Pinals, Debra A.

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Stalking: Advances in Conceptual Understanding and Management Debra A. Pinals, M.D., Associate Professor of Psychiatry, Law & Psychiatry Program, UMass Medical School Research BriefDec 2008Vol 5, Issue 8CMHSRbehavior to meet legal requirements. This is one aspect of stalking legislation that is unique among criminal laws.From a clinical perspective, the psychodynamicsof stalking behavior vary with the motivationof the stalker. Meloy2 has highlighted that motivational emotions within the stalker such as shame, rage, envy and jealousy are often involved. One theory for many cases of stalking, especially those that stemmed following the break up of a romantic relationship, is that narcissistic fantasies seem to fuel and excuse the stalking behavior. Persons who feel rejected may choose stalking behavior as a way to remain linked to the person who rejected them. Among other motives and emotions involved in certain stalking behavior includes an intense, and at times delusionally-based, belief of romantic love between the stalker and victim.Epidemiological StudiesLarge scale community surveys have helped The term stalking is commonly used to mean anything from lighthearted obsessionalpursuit to repeated following and inductionof fear possibly leading to physical injury or death. The phenomenon of stalking as a criminal offense and complex behavior has received increased societal attention over the last two decades and lead to more precise legal definitions. California passed the first anti-stalking legislation in 1990 after the murder of a popular television actress. Since then, stalking has become a crime in every state and many countries. IntroductionThe notion that repeated attempts at pursuit of a relationship may end in acceptance and love makes stalking a complicated issue to under-stand. Popular media displays this phenomenon routinely. In an attempt to codify when such behavior violates social norms, laws against stalking generally describe stalking as involving: A1.  pattern of conduct (i.e., generally at least two or more events) of unwanted intrusions toward another person; An implicit or explicit threat that is 2. evidencedin the pattern of conduct; and The experience of reasonable fear in the 3. person who is the object of the interpersonal intrusions.1 Challenges to criminal charges of stalking can include examination of any of the three main components. Statutes vary as to the degree of fear experienced by the victim for the stalking © 2008 Center for Mental Health Services Research, Department of Psychiatry University of Massachusetts Medical Schoolus understand the prevalence of stalking. Results from a nationally representative study involving telephone interviews of 8000 men and 8000 women indicated that roughly 8% of women and 2% of men experienced stalking in their lives.3 Most commonly, female victims are stalked by former partners. Other studies have shown that certain populations, including college students and mental health professionals, may be at greater risk of being stalked than the general population. Studies require cautious interpretation, however, because of varying definitions of stalking. Research shows that not all stalking leads to violence. The risk of experiencing physical violence has varied according to studies but ranges from 3-47%.4 Ranges vary due to how stalking and violence are defined. Most stalkers who threaten do not subsequently become violent, but for some, violence was not preceded by threats. The group of stalkers that are most likely to become violent are those who were formerly in an intimate relationship with their victim. Even for victims stalked by this type of stalker, the risk being killed is relatively low, though it is higher than the risk of being killed for the general population.4Stalking ClassificationsNumerous classifications have been proposed that examine stalker types including violent/non-violent and psychotic/non-psychotic types.4 Other classifications include an examination of motivation of the stalker, psychiatric diagnoses, and/or an examination of the relationship between the stalker and victim. Classifications for clinical assessment and management purposes are to be distinguished from classifications utilized for law enforcement or security purposes. Clinically based classifications tend to be more useful from a perspective of treating a stalker and for clinicians to work with stalking victims over time. Clinicians then may incorporate an understanding of diagnoses that would be part of a clinical formulation of a stalking case. Mullen and colleagues5 have advanced a clinically useful stalker classification model that can be helpful in determining the risk the stalker poses and in helping to sort out potential management strategies. Mullen and colleagues5 divide stalkers into the following types. (Prevalence among stalker subtypes5 are indicated in parenthesis below):Rejected type (35%)1. Intimacy-seeking type (32%)2. Resentful type (14%) 3. Incompetent type (14%) 4. Predatory type (5%)5.  