The annual Manfred S. Guttmacher Award Lecture was co-sponsored by the American Academy of Psychiatry and the Law and the American Psychiatric Association on Sunday May 6, 2000. Paul E. Mullen MBBS gave the lecture, with associates Michele Path‚ MBBS and Rosemary Purcell BSc. The group is from the Victorian Institute for Mental Health, of Monash University, in Melbourne, Australia.
The purpose of the discussion was to address the relevant parameters concerning stalking activity. The term stalking was defined as a constellation of behaviors involving repetitive and persistent attempts to impose on another person unwanted contacts or communications which induce fear and/or distress. Those contacts could include acts such as intrusive approaches, following the person, surveillance or loitering in a nearby location. The communications could include excessive calls, letters, faxes, or written notes.
The term stalking has been constructed essentially by bringing together several previously existing patterns of behavior. Some were part of widely defined deviant behaviors such as harassment and domestic violence. Others were considered a component of a continuum of increasingly problematic actions. Those could include being an obsessive fan, asserting the permanence of marriage, or just pressing a relationship too far. Perhaps, it was argued that our society has developed a preoccupation via our art and media with the concept of the obsessive intruder. There certainly may be a perceived failure in our society to protect mainly women who are being pursued by insistent males, or even stars of any gender by their fans. Finally, Dr. Mullen indicated that we must consider the possibility that there may actually be a real increase in this behavior.
Next, Dr. Mullen discussed an epidemiological study conducted by their group. In a random postal survey of 1844 persons selected from a standard voting list, participants were asked about their personal experiences with harassing intrusions into their lives and about their current mental health. The response rate was given at 74%. Slightly more than half (55%) of respondents reported episodes of stalking that had lasted longer than two weeks. Of the shorter duration episodes, 75% were by strangers. Of the longer episodes, there was about a 20-25% occurrence among four different groups. Those included strangers, work contacts, prior intimates, and casual acquaintances.
Subsequently, Dr. Mullen discussed a clinical study of victims that he and Michele Path‚ published in 1997. In that study there were one hundred participants, 83% of whom were female. A review of the impact of the stalking revealed that 94% had experienced major life changes, 70% noted decreased social activity, 53% had changed their respective employment, and 39% moved their home. The emotional response to the stalking behavior was also assessed. Of those questioned, 83% noted increased anxiety, 25% increased alcohol and tobacco use, and 24% acknowledged suicidal thoughts.
Dr. Mullen and his group have worked extensively on managing victims of stalking related behaviors as well. He identified a variety of effective practical intervention strategies such as informing others and including the police. Documenting the behavior, learning key telephone strategies, improving one's security, and obtaining a restraining order were considered helpful. From a treatment standpoint, several modalities were addressed. Those treatments included education and counseling, cognitive behavioral therapy (to treat anxiety and avoidance), medications, and group therapy.
Dr. Mullen delineated a study of stalkers that he published with his group in 1999. They identified a group of 145 stalkers referred to their forensic clinic. In this study group, 80% were male, 40% were unemployed, 80% did not have a current relationship, and, surprisingly, 8% held a managerial or professional position. Specific threats were made to victims 54% of the time, and to third party individuals in 39% of cases. Of those who threatened to assault, 43 % actually proceeded to do so, while 73% of all who assaulted had previously threatened.
Further, the data showed that those most likely to threaten were the resentful stalkers (87%) and the rejected stalkers (71%). In addition, threats were strongly predicted by a combination of typology, prior convictions, and a history of substance abuse. Further, when the group assessed both physical and sexual assaults, they found even more interesting differences. For example, the non-psychotic stalkers had a higher rate of assault at 43% than the psychotic stalkers at 26%. Moreover, 27% of all attacks by this group were sexual in nature. Types of stalkers were also evaluated in this cohort. The groups were sectioned into 36% rejected type, 34% intimacy seekers, 15% incompetent suitors, 11% resentful and 4% predatory in nature.
Finally, management of stalkers was discussed. First, the treating clinician was advised to manage the contributory mental disorder. These disorders can include psychotic illnesses, personality disorders, substance abuse, and obsession related disorders. Secondly, one should confront the self-deceptions that serve to deny, minimize, or justify the aberrant behavior. Thirdly, instilling a modicum of victim empathy was recommended.
In addition, addressing the rudimentary social skills of the stalker, while focusing on the acts that initiate and sustain the behavior was encouraged. Specifically, management of the rejected stalker would include teaching the individual to weigh the costs versus benefits of continued engagement. For management of the intimacy seeker, focusing on the mental disorder was seen as most beneficial. In management of the incompetent suitor, one would be advised to simply tell them to stop. Next, in management of the resentful stalker, the provider was encouraged to recognize the legitimacy of their basic grievance. Finally, to treat the predatory group, it was recommended that they be managed primarily as sexual offenders.
In conclusion, stalkers mainly come from lonely, isolated backgrounds. However, they can include persons from all walks of life. Practically, the average individual, if stalked, is most likely to be stalked by an ex-partner. Importantly, those persons whose professions bring them in contact with lonely and unstable individuals, particularly in the role of helper and sympathizer, are at highest risk of being stalked. This group is greater than those with prior convictions for violent offenses, substance abuse, or those who threaten. Likewise, the risk of progression to violence is lower among intimacy seekers and those with psychosis. It was opined that the cessation of stalking behavior requires an appropriate mixture of clinical treatment interventions and judicial sanctions.