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Stalking remains a neglected area in forensic research. PubMed lists only about 1,500 articles on stalking in the past 25 years — just over 1% of what appears for violence in the same period.
Dr. John Bradford highlighted the scant research during his February 6 presentation as part of the International Forensic Psychiatry Lecture Series. (You can watch a recording of the lecture online.)
He also shared examples of his experience of being stalked. Research from 2013 showed that 15% of physicians in the Greater Toronto Area and 11% of psychiatrists in the United Kingdom were stalked.
Introduction to Stalking
Stalking involves repeated, unwanted contact by one person that causes fear for the victim’s or a loved one’s safety. It can include watching the victim’s home or workplace, following them, contacting them (for example, by phone, text, or social media), threatening the victim or their family, damaging their property, and hurting their pets.
One research study found that most stalking is short-lived (one month or shorter), frequent, rejection-based, and involves close physical proximity to the victim. However, in 2006, Mohandie et al. found stalking lasted an average of 16 months.
Characteristics of People Who Stalk
Research from 2000 showed stalkers tend to be seeking intimacy. However, they are rejected because they are unsuitable partners and become resentful and predatory.
There are five types of stalkers:
- Someone who never met the victim but sees them as a soulmate,
- Someone with erotomania (a rare and difficult-to-treat delusional disorder) who believes the victim is in love with them,
- Someone with manic psychosis,
- An ex-partner (especially if there was intimate partner violence), and
- Someone who is a predator.
Research from 2006 created a relationship- and context-based typology (RECON) that classifies stalking as either intimate and acquaintance or public and private figures. The behaviourally based tool is helpful in medical and legal settings. It makes no assumptions of a mental disorder nor dynamic factors that may change the course of stalking.
The research found that most stalkers did not have a current intimate partner, were unemployed or underemployed, had high rates of mental disorders (particularly substance use disorder), and had high rates of suicide. About a third had stalked before, and about 15% were female.
Victims of Stalking
Stalking causes extreme distress, especially when victims feel their concerns are minimized. Many victims significantly change their lifestyles, avoid going out, and suffer relationship damage. There can be physical and psychological damage and even death.
About 85% of stalking victims are women who are often unsure about how to deal with the person stalking them. Some act nice, hoping it will stop, others minimize the risk in their minds that the person is harmless, while some confront the person. Unfortunately, none of these strategies work and can have the opposite effect, encouraging the stalker.
Men who are stalked may underestimate their risk. They are often not taken as seriously as women who are stalked, and the justice system may be reluctant to act.
Health professionals should be mindful that victims may have difficulty expressing their stalking situation in an organized way, especially if their previous concerns were devalued.
In the psychotherapy setting, more women than men stalk their doctors, and women are more likely than men to suffer from erotomania.
Dr. Bradford shared her personal experience of patients stalking him during his career.
Risk Assessment for Stalking
The risk of harm increases when there is:
- A detailed threat;
- Technical expertise;
- Access to weapons;
- A history of crime;
- A history of violence to others;
- A history of jealousy or violence toward the victim;
- Victim vulnerability;
- A history of substance use or mental health issues; and
- A lack of concern about going to jail, dying or any consequences.
Dr. Bradford said a disregard for consequences “is a very, very significant red flag. It sounds as though it’s common sense, but it’s sometimes ignored.”
Research from 2012 found other red flag indicators include suicidality, homicidality, last-resort thinking, high-risk psychotic phenomena, and psychopathy.
Dr. Bradford suggested people attending the lecture look for changes, increases in stalking behaviour, identification with warriors or assassins, and any signs of acceleration or warning, especially last-resort thinking.
Research from 2006 showed that the degree of prior intimacy is a key factor in determining risk. That research found that half the cases studied were intimate, with about a quarter including assault or vandalism. It clearly showed that people with psychosis were less violent than people without.
Research from 1994 with 14 patients with erotomania found that while the victim may be at risk for violence, the victim’s partner was at higher risk. While threats were common, assaults and fatalities were not.
Research from 1995 found that multiple delusional objects and serious antisocial behaviour together could predict dangerousness with 90% accuracy.
Written by Virginia St-Denis and approved by Dr. John Bradford.
