Department of Clinical Psychology, University of Amsterdam, The Netherlands
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Correspondence: J. H. Kamphuis, University of Amsterdam Clinical Psychology, Roetersstraat 15, 1018 WB Amsterdam, The Netherlands. Tel: 020-5256785; fax: 020-6391369; e-mail: kp.kamphuis{at}macmail.psy.uva.nl
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ABSTRACT |
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Aims To review demographic and clinical characteristics of stalkers as well as the psychological consequences for victims of stalking.
Method A Medline and PsycLit search was conducted on stalking, forensic psychiatry, personality disorders, de Clérambault syndrome and erotomania, with respect to the relevance of the articles selected for stalking.
Results Stalkers are best thought of as a heterogeneous group whose behaviour can be motivated by different forms of psychopathology, including psychosis and severe personality disorders.
Conclusions There is a clear need to arrive at a consensus on a typology of stalkers and associated diagnostic criteria. The effectiveness of psychological and pharmacological treatments have not yet been investigated. Treatment may need to be supplemented with external incentives provided by the legal system.
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INTRODUCTION |
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Forensic psychiatry has given scant attention to the phenomenon of stalking. Few studies have investigated the psychological make-up of stalkers, and to date only one study (Pathé & Mullen, 1997) has reported on the psychological impact of stalking on its victims. There are no reports of the development of any specific treatment programmes, either for stalkers or for their victims. This article aims to give an overview of stalking and its clinical ramifications.
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CURRENT DEFINITION |
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As often found with recently developed behavioural concepts, there is no consensus about the exact definition of stalking. Most of the disagreement seems to centre on the degree of emphasis placed on the extent to which the stalking evokes a subjective sense of threat. Generally, the various definitions have the following elements in common: (a) a pattern of intrusive behaviour, akin to harassment; (b) an implicit or explicit threat that emanates from the behavioural pattern; and (c) as a result, the target experiences considerable real fear (Meloy, 1998). In this article we use Meloy and Gothard's definition: "Stalking is typically defined as the wilful, malicious, and repeated following or harassing of another person that threatens his or her safety" (Meloy & Gothard, 1995, p. 258).
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NATURE AND PREVALENCE OF STALKING |
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In some cases, the violence may escalate until the stalker actually murders the victim and/or his/her children. In the United States, it is estimated that between 21% and 25% of forensic stalking cases culminate in significant violence (Harmon et al, 1995; Meloy & Gothard, 1995). The incidence of murder or manslaughter in stalking cases in the United States is estimated at 2% (Meloy, 1996). Fritz (1995) showed that 90% of women killed by their exhusband had previously been stalked. These numbers should probably not be extrapolated unreservedly to the European situation: for one reason, because of differences in the availability and possession of firearms.
Obtaining reliable data regarding the prevalence and incidence of stalking is a formidable international problem. Inconsistent definition and demarcation of the concept is partly responsible for this state of affairs. In some European countries stalking by itself is not considered a distinct legal offence which compounds the problem of monitoring and tracking cases for both police and forensic researchers. As a result, estimates of prevalence and incidence are based on very few, predominantly American studies. The US National Violence Against Women Survey contacted 8000 women and 8000 men by telephone, and asked them about stalking experiences (Tjaden & Thoenness, 1997): 8% of the women and 2% of the men had been stalked at some point in their life. This research also illustrates that criminal stalking cases merely reflect the tip of the iceberg: only 50% of stalking cases were reported to the police, of which 25% led to an arrest, and only 12% resulted in criminal prosecution.
Some research has focused on the prevalence of stalking within specific groups. Among 178 randomly sampled American university counselling centre professionals, one in every 18 therapists reported having been harassed or stalked by a previous or current patient (Romans et al, 1996).
In sum, there is a great international need for systematic monitoring of stalking cases, based on some consensual definition, to arrive at reliable estimates of the magnitude of the problem.
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THE STALKER |
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Typology of stalkers
Several authors have proposed stalker typologies
(Zona et al, 1993;
Harmon et al, 1995;
Wright et al, 1996;
Mullen et al, 1999)
based on purported psychological characteristics of the stalker and/or the
relationship between the stalker and the victim. Most authors agree on the
importance of the distinction between stalking in the context of (some sort
of) prior relationship and stalking where there has not been a real
relationship at all; but they differ in the details of subdivision.
