Evidence-Based Reviews

Stalking intervention: Know the 5 stalker types, safety strategies for victims

Current Psychiatry. 2007 May;6(5):31-38

References

1. Basile KC, Swahn MH, Chen J, Saltzman LE. Stalking in the United States: recent national prevalence estimates. Am J Prev Med 2006;31(2):172-5.

2. McEwan T, Mullen PE, Purcell R. Identifying risk factors in stalking: a review of current research. Int J Law Psychiatry 2007;30:1-9.

3. Spitzberg BH, Cupach WR. The state of the art of stalking: taking stock of the emerging literature. Aggression and Violent Behavior 2007;12:64-86.

4. Mullen P, Mackenzie R, Ogloff JR, et al. Assessing and managing the risks in the stalking situation. J Am Acad Psychiatry Law 2006;34:439-50.

5. Mohandie K, Meloy JR, McGowan MG, Williams J. The RECON typology of stalking: reliability and validity based upon a large sample of North American stalkers. J Forensic Sci 2006;51(1):147-55.

6. James DV, Farnham FR. Stalking and serious violence. J Am Acad Psychiatry Law 2003;31(4):432-9.

7. McFarlane J, Campbell JC, Watson K. Intimate partner stalking and femicide: urgent implications for women’s safety. Behav Sci Law 2002;20(1-2):51-68.

8. Mullen PE, Pathé M, Purcell R. Stalkers and their victims. Cambridge, UK: Cambridge University Press; 2000.

9. Binder RL. Commentary: the importance of professional judgment in evaluation of stalking and threatening situations. J Am Acad Psychiatry Law 2006;34(4):451-4.

10. White S, Cawood J. Threat management of stalking cases. In: Meloy JR, ed. The psychology of stalking: clinical and forensic perspectives. San Diego, CA: Academic Press; 1998:295-314.

11. Orion D. I know you really love me: a psychiatrist’s journal of erotomania, stalking, and obsessive love. New York: Macmillan; 1997.

12. Maxey W. The San Diego stalking strike force: a multi-disciplinary approach to assessing and managing stalking and threat cases. Journal of Threat Assessment 2002;2(1):43-53.

13. McFarlane J, Malecha A, Gist J, et al. Protection orders and intimate partner violence: an 18-month study of 150 black, Hispanic, and white women. Am J Public Health 2004;94(4):613-8.

14. Melton HC. Predicting the occurrence of stalking in relationships characterized by domestic violence. J Interpers Violence 2007;22(1):3-25.

15. Meloy JR. The clinical risk management of stalking: “someone is watching over me….” Am J Psychother 1997;51(2):174-84.

16. Purcell R, Pathé M, Mullen PE. When do repeated intrusions become stalking? J Forensic Psychiatry Psychol 2004;15(4):571-3.

17. Pathé M. Surviving stalking. Cambridge, UK: Cambridge University Press; 2002.

18. Kamphuis JH, Emmelkamp PMG. Traumatic distress among support-seeking female victims of stalking. Am J Psychiatry 2001;158:795-8.

19. Pathé M, Mullen PE. The impact of stalkers on their victims. Br J Psychiatry 1997;170:12-7.

20. Turmanis SA, Brown RI. The stalking and harassment behavior scale: measuring the incidence, nature, and severity of stalking and relational harassment and their psychological effects. Psychol Psychother 2006;79(Pt 2):183-98.

21. Ashmore R, Jones J, Jackson A, Smoyak S. A survey of mental health nurses’ experiences of stalking. J Psychiatr Ment Health Nurs 2006;13:562-9.

22. De Becker G. The gift of fear: survival signals that protect us from violence. New York: Dell Publishing; 1997.

Clinical Point

Advise a victim who obtains a protective order not to develop a false sense of security

Intervention dilemma. Before taking any action, consider that taking direct measures against the stalker to reduce stalking may increase the risk of violence.¹⁰ A law enforcement intervention may provoke a stalker by challenging or humiliating him or her. Therefore, there is no single best approach to risk management. Consider the significance of individual-specific nuances, and solicit input from different disciplines. In some cases, no direct action may be preferable.