The rejected types engage in stalking behavior following the disruption of a meaningful relationship. This type is the most likely compared to the other types to engage in violence toward their victims. The intimacy seeking stalkers are those driven by a desire for intimacy with a partner. Approximately 60% of an earlier sample of the intimacy seekers had erotomanic delusions. Predatory types, which were the least common, commonly have sexual paraphilias and are atypical stalkers in that they generally remain hidden until they attack (usually attacks are of a sexual nature for the predatory type). They are classified as stalkers because of the repeated pursuit and the idea that the victim would be fearful if they knew they were being pursued. A more recent classification by Mohandie and colleagues6 called RECON (Relationship and Context-based) divided stalkers by Prior Relationship (intimate or acquaintance) or No Prior Relationship (public figure or private stranger). This classification scheme is unrelated to motivation, emotions, or psychiatric symptoms for the stalker, and thus may be easier to use for security professionals. According to this typology, consistent with other classification schemes, the study authors found a very high risk of threats and violence among stalkers who were in prior intimate relationships with their victims, with a relatively low risk of threats and violence among public figure (celebrity) stalkers. They also found a negative relationship between stalking violence and psychosis. Nearly a third of the total sample of stalkers assaulted the victim, and 3% assaulted a third party. Almost half of the stalkers demonstrated some violence to persons or property....not all stalking leads to violence.Risk Assessment:As of yet there are no risk assessment instruments that have been studied to help assess the risk of violence related to stalking, though some are under development (personal communication: Dr. Graham Glancy, October 2008). Risk factors for violence among stalkers include:sub• stance use, a history of criminal offenses, • threats, • suicidality, • an ex-intimate relationship with the victim, • personality disorders, • erotomanic delusions, • social isolation, and • escalation of behavior.• 4 Celebrity stalkers and cyberstalkers (i.e., those that stalk through the internet) present different risk factors for violence, and the need to examine the stalkers access to potential celebrity victims should be taken into account in assessing risk. Stalker violence is also distinguished between that resulting from affective hyperarousal states, and that resulting from predatory and planful activities. Stalking in the context of domestic violence raises particular concerns related to risk of violence as noted above. Emotions such as humiliation, jealousy, and anger are important components of what may lead to ultimate violence, and thus should be tracked in risk assessments. Interventions against stalkers at times can serve to escalate the risk to the victim, and must be considered carefully.Risk Management Strategies: Management approaches to stalking should be determined based on the individual nuances of the situation. Stalking victims may have difficult decisions to make. Some will be able to manage the situation on a local level. In extreme cases, stalking victims may choose to leave their homes, schools, or places of employment to gain further distance from their stalkers. The stalking victim is often left to feel powerless, which can further the goal of the stalker. An important component of helping victims feel more in control is in providing support and education to help them make choices they see as best for their situation.Generally, victims of stalking should give their stalker a clear message that contact should cease and should thereafter avoid re-engaging with the stalker. Ideally, this message should be early on so that it comes before the stalker is overly invested in the stalking behavior. Documentation of any further contact by the stalker can be critical if subsequent legal intervention is pursued.4 If a person is being stalked, personal security measures can be important. These include asking for escorts to one’s car, letting landlords, neighbors, and/or co-workers know of the situation so that they are alert if someone comes to see the victim unannounced. It can also be helpful to speak with local police to alert them of the situation in the event that law enforcement needs to be called in a crisis. Interventions may lead to a number of outcomes, ranging from quieting to fueling the behavior. Restraining orders, for example, can be effective, ignored, or ignite anger in the stalker. Court