we" with him in some predicament.
2. Charm, which usually has motive driving it. Be aware of the possibilities.
3. Too many details in some narratives indicate possible deception.
4. Loan sharking, or doing something to make you feel you owe him.
5. Unsolicited promises
6. Ignoring the word "no," through things like proposing alternatives}

· Community surveys suggest that each year between 1% and 2% of women and 0.25% to 0.5% of men are stalked

Women report to the police only 50% of all stalkings perpetrated. Almost 5% of women and 0.6% of men in the survey indicated that an intimate had stalked them, with an annual rate of 0.5% of surveyed women and 0.2% of surveyed men. Extrapolation from these data indicates that 503,485 women and 185,496 men were stalked by an intimate partner within the previous 12 months.

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