by Sara G. West, MD, and Susan Hatters Friedman, MD
stalker, female, criminal behavior, mental health professional
An Introduction to Stalking
Stalking has likely existed since the dawn of mankind, but it is only in the past several decades that the subject has appeared regularly in the psychiatric literature. It was not until 1989, when the actress Rebecca Schaeffer was murdered by a stalker, that the movement to create antistalking laws was initiated. However, it is important to recognize that “stalking is not only a crime for celebrities.”
According to Meloy, stalking is “the willful, malicious, and repeated following or harassing of another person that threatens his or her safety.” Though state laws differ somewhat, this behavior is illegal in all 50 states. Large community surveys indicate that the lifetime risk for becoming the victim of stalking for a man is two percent and for a woman is eight percent.[6,7]
In 1999, Mullen, et al., published a landmark study based on a population of 145 stalkers referred to a forensic psychiatric clinic. The sample consisted of 115 men and 30 women. Researchers examined the duration and methods associated with the stalking, the occurrence of threats and violence, the relationship of the stalker to the victims, and the 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. 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.” 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 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.
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. The stalker was frequently under the direct care of the victim, and the motive was often a desire for greater intimacy.
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. 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). 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.
In order to discourage potential stalkers, clinicians should carefully protect their private information (e.g., home address, cell phone numbers). If stalking is suspected, consultation with forensic specialists, the police, or lawyers may be necessary. It may also be necessary to alert one’s own family to the threat, given that their safety may be in jeopardy. A restraining order may be another alternative, though they are not always effective.
The Research on Female Stalkers
International survey study. Meloy and Boyd collected data on 82 adult women who had engaged in stalking behavior via a survey sent to mental health and law enforcement professionals in the United States, Canada, and Australia. Though this study has some limitations, including a dependence on the observations of a variety of clinicians who were not using a standardized instrument to evaluate the female subjects, it assesses one of the large groups of female stalkers found in the literature.
Typically, the perpetrators were Caucasian, heterosexual, single women with a mean age of 35 (ranging from 18–58 years old). Often, these women did not have children. They appeared to be educated, with a large majority having graduated from high school and a solid minority having achieved a college or graduate degree. Their intelligence may have allowed them to be more successful in pursuing their victims.
Reports of substance abuse were not common, but about one-third of women used substances while stalking. Available data suggested the presence of Axis I and II disorders. Twenty percent of those with Axis I disorders were diagnosed with delusional disorder. The most common Axis II diagnosis was borderline personality disorder (n=10 of 22). Antisocial personality disorder was not diagnosed in any of the women. Despite incomplete data, there appeared to be a high rate of sexual (n=18 of 40) and physical (n=12 of 40) abuse in the personal histories of the female stalkers, which may have predisposed these women to the development of borderline personality characteristics or posttraumatic stress disorder.
A great majority of the victims of female stalkers were known to them, either as acquaintances, former lovers, or family members. However, one-fifth of the victims were completely unknown to their stalkers. Frequent reasons for stalking included anger, obsession, feelings of abandonment, loneliness, and dependency. Usual stalking behaviors included telephone calls and messages, giving letters and gifts, driving by the victim’s location, trespassing, and following the victim. More than half of the women threatened their victims, and a quarter were physically violent, with three victims losing their lives to their stalkers. Most episodes of violence, however, did not involve the use of a weapon and did not result in injuries. Violence was more likely if the stalker and the victim had been previously sexually intimate. In more than half of the cases, the behavior increased in frequency and intensity. The victims were usually Caucasian, heterosexual males with a mean age of 41 (ranging from 16–68 years). Female victims were targeted one third of the time. The perpetrators pursued their victims for an average of 22 months.
Australian forensic clinic study. In 2001, Purcell, et al., published a study that compared female stalkers (n=40) to their male counterparts (n=150). The data was collected based on referrals to a community forensic mental health clinic that specializes in the assessment of stalkers. One of the limitations of this study is that it involved a retrospective analysis of data collected from evaluations performed over a period of eight years.
