Psychiatry - August 2008 - (Page 38)

psychiatric status and criminal histories of the stalker. From their data, the authors derived the following typology for classifying stalkers, which aids in understanding the range of motivations for the behavior (Table 1): The rejected stalker. This was the largest group (n=52), and their behavior was brought about by the termination of a relationship, most commonly with a romantic partner, but also with estranged mothers, broken friendships, or strained work relationships. Often, these stalkers experienced ambivalent feelings about reconciliation and revenge regarding their targets. The majority suffered from personality disorders, although about one-fifth had delusional disorders. This group had the widest range of methods associated with stalking but was significantly associated with telephone harassment. The intimacy seeking stalker. This group was also large (n=49). Classification was based on the desire for intimacy with someone that the stalkers had identified as their true love. Half believed that their love was requited, qualifying for the Diagnositc and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV) diagnosis of delusional disorder, erotomanic type.9 The other half were termed to have morbid infatuations, in which they recognized that their love was not returned but “insist(ed), with delusional intensity, on both the legitimacy and the eventual success of their quest.”10 Along with the rejected stalkers, this group tended to be the most persistent over time. The incompetent stalker. These stalkers (n=22) lacked appropriate social skills and knowledge of courtship rituals but hoped that, regardless of these deficits, their behavior would lead to intimacy. These stalkers targeted people that they believed would be good romantic partners but were not infatuated with them to the same degree as the intimacy seekers. They too did not believe that their feelings were reciprocated, but rather that 38 Psychiatry 2008 [ A U G U S T ] they were entitled to a relationship. This group had often stalked other victims before. The resentful stalker. This category (n=16) included those stalkers whose behaviors were meant to distress and frighten their victims. Half acted on grievances against specific people, while the others were generally disgruntled and chose targets at random. In addition to the rejected group, these stalkers were most likely to threaten their victims. The predatory stalker. While most notorious, this was the smallest group (n=6) and contained only men. These stalkers acted in preparation for a sexual attack. They enjoyed the power inherent in their stalking behavior. They were predominantly diagnosed with paraphilias and were the most likely to have prior convictions for sexual offenses. TABLE 1. Mullen’s stalker typology8 The Rejected Stalker—stalking follows the end of a relationship The Intimacy Seeking Stalker— stalking based on a desire for intimacy The Incompetent Stalker—stalking with lack of social skills; stalker feels entitled to a relationship The Resentful Stalker—stalking meant to frighten victims The Predatory Stalker—stalking in preparation for a sexual attack TABLE 2. Common characteristics of stalkers who target mental health professionals Male Axis I and/ or Axis II diagnosis Prior history of stalking Often under the clinician’s direct care Motivated by a desire for greater intimacy RELEVANCE TO MENTAL HEALTH PROFESSIONALS In addition to being called upon to treat both stalkers and their victims, there is another important reason that mental health professionals should be familiar with the characteristics of stalking: mental health professionals may themselves become victims of stalkers. Research demonstrates that, in a variety of samples, 11 percent of mental health professionals have been the victims of stalking (a weighted mean with a range of 3–29%).11–15 Stalkers who targeted mental health professionals (Table 2) were typically male with a major mental disorder diagnosed on Axis I and a comorbid personality disorder on Axis II. They may also have had a prior history of stalking behavior.16 The stalker was frequently under the direct care of the victim, and the motive was often a desire for greater intimacy.11 Of all the mental health professionals, psychiatrists and psychologists were the most likely to be stalked; this may be related to a patient’s potential to misconstrue boundaries and assign an inappropriate amount of intimacy to his or her therapeutic relationship with the practitioner.11 Clinicians who are stalked must be wary not to minimize their patients’ behavior and to also recognize that the stalkers may pose a serious threat (Table 3).16 Certain prodromal behaviors, such as requests for personal information or chance meetings outside the office setting, should be noted. It is useful to systematically document this and other suspicious activities, such as gifts or unusual phone messages, in a separate file along with the dates and times at which they occurred.17,18 All of this information should also be reported in team meetings or supervision.11 In order to discourage potential stalkers, clinicians should carefully protect their private information (e.g., home address, cell phone numbers). If stalking is suspected,

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Psychiatry - August 2008 Editor’s Message Editorial Advisory Board Contents Borderline Personality Disorder: Are Proliferative Symptoms Characteristic? Short-acting versus Long-acting Medications for the Treatment of ADHD Baby Stimuli and the Parent Brain: Functional Neuroimaging of the Neural Substrates of Parent-Infant Attachment These Boots Are Made for Stalking: Characteristics of Female Stalkers Managing Attention Deficit Hyperactivity Disorder in the Emergency Department Obstructive Sleep Apnea, Hypoxia, and Metabolic Syndrome in Psychiatric and Nonpsychiatric Settings Improving the Quality of Life in Patients with Alzheimer’s Disease The Process of Getting New Drugs to Market Journal Watch Classified Advertising Information for Authors

Psychiatry - August 2008

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