Stalking: why do people do it?BMJ 2000; 320 doi: http://dx.doi.org/10.1136/bmj.320.7248.1486 (Published 03 June 2000) Cite this as: BMJ 2000;320:1486
The behaviour is newsworthy but complex
- Rajesh Nadkarni, specialist registrar,
- Don Grubin, professor
In June 1997 the Protection from Harassment Act was passed in England and Wales. Commonly referred to as “anti-stalking” legislation, this act allows a person convicted of “pursuing a course of conduct amounting to the harassment of another” to be fined or imprisoned and made subject to a restraining order. When the act was passed it was expected that about 200 cases would arise from it annually. According to the Suzy Lamplugh Trust, however, 1180 people were brought to court under the act in the first six months of 1998,of whom 1013 were convicted.
Although associated with stalking, the harassment act encompasses a wide range of behaviours, not all of which are stalking. Most definitions of stalking include the repeated targeting of a specific victim with harassment or following,1 but the border between legitimate courtship and stalking can be blurred. Generally, to be defined as stalking the behaviour must be unwanted and intrusive.2 We would argue that the stalker must also have an intense preoccupation with the victim.
The range of behaviour involved in stalking can be broadly grouped in three categories. Firstly, there is following, which includes frequenting workplaces and homes, maintaining surveillance, and engineering “coincidences.” Secondly, there is communicating—by phone, letters, cards, graffiti, gifts, and, increasingly, electronic mail and the internet (“cyberstalking”). Often the stalker will order goods and services on the victim's behalf. Finally comes aggression or violence, in which stalkers threaten their victims, harass their families, damage their property, make false accusations about them, and cause sexual or physical injury.
Media coverage of stalking tends to focus on celebrity victims stalked by a “crazed” fan—such as Robert Hoskins, who stalked Madonna and was eventually confronted and shot by her bodyguard.3 Hoskins' preoccupation continued even after his imprisonment, demonstrated by the graffiti “I love Madonna” and “the Madonna stalker” on his cell walls. Such cases, however, are in the minority, with most victims being ordinary citizens.
Most stalkers are men and most victims women. Both tend to be older than criminals and crime victims generally.4 Stalkers are often unemployed or underemployed at the time of the stalking and better educated than other criminals. Motivations underlying the stalking behaviour range from reasserting power over a rejecting partner to the quest for a loving relationship.5
Classifications of stalking behaviour have tended to concentrate on the stalker-victim relationship. Perhaps the most frequently referred to is that of Zona et al, which is based on their study of 74 cases handled by the Los Angeles police.6 They classify stalkers into a simple obsessional group, where the stalker and victim had a prior relationship; a love obsessional group, where there was no prior relationship; and an erotomanic group, where the stalker developed a delusion that the victim was in love with him or her. The simple obsessional group is most common and reported to be the most likely to resort to violence.7 8 Celebrity stalkers are usually found in the love obsessional group, a high proportion of whom suffer from psychotic illnesses. Those in the erotomanic group are usually women, with their victims being older men of higher socioeconomic status.
Although this classification is useful, it has its limitations. In particular, it largely ignores the offender's motivation. It is also not clear how reliably the last two groups can be distinguished, how well the typology differentiates between persistent courtship and stalking, and whether it has any predictive validity.
We believe stalking is best understood through a multi-dimensional model involving the relationship of the stalker to the victim, the motivation of the stalker, and the severity of the stalking behaviour. Such an approach provides a basis for risk assessment.
The successful management of stalking requires cooperation between health professionals and others in the criminal justice system. It should include a comprehensive risk assessment addressing motivation, persistence, and likelihood of violence. Some individuals will cease the behaviour after a period of detention or if threatened with arrest. Factors which may increase risk, such as substance misuse, can be addressed in their own right, while neuroleptic medication may have a role if psychotic symptoms are evident, and low dose neuroleptics can be effective even in the absence of psychosis.9 Similarly, intrusive thoughts about the victim may improve after treatment with selective serotonin reuptake inhibitors. Mental health professionals can therefore usefully support others involved in risk management.
Victims of stalkers may consult general practitioners. Doctors need to be aware of the psychological sequelae of being stalked and the legal protections available for victims and be able to direct them to local support groups. Organisations such as the Suzy Lamplugh Trust can provide useful information to professionals as well as victims.
The effects of stalkers on their victims are immense and can result in significant psychiatric morbidity.10 Only recently, however, has the behaviour become the subject of scientific study, and research remains in its infancy. We know little about who is most vulnerable to becoming a stalker, and more needs to be known about treatment and risk management. Stalking provides good material for literature and films, but the effects in real life can be very damaging.