Similar to the men, the women, on average, were 35 years old, single, and employed. Women were less likely to have a history of criminal behavior. Almost half of the women (n=18 of 40) had an Axis I diagnosis, most commonly (10 of 18) delusional disorder. Half (n=20 of 40) were diagnosed with an Axis II disorder, including borderline, dependent, and narcissistic personality disorders. The diagnostic profiles of these women did not differ from their male counterparts, except women had lower rates of substance use.
With only two exceptions, female stalkers knew their victims. Forty percent of the victims were professional contacts, frequently mental health professionals. Men were comparatively more likely to pursue strangers. Same gender stalking was more frequent among women than men. Based on Mullen’s typology, women’s primary motive for stalking behavior in almost half of the cases was to seek intimacy. In the female group, there were no cases of sexually motivated predatory stalking, which differed from the male stalkers. Women and men appeared to stalk their victims for a similar duration of time. Women were more likely to harass their victims via telephone call but less likely to physically pursue them when compared to men. Strikingly, women had the same propensity to make threats and become violent, including property damage and assault, as the male stalkers.
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. 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 self-harm. 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., 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 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., 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.
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. 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, Reisner 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 primary care provider. She called this doctor’s medical practice numerous times, day and night. She loitered in the office building that housed the practice. She made false allegations about a sexual assault involving her physician, and she threatened to kill her physician. Ultimately, both police and the medical board assisted in establishing firm boundaries to prevent the continuation of this behavior.
See Table 4 for characteristics of female stalkers.
Female Celebrity Stalkers and Hollywood
In 1949, Eddie Waitkus, a 29-year-old first baseman for the Philadelphia Phillies, was lured to a hotel room and shot by Ruth Ann Steinhagen, a fan who had been obsessed with him for a number of years. Public personas, such as athletes, actors, and television personalities, are a common target for stalkers. This may be because “the mentally ill will develop delusions about whatever is in their environment, and television became an important part of the environment, bringing new people and new faces into their lives.” Female stalkers are no exception to this. David Letterman, long-time host of late night television, was plagued by the stalking behavior of Margaret Ray, a mentally ill woman who ultimately committed suicide in 1998. Brad Pitt and John Cusack have also been prey to female stalkers. According to Mullen, et al., most celebrity stalkers resemble the rejected or intimacy seeking stalker.
Hollywood has capitalized on the phenomenon of female stalkers. Fatal Attraction, a 1987 film, concerns a man who has a one-night stand with a woman who stalks him and terrorizes his family. Misery, a novel by Stephen King that was later made into a film, tells the story of an obsessive female fan of an author who abducts him after his car crashes and then tortures him under the guise of caring for him. Single White Female, a 1992 film, describes a woman who becomes obsessed with her roommate to the point where she assumes her identity. In Wicker Park, a 2004 film, the male protagonist may have been stalked by a woman (but we don’t want to give away the ending).
Women who stalk may make headlines as celebrity stalkers or as the subject of Hollywood films. However, these behaviors are not simply limited to the popular press. In general, female stalkers tend to be single and in their mid-30s and may carry diagnoses on both Axis I and Axis II. A common Axis I diagnosis is delusional disorder, which requires a belief that the object of the woman’s affection reciprocates her feelings of love. Borderline personality disorder is a frequently mentioned diagnosis on Axis II.
Female stalkers tend to target people that they know, and they are capable of threatening their victims and even becoming violent. We must be cautious not to underestimate women’s potential for violence secondary to a gender bias. Though there are a variety of motives for their behavior, women do not often engage in sexually predatory behavior. Finally, mental health professionals should be aware of the possibility of female stalkers in both their clinical practice and their personal life, as stalkers may target their care providers.
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Dr. West is from the Department of Psychiatry, University Hospitals/ Case Western Reserve University School of Medicine in Cleveland, Ohio; Dr. Friedman is from the Department of Psychiatry, University Hospitals/ Case Western Reserve University School of Medicine in Cleveland, Ohio, and from Forensic Psychiatry, Northcoast Behavioral Healthcare in Northfield, Ohio.