Protective orders. Obtaining a protective order may or may not be helpful. Most domestic violence research indicates that such orders protect abused women.¹³ This is important because stalking by a former intimate partner often occurs in relationships characterized by domestic violence.¹⁴ In addition to potentially preventing stalking behavior, a protective order may provide legal evidence of the course of stalking, as well as document a “fearful victim,” which is required by law to obtain a criminal conviction.

No conclusive studies have investigated the effectiveness of protective orders specifically related to stalkers, so consider the stalker’s reaction to previous orders.¹⁵ Counsel a victim who obtains a protective order against a former intimate partner to avoid developing a false sense of security. Rejected stalkers who have considerable emotional investment in the relationship may not be deterred by the threat of criminal sanctions. Furthermore, stalkers who are psychotic may misperceive and disregard criminal injunctions. In rare cases, a protective order may escalate stalking and violence.¹⁵

Dramatic moments. Advise a victim to remain vigilant during “dramatic moments” when violence risk may be especially heightened.¹⁵ These include:

arrests
issuance of protective orders
court hearings
custody hearings
anniversary dates
family-oriented holidays.

Legal intercessions—such as receiving a protective order, being arrested, or appearing in court—may cause the stalker intense humiliation or narcissistic injury. A victim might be at greatest risk immediately after such events because the stalker may feel humiliated but retains his or her freedom.

Clinical Point

Encourage victims to record the dates and times of each unwanted contact with the stalker

Encourage a victim who is especially concerned about an impending dramatic moment to prepare by:

arranging to be out of town on that date
notifying law enforcement and victim advocates.

Box

Anti-stalking teams: an effective approach

A multidisciplinary approach is the most effective way to reduce stalking violence risk. In addition to mental health professionals, an effective team usually includes law enforcement and criminal justice personnel, attorneys, security specialists/private investigators, victim advocates, and the victim and his or her social network.

The victim can increase the chances that officials will view his or her case as a priority by establishing rapport with the senior police official and district attorney assigned to the case.^10,11 Such rapport also allows the victim to learn about the laws and resources available for managing stalking risk.

A multidisciplinary team can assess and manage risk, provide education, and support victims. One well-established anti-stalking team—the San Diego Stalking Strike Force—meets monthly to evaluate cases.¹² Members also are on-call for emergencies. By exchanging information monthly, the case manager and parole agent enhance stalker supervision.

In court, advocacy is critical. The consultant psychiatrist or victim advocate can educate the court that stalking is not a “lovers’ spat” (in the case of the rejected stalker) or mere nuisance behavior (in the case of other stalker types). The victim and psychiatrist may need to mobilize resources and promote collaboration among professionals in communities that do not have advocates or anti-stalking services.

Treating victims’ symptoms

As a result of the risks they face, stalking victims often suffer significant “social damage.” To cope with being stalked, many victims must make substantial life changes, such as relocating or finding new employment. They may need to restrict outings, adapt security measures, and take time off from work.¹⁶ This social damage and anxiety may predispose them to substance abuse.¹⁷

Stalking victims also experience emotional distress.^3,18 They commonly report symptoms of anxiety disorders, in particular PTSD, and one-quarter experience depression and suicidal ruminations.¹⁹ Victims who perceive their stalking as severe report elevated levels of helplessness, anxiety, PTSD, and depression.²⁰

Few studies focus on the duration of victims’ symptoms or their successful treatment.²¹ Mullen⁸ has recommended a comprehensive approach that includes education, supportive counseling, psychotherapy, and pharmacotherapy. In particular, cognitive-oriented therapy can target common issues such as anxiety leading to feelings of loss of control and associated avoidance. Pharmacotherapy for anxiety or depressive symptoms follows recommended treatment guidelines.

Because the stalking and associated stress may have an adverse impact on the victim’s personal relationships, partner and family therapy may be necessary. Support organizations for stalking victims, such as Survivors of Stalking, can provide education, safety information, and emotional support.