Commentary: Stalking Risk Profile
http://www.100md.com
《美国精神病学与法律学报》
Dr. Schwartz-Watts, is Clinical Professor of Psychiatry and Director of Forensic Services, Department of Neuropsychiatry, University of South Carolina School of Medicine, Columbia, SC.
Abstract
Paul Mullen and his colleagues have developed a Stalking Risk Profile that is the latest model for assessing and managing stalkers. The model includes an assessment of the nature of the relationship between the stalker and his victim; the stalker's motivations; the general psychological, psychopathological, and social realities of the stalker; the circumstances of the victim, and the legal and mental health context. The model is not an actuarial scale, but rather an assessment to be used on a case-by-case basis. It recommends certain standardized tests as part of the assessment. The Stalker Risk Profile is the most thorough risk assessment to date. It includes victim variables and provides specifics for assessment and specifics for treatment of the stalker.
The first anti-stalking legislation appeared in the United States 16 years ago.1 Before anti-stalking legislation was enacted, little was known about stalkers. After the initial laws were passed, stalkers and their victims became a focus of research. A Medscape2 search conducted for this publication revealed 110 articles about stalkers.
To date, research has supplied consistent demographic data about stalkers. They are older than other offenders, are typically male, and are unmarried at the time of offending.3–5 Now that we are entering the second decade of research on stalking, various demographic data about subsets of stalkers are being compiled as they relate to predictors of violence.6
Research reveals stable victim characteristics. The typical stalking victim is female7 and a former intimate of the stalker.8,9 Epidemiological studies have been conducted7,10 and demonstrate that between 8 and 15 percent of women and 2 percent of men report having been stalked. Stalking remains underreported.10 Only one half to one third of stalking victims reported such crimes.7,11
Epidemiological studies have stimulated researchers to study nonforensic populations of stalkers. Concern has arisen among researchers that forensic stalkers differ from nonforensic stalkers. Attempts have been made to characterize these groups better by studying college students. Roberts12 compared the experiences of female students whose relationships ended with stalking, with harassment, and with no harassment. The study concluded that the longer the relationship, the more the risk of stalking.
Epidemiological studies have also been useful in delineating the natural course of stalking. Purcell et al.13 conducted an epidemiological study that examined the nature and prevalence of stalking in an Australian community. Of 1844 survey respondents, 23 percent met the legal criteria for stalking. In almost half of the cases, stalking abated within two weeks. After two weeks, stalking persisted for a median of six months. Strangers typically stalked their victims for less than two weeks. Someone known to the victim typically engaged in stalking that persisted more than two weeks. Harassment became more intrusive after two weeks. Threats, as well as assaults, were more likely to occur after a two-week period. Subjects harassed less than two weeks did not differ psychiatrically from a group of people who were never harassed.
Although his was not an epidemiological study, Rosenfeld14 found that 49 percent of stalkers recidivate, and 80 percent of those reoffend in the first year. Recidivism was associated with substance abuse and a personality disorder.
While demographic data and epidemiological studies are somewhat consistent, there has been no agreement concerning classification. Some classification systems are being incorporated into research models, although there is still no uniform classification model.
To date, there have been several classification systems. Some describe the nature of the attachment of the stalker to his victim, while others rely on characteristics of the stalker himself. As recently as January 2006, a new classification system was proposed.15
Presently, research is most focused on the relationship between stalking and violence. Studies correlate violence with the demographic variables of victims, stalkers, and the nature of the relationship between the stalkers and victims. The risk of lethal violence and stalking has been researched. A recent study by McFarlane et al.16 reported that 76 percent of femicide victims were stalked by their assailants in the 12 months prior to their murders.
Harmon et al.6 found that stalkers who were former intimates were violent, had an Axis II disorder, abused substances, and threatened their victims. Roberts17 studied 220 female undergraduates who were stalking victims. He found that violence was associated with a direct threat made during stalking, with the stalker's abuse of prescription drugs, or with the former partner's being jealous.