Zona et al (1993) distinguished the following stalkers: (a) the classic erotomanic stalker, who is usually a woman with the delusional belief that an older man of higher social class or social esteem is in love with her; (b) the love-obsessional stalker, who is typically a psychotic stalker targeting famous people or total strangers; and, most common, (c) the simple obsessional stalker, who stalks after a real relationship has gone sour, leaving him with intense resentment following perceived abuse or rejection. Wright et al (1996) present a slightly different classification. They distinguish the domestic stalker and the nondomestic stalker: the former is comparable to Zona et al's simple obsessional stalker, whereas the non-domestic stalker comes in two types: the organised stalker and the delusional stalker. The delusional stalker corresponds with Zona et al's erotomanic stalker and love obsessional stalker. The organised stalker targets previously unknown persons through anonymous communication. The victims usually have no knowledge of the identity of the stalker. Finally, Mullen et al (1999) distinguish five types of stalkers: (a) the rejected stalker, who has had a relationship with the victim and who is often characterised by a mixture of revenge and desire for reconciliation; (b) the stalker seeking intimacy, which includes individuals with erotomanic delusions; (c) the incompetent stalker usually intellectually limited and socially incompetent individuals; (d) the resentful stalker, who stalks to frighten and distress the victim; and finally (e) the predatory stalker, who is preparing a sexual attack. In addition to these categories, there are reports on the so-called false victimisation syndrome, during which the victim pretends to have been stalked, by pursuing herself, in order to gain attention (Pathé et al, 1999).
There is a clear need to derive a consensus on a typology of stalkers, with associated diagnostic criteria. At present, there is no evidence that one proposed typology is superior to another. The typology eventually agreed upon should have clear implications for treatment.
Personality of stalkers
To date, no systematic research has investigated the motivations and
personality of stalkers. Reconciliation and reunion on the one hand
v. revenge and intimidation on the other, are frequently mentioned as
motivating stalkers. Tjaden & Thoenness
(1997) found that stalkers'
most common motivation was the desire to maintain control over their victims.
Again, it deserves mention that most of these findings are based on stalking
cases associated with romantic relations gone sour. Reflections
on the personality and intrapsychic functioning of stalkers are predominantly
psychodynamic in nature, and are focused on the simple obsessional subgroup.
The central feature in these theories is an intense narcissistic reaction to
rejection and loss, in combination with borderline defence mechanisms such as
splitting, initial idealisation, subsequent devaluation, projection and
projective identification. The stalker is thought to defend him/herself
against intense feelings of humiliation, shame and sadness by narcissistic
rage, during which he/she starts devaluing and torturing the love object to
maintain the narcissistic linking fantasy
(Meloy, 1996).
A related perspective is to describe the stalker's dynamics from the point of view of pathological mourning: stalkers cannot adequately process the traumatic object loss, and as a result cannot move on to build new connections, and thus they remain stuck. Several authors have proposed that attachment pathology underlies the disturbed behaviour. Most notably, Meloy (1998) has formulated a tentative model which assigns to attachment pathology the pivotal role in developing stalking behaviours. Some evidence consistent with this line of theorising comes from inspection of stalkers' childhood histories and life-events which immediately preceded stalking. For example, Kienlen (1998) found that a large proportion of stalkers had experienced significant discontinuity in their childhood (e.g. loss of a carer) and that many incidences of stalking immediately follow object loss.
Despite considerable effort (e.g. Dietz et al, 1991a,b; Meloy, 1997; Mullen et al, 1999), the current body of evidence is insufficient for the accurate prediction of stalking cases and of subsequent violent behaviour (including murder). Some stable risk factors have been identified: a history of (domestic) violence, psychiatric history, antisocial personality disorder and a criminal record. An expert witness testimony predicting violence is not to be recommended, given the current shortage of research data. This statement signals no more than one of the most urgent and difficult problems in forensic psychiatry: how to predict dangerousness.
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THE STALKER'S VICTIM |
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It is not hard to imagine that months or years of exposure to persecution and threats can lead to serious psychological consequences. In particular, it is the constancy of threat into the private domain that causes the greatest distress to victims of stalking. The protracted and intense sense of intrusion and violation, by definition without an escape haven, is what seems to set stalking distress apart from other more or less traumatic types of stress. However, there is a remarkable lack of solid data on victim psychomorbidity following stalking. In their sample of stalking victims, Pathé & Mullen (1997) found predominantly depression, anxiety and traumatic psychomorbidity. On the basis of self-reports, 37% of the respondents qualified for a diagnosis of post-traumatic stress disorder (PTSD). This percentage is much the same as the proportion of PTSD cases in victims of domestic violence, which varies from 40% to 60% between different studies (Holtzworth-Munroe et al, 1998). Hall (1998) found that victims of stalking perceived personality changes in themselves as a result of the ordeal they had suffered. Increases in caution, suspiciousness, anxiety and aggression were noted most frequently.
Victims of stalking also reacted by making significant changes in their social and professional life (Pathé & Mullen, 1997). Nearly all victims adjusted their daily routines (routes, habits), and a majority took additional safety precautions such as getting a secret telephone number, house alarm, etc. Four out of ten stalking victims changed their job or moved away in order to escape the stalking terror. About half reported a partial or total loss of productivity (work or study) and decreased social activity. The perceived lack of safety also led many to carry weapons, including firearms.