involvement may be more or less effective depending on stalker type and prior response to legal sanctions. At times, criminal sanctions, combined with mental health interventions, can be helpful. Risk assessments should be conducted by someone knowledgeable about the latest in stalking literature and include an assessment of stalker type. Treatment of stalkers should ideally include medications if indicated. For example, a stalker who is experiencing depression may improve if treated with antidepressant medication. A stalker who exhibits delusional symptoms that contribute to the stalking may benefit from antipsy-chotic medications. Non-pharmacological efforts can also be helpful, such as efforts to engage stalkers in prosocial activities and programs. Periodic risk assess-ments, including a multidisciplinary approach to identifying effective management strategies can be an important strategy to ensure that the risk mitigation options are attended to in a formal, regular manner. Security, police, legal and mental health professionals can all contribute to developing management strategies.Fortunately, there is now an array of resources for stalking victims (see Figure 1). Psychological consequences can result from experiencing stalking, even in the absence of overt threats and physical aggression by the stalker. Stalking victims are at risk ReferencesMeloy, J.R. (Ed.). (1998). The psychology of 1. stalking: Clinical and forensic perspectives. San Diego: Academic Press.Meloy, J.R. (1999). Stalking: An old behavior, 2. a new crime. The Psychiatric Clinics of North America, 22, 85-99.Tjaden, P., & Thoennes, N. (1998). Stalking in 3. America: Findings from the National Violence Against Women Survey (Research in Brief Se-ries, Publication NCJ 169592). Washington, D.C.: National Institute of Justice and Centers for Disease Control and Prevention.Pinals, D.A. (Ed.) (2007). Stalking: Psychi-4. atric Perspectives and Practical Approaches New York, New York, Oxford University Press (Chapters 1, 2, 3 and 4 highlighted in this re-view).Mullen, P.E., Pathe, M., & Purcell, R. (2000) 5. Stalkers and their victims. Cambridge, UK: Cambridge University Press.Mohandie, K., Meloy, J.R., McGowan, M.G., 6. & Williams, J. (2006). The RECON typology of stalking: Reliability and validity based upon a large sample of North American stalkers. Journal of Forensic Sciences, 51, 147-155.Glancy, G.D., Hayos, C., Resnick, P.J., & Pi-7. nals, D.A. The Stalking HARM: A new guide to the risk management of stalking. Presented at the 39th Annual Meeting of the American Academy of Psychiatry and the Law, Seattle, WA, October 2008.Visit us on-line at  http://www.umassmed.edu/cmhsrSend Comments to CMHSR@umassmed.eduOpinions expressed in this brief are those of the authors and not necessarily those of UMass Medical School or CMHSR.Figure 1. Website Resources for Service Providers, Researchers, & Stalking Victimshttp://www.feelsafeagain.org/http://www.ncvc.org/src/http://www.ojp.usdoj.gov/nij/top-ics/crime/stalking/welcome.htmhttp://www.ovw.usdoj.gov/about-stalking.htmof developing mood disorders and anxiety symptoms similar to posttraumatic stress disorder, and can be at increased risk of suicide. It is incumbent upon professionals dealing with stalking victims to work with them respectfully and to help them, within the boundaries of professional roles, through a difficult and complex maze of potential strategies to minimize the risk of further stalking and stalking-related harms. Recommendations for service providers and researchers:Service providers who are working with persons who have engaged in stalking should attend to their client’s history by reviewing record information and being clear as to what stalking behavior has occurred, whether there has been formal legal involvement, and how the stalker has responded to various interventions. It is also important to understand whether the stalker continues to pursue the victim. In some situations, service providers may be concerned for their staff that have been targets of stalking behaviors. In those cases, it is important to have a planned approach to management. Risk management consultation can be important for provider agencies serving clients who are engaging in stalking behavior or other persons who are victims of stalking. Future research will also be helpful as we learn more about various types of stalking. Risk assessment tools, such as one being developed currently7, may prove to be of assistance in determining risk factors that warrant further intervention. Other areas for improved understanding include learning more about juvenile stalking behaviors and stalking through the internet.  

Stalking: Advances in Conceptual Understanding and Management

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Stalking: Advances in Conceptual Understanding and Management

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