While violence and its association with stalking are vital, Purcell and her colleagues13 point out that most stalking does not result in violence. The area of stalking research that has received the least attention is risk assessment. Yet, forensic psychiatrists and psychologists routinely perform risk assessments of individuals charged with stalking.
A risk assessment has been proposed by James and Farnham18 for assessing stalkers for serious violence. They studied 85 stalkers in London and found that previous risk factors associated with violence did not apply to a subgroup of stalkers who were seriously violent. They did not find that substance abuse, the presence of a personality disorder, or a history of previous convictions for violence were associated with serious violence. Serious violence was found to be associated with prior visits to the victim's home and former sexual intimacy.
There have been no models for assessing stalkers for less serious violence, although Mullen et al.19 clearly discussed and outlined such factors in a study of 145 stalkers in 1999. Studies have addressed violence and stalking but have not delineated degrees of violence as separate factors.
A recent risk assessment model proposed by Kropp and colleagues20 described the difficulty with assessments and offered a model that relies on yet another method of classifying stalkers. More important, these investigators noted that actuarial assessments are not useful because stalking is targeted violence, the stalking behavior is not always violent, and the behavior can persist for long periods.
Morrison21 studied 100 aggressive stalkers in Canada and found that previous violent behavior, strong negative emotions, and obsessional tendencies toward the victim were the strongest predictors of violence.
Meloy22 proposed a different model of risk management dependent on whether the stalker was harassing a public figure or a former intimate. While the risk assessments mentioned herein focus on stalker characteristics, a recent attempt was made to associate victimization with a risk of violence. Brewster23 focused on former intimate victims instead of current intimate victims. A moderate correlation between verbal threats and physical violence was found among surveyed victims. Threats of violence were found to be better predictors of violence during stalking than was past violence.
Investigators in a few studies have used statistical measures to quantify the psychological effects of stalking on victims. Blaauw et al.24 studied stalking victims and compared their symptoms of psychopathology and features of the stalking. They found that symptoms reported by stalking victims were more comparable with those of psychiatric outpatients than with those in the general population. They also found that 75 percent of stalking victims displayed symptoms consistent with a psychiatric disorder. Some studies have focused on specific psychiatric syndromes among victims, such as post-traumatic stress disorder.25
Davis and colleagues26 examined the relationship of stalking victimization, level of fear, and health outcomes in men. They found that women were more likely to report fear than were men, men were more likely to be stalked by a stranger, stalking behaviors were similar across gender, and poor current health for women especially was most highly associated with level of fear. Both sexes reported a greater likelihood of having developed a chronic disease and having been injured.
a review of the literature just discussed, it is clear that more data are needed on assessing and managing risk among stalkers. Prospective studies are necessary, and a uniform classification system would be helpful. Warren et al.27 recently proposed a problem behavior model that recommends specifics for assessment and individualized treatment through the use of clinics that target specific behavior. Treatment included components such as cognitive therapy, victim empathy, substance abuse treatment, social skills, and a combination of specific therapeutic interventions coupled with the imposition of judicial sanctions.28
In this significant addition to the stalking research literature, Mullen and colleagues29 have developed a Stalking Risk Profile that incorporates the nature of the relationship between stalker and victim; the stalker's motivations; the general psychological, psychopathological, and social realities of the stalker; the circumstances of the victim; and the legal and mental health context. This model is not an actuarial scale, but rather an assessment to be used on a case-by-case basis.
Included in this profile is a recommended assessment of the stalker that features standardized tests of cognitive function, experience and expression of anger, personality traits, self-image, acceptance of responsibility for behavior and interpersonal attachment style. The authors also use the HCR-2030 and Spousal Assault Risk Assessment31 when indicated.
The risk assessment model advanced by Mullen and associates28 includes victim variables and provides specifics for assessment and treatment of the stalker. The authors discuss in less detail the assessment and treatment of victims.