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DIAGNOSTIC ASSESSMENT |
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TREATMENT OF STALKERS |
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A primary problem in treating stalkers is to motivate them for therapy. By the very nature of the problem, stalkers are unlikely to report themselves for psychiatric or psychological treatment. In sum, there is a clear need for controlled studies into the effectiveness of psychotherapy and drug therapy for stalkers.
Primary prevention should receive more attention in one particular subset of stalking cases. As discussed, a large proportion of stalking cases follows from histories of domestic violence (Kurt, 1995). Earlier intervention in domestic violence and family counselling can promote a more satisfactory end to relationships and thus prevent subsequent resentment spilling over in stalking.
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Clinical Implications and Limitations |
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LIMITATIONS
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REFERENCES |
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Dietz, P. E., Matthews, D. B., Van Duyne, C., et al (1991a) Threatening or otherwise inappropriate letters to Hollywood celebrities. Journal of Forensic Sciences, 36, 185-209.
Dietz, P. E., Matthews, D. B., Martell, D., et al (1991b) Threatening or otherwise inappropriate letters to members of the United States Congress. Journal of Forensic Sciences, 36, 1445-1468.[Medline]
Fritz, J. P. (1995) A proposal for mental health provisions in state anti-stalking laws. Journal of Psychiatry & Law, 23, 295-318.
Hall, D. M. (1998) The victims of stalking. In The Psychology of Stalking: Clinical and Forensic Perspectives (ed. J. R. Meloy), pp. 113-137. San Diego, CA: Academic Press.
Harmon, R., Rosner, R. & Owens, H. (1995) Obsessional harassment and erotomania in a criminal court population. Journal of Forensic Sciences, 40, 188-196.[Medline]
Holtzworth-Munroe, A., Smutzler, N., Jouriles, E. N., et al (1998) Victims of domestic violence. In Comprehensive Clinical Psychology, Volume 9 (eds A. S. Bellack & M. Hersen), pp. 325-339. Oxford: Pergamon.
Kienlen, K. K. (1998) Developmental and social antecedents of stalking. In The Psychology of Stalking: Clinical and Forensic Perspectives (ed. J. R. Meloy). San Diego, CA: Academic Press.
Kurt, J. L. (1995) Stalking as a variant of domestic violence. Bulletin of the American Academy of Psychiatry and the Law, 23, 219-230.[Medline]
Meloy, J. R. (1996) Stalking (obsessional following): A review of some preliminary studies. Aggression and Violent Behaviour, 1, 147-162.[CrossRef]
Meloy, J. R. (1997) The clinical risk management of stalking: "someone is watching over me...". American Journal of Psychotherapy, 51, 174-184.[Medline]
Meloy, J. R. (1998) The Psychology of Stalking: Clinical and Forensic Perspectives. San Diego, CA: Academic Press.
Meloy, J. R. & Gothard, S. (1995) Demographic and clinical comparison of obsessional followers and offenders with mental disorders. American Journal of Psychiatry, 152, 258-263.[Abstract]
Mullen, P. E. & Pathé, M. (1994) The pathological extensions of love. British Journal of Psychiatry, 165, 614-623.[Abstract]
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Pathé, M. & Mullen, P. E. (1997) The impact of stalkers on their victims. British Journal of Psychiatry, 170, 12-17.[Abstract]
Pathé, M., Mullen, P. E. & Purcell, R. (1999) Stalking: false claims of victimisation. British Journal of Psychiatry, 174, 170-172.[Abstract]
Romans, J. S. C., Hays, M. J. R. & White, T. K. (1996) Stalking and related behaviours experienced by counseling center staff members from current or former clients. Professional Psychology: Research and Practice, 27, 595-599.[CrossRef]
Tjaden, P. & Thoenness, N. (1997) Stalking in America: Findings from the National Violence against Women Survey. Denver, CO: Center for Policy Research.
Walker, L. E. & Meloy, J. R. (1998) Stalking and domestic violence. In The Psychology of Stalking: Clinical and Forensic Perspectives (ed. J. R. Meloy), pp. 139-161. San Diego, CA: Academic Press.
Wilson, M. & Daly, M. (1993) Spousal homicide risk and estrangement. Violence and Victims, 8, 3-16.[Medline]
Wright, J. A. Burgess, A. G., Burgess, A. W., et al (1996) A typology of stalking. Journal of Interpersonal Violence, 11, 487-502.
Zona, M. A., Sharma, K. K. & Lane, J. C. (1993) A comparative study of erotomanic and obsessional subjects in a forensic sample. Journal of Forensic Sciences, 38, 894-903.[Medline]
Received for publication July 22, 1999. Revision received September 30, 1999. Accepted for publication October 1, 1999.