Psychiatry - August 2008 - (Page 40)

Battered women who stalk. A study focusing on stalking and unwanted pursuit behavior perpetrated by 55 women residing in a battered women’s shelter was published in 2006.21 A limitation of this study, as described by the authors, involved an inability to ask the subjects, due to the concerns of the shelter employees, about their motivations for perpetrating the stalking behavior. The women, on average, were in their early 30s, were unemployed, and had children. The specific acts perpetrated by this group of women included begging the abuser not to leave, seeking information from others about the abuser, giving the abuser unwanted gifts, visiting the abuser unexpectedly, following the abuser, making a threat toward the abuser, or threatening suicide or selfharm. It was noted that, if these women had themselves previously been a victim of these behaviors, they were more likely to become a perpetrator of similar behavior. These women were more likely to form insecure attachments, suffer from depression, blame themselves for the abuse, and leave the shelter quickly compared to other women in the shelter who did not participate in stalking or unwanted pursuit behavior. LAPD study. In an effort to determine the degree of intimacy in the stalker-victim relationship, Palarea, et al.,22 compared 135 intimate and 88 nonintimate stalkers investigated by the Los Angeles Police Department’s Threat Management Unit. Women accounted for 22 percent of the sample. Unfortunately, despite a large amount of data collected on this group, not much of it was analyzed specifically by gender. Intimate stalkers were married to, engaged to, cohabited with, dated, or had a casual sexual relationship with the victim. The authors determined that women were somewhat more likely to participate in nonintimate stalking (n=28 of 49 or 57.1%) when compared to intimate stalking. This differed from the men, who were 40 Psychiatry 2008 [ A U G U S T ] more likely to be suspects in the intimate stalking cases (n=114 of 174 or 65.5%). Case reports. There have been a number of interesting case reports published on female stalkers. The first case highlights a potential etiology for stalking behavior. Soliman, et al.,23 described a woman diagnosed with Huntington’s disease exhibiting escalating stalking behavior directed toward her female therapist. This was accompanied by amorous feelings toward and obsessive thoughts about this therapist. Her behaviors included frequent phone calls, unwanted gifts, threats, and physical assault. The stalking behavior in this patient may have been linked to caudate dysfunction caused by the Huntington’s disease. Basal ganglia lesions may have accounted for the obsessive thoughts and amorous feelings. Her thoughts and behavior resolved following treatment with a selective serotonin reuptake inhibitor (SSRI) and an antipsychotic. This case supports the theory that stalking behavior may be caused by an increase in subcortical dopaminergic function and a decrease in serotonergic activity.24 According to another case report, therapy addressing psychodynamic issues may be an effective treatment for stalkers. A 34-year-old woman requested to see a psychiatrist after disclosing to her primary care physician her long-standing history of stalking behavior.25 She had been following an older female colleague who held a superior position at her place of employment. The patient followed this woman to her home but denied any violent or sexual fantasies about her. The patient described she had a similar obsession concerning a female teacher from the ages of 12 to 16. Additionally, she had previously been terminated by a female therapist who was the target of similar thoughts and behaviors. The patient’s history revealed that she was adopted and had a twin whose personality was described as outgoing and exuberant and with whom she had little contact. She discovered the existence of her twin at age seven, at which point it was confirmed by her adoptive mother and never mentioned again. The patient chose not to contact her biological mother for fear that it would distress her adoptive mother. On examination, the patient did not fulfill DSM diagnostic criteria for obsessive compulsive disorder, a delusional disorder, or a personality disorder. Psychodynamically, it was postulated that she was looking for a maternal figure and role model in the women that she followed. After she agreed to cease this behavior, she was referred to a male therapist for ongoing psychotherapy around these issues. In 2006, Reisner26 published a case report on a female stalker with multiple psychiatric diagnoses, including Munchausen syndrome by proxy (MSBP) and borderline personality disorder. The patient lost custody of her two young children after it became evident that she harmed her older child in a manner consistent with MSBP. She later admitted to overdosing him on diphenylhydantoin and injecting him with soda or saliva. While she was being investigated for this behavior, she began stalking the child protective service worker who was assigned to her case. She allegedly harassed the case worker through the internet and threatened to kill her; for this, she was charged with aggravated menacing. She received intense psychiatric treatment and responded well to clozapine and, later, quetiapine. As indicated earlier, clinicians not only treat stalkers and their victims, but they may also find themselves the targets of stalking behavior. Another report described a female patient who presented to a family practice group complaining of depression and was prescribed a one-week supply of an antidepressant. She took the pills all at once and went to the emergency room, where a computed tomography (CT) scan revealed brain atrophy. She erroneously believed that this was caused by her

Table of Contents Feed for the Digital Edition of Psychiatry - August 2008

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

For optimal viewing of this digital publication, please enable JavaScript and then refresh the page. If you would like to try to load the digital publication without using Flash Player detection, please click here.