References
Cal. Penal Code 646.9 (1990)
Medscape Search for Stalkers. Available at http://www.medscape.com. Accessed September 23, 2006
Harmon R, Rosner R, Owens H: Obsessional harassment and erotomania in a criminal court population. J Forensic Sci 40:188–96, 1995
Meloy J, Gothard S: Demographic and clinical comparisons of obsessional followers and offenders with mental disorders. Am J Psychiatry 152:258–63, 1995
Schwartz-Watts DM, Morgan DW, Barnes C: Stalkers: the South Carolina experience. J Am Acad Psychiatry Law 2:541–5, 1998
Harmon RB, Rosner RR, Owens H: Sex and violence in a forensic population of obsessional harassers. Psychol Public Policy Law 4:236–49, 1998
Tjaden P, Thoennes N, Allison C: Comparing stalking victimization from legal and victim perspectives. Violence Vict 15:7–22, 2000
Meloy JR, Davis B, Lovette J: Risk factors for violence among stalkers. J Threat Asses 1:3–16, 2001
Farnham FR, James DV, Cantrell P: Association between violence, psychosis and relationship to victim in stalkers. Lancet 355:199, 2000
Australian Bureau of Statistics: Women's Safety, Australia, 1996. Canberra, Australia: Commonwealth of Australia, 1996
Westrup D, Fremouw WJ, Thompson RN, et al: The psychological impact of stalking on female undergraduates. J Forensic Sci 44:554–7, 1999
Roberts K: Stalking following the breakup of romantic relationships: characteristics of stalking former partners. J Forensic Sci 47:1070–7, 2002
Purcell R, Pathé M, Mullen P: Editorial: when do repeated intrusions become stalking J Forensic Psychiatry Psychol 15:571–83, 2004
Rosenfeld B: Recidivism in stalking and obsessional harassment. Law Hum Behav 27:251–65, 2003
Mohandie K, Meloy JR, McGowan MG: The RECON typology of stalking; reliability and validity based upon a large sample of North American stalkers. J Forensic Sci 51:147–55, 2006
McFarlane J, Campbell J, Wilt S, et al: Stalking and intimate partner femicide. Homicide Studies 3:300–16, 1999
Roberts K: Women's experience of violence during stalking by former romantic partners: factors predictive of stalking violence. Violence Against Women: 11:89–114, 2005
James D, Farnham F: Stalking and serious violence. J Am Acad Psychiatry Law 31:432–9, 2003
Mullen P, Pathé M, Purcell R, et al: Study of stalkers. Am J Psychiatry 156:1244–9, 1999
Kropp PR, Hart SD, Lyon DR: Risk assessment of stalkers: some problems and possible solutions. Crim Just Behav 29:590–616, 2002
Morrison KA: Predicting violent behavior in stalkers: a preliminary investigation of Canadian cases in criminal harassment. J Forensic Sci 46:1403–10, 2001
Meloy JR: When stalkers become violent: the threat to public figures and private lives. Psychiatr Ann 33:659–65, 2003
Brewster M: Stalking by former intimates: verbal threats and other predictors of physical violence. Violence Vict 15:41–54, 2000
Blaauw E, Winkel F, Arensman E, et al: The toll of stalking: the relationship between features of stalking and psychopathology of victims. Interpers Violence 17:50–63, 2002
Kamphius JH, Emmelkamp PMG, Bartak A: Individual differences in post-traumatic stress following post-intimate stalking: stalking severity and psychosocial variables. J Psychol 42:145–56, 2003
Davis KE, Coker AL, Sanderson M: Physical and mental health effects of being stalked for men and women. Violence Vict 17:429–43, 2002
Warren LJ, MacKenzie R, Mullen PE, et al: The problem behavior model: the development of a stalkers clinic and a threateners clinic. Behav Sci Law 23:387–97, 2005
Mullen P, Pathe M, Purcell R: The management of stalkers. Adv Psychiatr Treat 7:335–42, 2001
Mullen PE, Mackenzie R, Ogloff JRP, et al: Assessing and managing the risks in the stalking situation. J Am Acad Psychiatry Law 34:439–50, 2006
Webster CD, Douglas KS, Eaves D, et al: HCR-20: Assessing Risk for Violence (version 2). Burnaby, BC, Canada: Mental Health, Law, Policy Institute, Simon Fraser University, 1997
Douglas KS, Ogloff JRP: Evaluation of a model of violence risk assessment among forensic psychiatric patients. Psychiatr Serv 54:1372–9, 2003(Donna M. Schwartz-Watts, MD)
Abstract
Paul Mullen and his colleagues have developed a Stalking Risk Profile that is the latest model for assessing and managing stalkers. The model includes an assessment of the nature of the relationship between the stalker and his victim; the stalker's motivations; the general psychological, psychopathological, and social realities of the stalker; the circumstances of the victim, and the legal and mental health context. The model is not an actuarial scale, but rather an assessment to be used on a case-by-case basis. It recommends certain standardized tests as part of the assessment. The Stalker Risk Profile is the most thorough risk assessment to date. It includes victim variables and provides specifics for assessment and specifics for treatment of the stalker.
The first anti-stalking legislation appeared in the United States 16 years ago.1 Before anti-stalking legislation was enacted, little was known about stalkers. After the initial laws were passed, stalkers and their victims became a focus of research. A Medscape2 search conducted for this publication revealed 110 articles about stalkers.
To date, research has supplied consistent demographic data about stalkers. They are older than other offenders, are typically male, and are unmarried at the time of offending.3–5 Now that we are entering the second decade of research on stalking, various demographic data about subsets of stalkers are being compiled as they relate to predictors of violence.6
Research reveals stable victim characteristics. The typical stalking victim is female7 and a former intimate of the stalker.8,9 Epidemiological studies have been conducted7,10 and demonstrate that between 8 and 15 percent of women and 2 percent of men report having been stalked. Stalking remains underreported.10 Only one half to one third of stalking victims reported such crimes.7,11
Epidemiological studies have stimulated researchers to study nonforensic populations of stalkers. Concern has arisen among researchers that forensic stalkers differ from nonforensic stalkers. Attempts have been made to characterize these groups better by studying college students. Roberts12 compared the experiences of female students whose relationships ended with stalking, with harassment, and with no harassment. The study concluded that the longer the relationship, the more the risk of stalking.
Epidemiological studies have also been useful in delineating the natural course of stalking. Purcell et al.13 conducted an epidemiological study that examined the nature and prevalence of stalking in an Australian community. Of 1844 survey respondents, 23 percent met the legal criteria for stalking. In almost half of the cases, stalking abated within two weeks. After two weeks, stalking persisted for a median of six months. Strangers typically stalked their victims for less than two weeks. Someone known to the victim typically engaged in stalking that persisted more than two weeks. Harassment became more intrusive after two weeks. Threats, as well as assaults, were more likely to occur after a two-week period. Subjects harassed less than two weeks did not differ psychiatrically from a group of people who were never harassed.
Although his was not an epidemiological study, Rosenfeld14 found that 49 percent of stalkers recidivate, and 80 percent of those reoffend in the first year. Recidivism was associated with substance abuse and a personality disorder.
While demographic data and epidemiological studies are somewhat consistent, there has been no agreement concerning classification. Some classification systems are being incorporated into research models, although there is still no uniform classification model.
To date, there have been several classification systems. Some describe the nature of the attachment of the stalker to his victim, while others rely on characteristics of the stalker himself. As recently as January 2006, a new classification system was proposed.15
Presently, research is most focused on the relationship between stalking and violence. Studies correlate violence with the demographic variables of victims, stalkers, and the nature of the relationship between the stalkers and victims. The risk of lethal violence and stalking has been researched. A recent study by McFarlane et al.16 reported that 76 percent of femicide victims were stalked by their assailants in the 12 months prior to their murders.
Harmon et al.6 found that stalkers who were former intimates were violent, had an Axis II disorder, abused substances, and threatened their victims. Roberts17 studied 220 female undergraduates who were stalking victims. He found that violence was associated with a direct threat made during stalking, with the stalker's abuse of prescription drugs, or with the former partner's being jealous.
While violence and its association with stalking are vital, Purcell and her colleagues13 point out that most stalking does not result in violence. The area of stalking research that has received the least attention is risk assessment. Yet, forensic psychiatrists and psychologists routinely perform risk assessments of individuals charged with stalking.
A risk assessment has been proposed by James and Farnham18 for assessing stalkers for serious violence. They studied 85 stalkers in London and found that previous risk factors associated with violence did not apply to a subgroup of stalkers who were seriously violent. They did not find that substance abuse, the presence of a personality disorder, or a history of previous convictions for violence were associated with serious violence. Serious violence was found to be associated with prior visits to the victim's home and former sexual intimacy.
There have been no models for assessing stalkers for less serious violence, although Mullen et al.19 clearly discussed and outlined such factors in a study of 145 stalkers in 1999. Studies have addressed violence and stalking but have not delineated degrees of violence as separate factors.
A recent risk assessment model proposed by Kropp and colleagues20 described the difficulty with assessments and offered a model that relies on yet another method of classifying stalkers. More important, these investigators noted that actuarial assessments are not useful because stalking is targeted violence, the stalking behavior is not always violent, and the behavior can persist for long periods.
Morrison21 studied 100 aggressive stalkers in Canada and found that previous violent behavior, strong negative emotions, and obsessional tendencies toward the victim were the strongest predictors of violence.
Meloy22 proposed a different model of risk management dependent on whether the stalker was harassing a public figure or a former intimate. While the risk assessments mentioned herein focus on stalker characteristics, a recent attempt was made to associate victimization with a risk of violence. Brewster23 focused on former intimate victims instead of current intimate victims. A moderate correlation between verbal threats and physical violence was found among surveyed victims. Threats of violence were found to be better predictors of violence during stalking than was past violence.
Investigators in a few studies have used statistical measures to quantify the psychological effects of stalking on victims. Blaauw et al.24 studied stalking victims and compared their symptoms of psychopathology and features of the stalking. They found that symptoms reported by stalking victims were more comparable with those of psychiatric outpatients than with those in the general population. They also found that 75 percent of stalking victims displayed symptoms consistent with a psychiatric disorder. Some studies have focused on specific psychiatric syndromes among victims, such as post-traumatic stress disorder.25
Davis and colleagues26 examined the relationship of stalking victimization, level of fear, and health outcomes in men. They found that women were more likely to report fear than were men, men were more likely to be stalked by a stranger, stalking behaviors were similar across gender, and poor current health for women especially was most highly associated with level of fear. Both sexes reported a greater likelihood of having developed a chronic disease and having been injured.
a review of the literature just discussed, it is clear that more data are needed on assessing and managing risk among stalkers. Prospective studies are necessary, and a uniform classification system would be helpful. Warren et al.27 recently proposed a problem behavior model that recommends specifics for assessment and individualized treatment through the use of clinics that target specific behavior. Treatment included components such as cognitive therapy, victim empathy, substance abuse treatment, social skills, and a combination of specific therapeutic interventions coupled with the imposition of judicial sanctions.28
In this significant addition to the stalking research literature, Mullen and colleagues29 have developed a Stalking Risk Profile that incorporates the nature of the relationship between stalker and victim; the stalker's motivations; the general psychological, psychopathological, and social realities of the stalker; the circumstances of the victim; and the legal and mental health context. This model is not an actuarial scale, but rather an assessment to be used on a case-by-case basis.
Included in this profile is a recommended assessment of the stalker that features standardized tests of cognitive function, experience and expression of anger, personality traits, self-image, acceptance of responsibility for behavior and interpersonal attachment style. The authors also use the HCR-2030 and Spousal Assault Risk Assessment31 when indicated.
The risk assessment model advanced by Mullen and associates28 includes victim variables and provides specifics for assessment and treatment of the stalker. The authors discuss in less detail the assessment and treatment of victims.
References
Cal. Penal Code 646.9 (1990)
Medscape Search for Stalkers. Available at http://www.medscape.com. Accessed September 23, 2006
Harmon R, Rosner R, Owens H: Obsessional harassment and erotomania in a criminal court population. J Forensic Sci 40:188–96, 1995
Meloy J, Gothard S: Demographic and clinical comparisons of obsessional followers and offenders with mental disorders. Am J Psychiatry 152:258–63, 1995
Schwartz-Watts DM, Morgan DW, Barnes C: Stalkers: the South Carolina experience. J Am Acad Psychiatry Law 2:541–5, 1998
Harmon RB, Rosner RR, Owens H: Sex and violence in a forensic population of obsessional harassers. Psychol Public Policy Law 4:236–49, 1998
Tjaden P, Thoennes N, Allison C: Comparing stalking victimization from legal and victim perspectives. Violence Vict 15:7–22, 2000
Meloy JR, Davis B, Lovette J: Risk factors for violence among stalkers. J Threat Asses 1:3–16, 2001
Farnham FR, James DV, Cantrell P: Association between violence, psychosis and relationship to victim in stalkers. Lancet 355:199, 2000
Australian Bureau of Statistics: Women's Safety, Australia, 1996. Canberra, Australia: Commonwealth of Australia, 1996
Westrup D, Fremouw WJ, Thompson RN, et al: The psychological impact of stalking on female undergraduates. J Forensic Sci 44:554–7, 1999
Roberts K: Stalking following the breakup of romantic relationships: characteristics of stalking former partners. J Forensic Sci 47:1070–7, 2002
Purcell R, Pathé M, Mullen P: Editorial: when do repeated intrusions become stalking J Forensic Psychiatry Psychol 15:571–83, 2004
Rosenfeld B: Recidivism in stalking and obsessional harassment. Law Hum Behav 27:251–65, 2003
Mohandie K, Meloy JR, McGowan MG: The RECON typology of stalking; reliability and validity based upon a large sample of North American stalkers. J Forensic Sci 51:147–55, 2006
McFarlane J, Campbell J, Wilt S, et al: Stalking and intimate partner femicide. Homicide Studies 3:300–16, 1999
Roberts K: Women's experience of violence during stalking by former romantic partners: factors predictive of stalking violence. Violence Against Women: 11:89–114, 2005
James D, Farnham F: Stalking and serious violence. J Am Acad Psychiatry Law 31:432–9, 2003
Mullen P, Pathé M, Purcell R, et al: Study of stalkers. Am J Psychiatry 156:1244–9, 1999
Kropp PR, Hart SD, Lyon DR: Risk assessment of stalkers: some problems and possible solutions. Crim Just Behav 29:590–616, 2002
Morrison KA: Predicting violent behavior in stalkers: a preliminary investigation of Canadian cases in criminal harassment. J Forensic Sci 46:1403–10, 2001
Meloy JR: When stalkers become violent: the threat to public figures and private lives. Psychiatr Ann 33:659–65, 2003
Brewster M: Stalking by former intimates: verbal threats and other predictors of physical violence. Violence Vict 15:41–54, 2000
Blaauw E, Winkel F, Arensman E, et al: The toll of stalking: the relationship between features of stalking and psychopathology of victims. Interpers Violence 17:50–63, 2002
Kamphius JH, Emmelkamp PMG, Bartak A: Individual differences in post-traumatic stress following post-intimate stalking: stalking severity and psychosocial variables. J Psychol 42:145–56, 2003
Davis KE, Coker AL, Sanderson M: Physical and mental health effects of being stalked for men and women. Violence Vict 17:429–43, 2002
Warren LJ, MacKenzie R, Mullen PE, et al: The problem behavior model: the development of a stalkers clinic and a threateners clinic. Behav Sci Law 23:387–97, 2005
Mullen P, Pathe M, Purcell R: The management of stalkers. Adv Psychiatr Treat 7:335–42, 2001
Mullen PE, Mackenzie R, Ogloff JRP, et al: Assessing and managing the risks in the stalking situation. J Am Acad Psychiatry Law 34:439–50, 2006
Webster CD, Douglas KS, Eaves D, et al: HCR-20: Assessing Risk for Violence (version 2). Burnaby, BC, Canada: Mental Health, Law, Policy Institute, Simon Fraser University, 1997
Douglas KS, Ogloff JRP: Evaluation of a model of violence risk assessment among forensic psychiatric patients. Psychiatr Serv 54:1372–9, 2003(Donna M. Schwartz-Watts, MD)