Stalking and Mental Illness

Mental disorders are not uncommon among stalkers whose behaviour attracts attention from criminal justice and mental health services. Research in the United States and Australia on stalkers who have entered the criminal justice system suggests that at least 50% and potentially up to 75% of this group experience some sort of mental disorder, with personality disorders, schizophrenia and other psychotic disorders, depression, and substance use disorders being most common (McEwan & Strand, 2013; Nijdam-Jones et al., 2018). Research has also shown that the vast majority of people whose stalking attracts criminal justice attention have had contact with mental health services, often around the time of the stalking (Albrecht et al., 2022).

Stalking is a behaviour not a mental disorder. Where mental disorder does play a role in stalking, its contribution varies greatly depending on the nature of the symptoms experienced, the context in which they are experienced, and the role of other personal and environmental factors. Stalkers present with a wide variety of mental disorders, with psychosis often playing a role for those stalkers with Intimacy Seeking or Resentful motivations, while personality disorders, depression and substance misuse are common amongst those with Rejected, Resentful, and Predatory motivations. Stalkers who are classified as Incompetent Suitors (those whose stalking is an inept attempt to get a date) sometimes present with development disorders such as intellectual disability and/or autism spectrum disorders, with the stalking behaviour being a consequence of social skills deficits associated with these disorders. Amongst Predatory stalkers, paraphilias (disorders of sexual attraction) may play a role in motivating the stalking behaviour. In many cases stalkers present with multiple mental disorders, or a primary disorder is accompanied by specific personality traits that are linked to the stalking behaviour but are not sufficient for a diagnosis of personality disorder.

Given the complex and heterogeneous nature of mental disorder among stalkers, it’s role can vary widely. Drawing from published research to-date, and from clinical experience, we suggest that mental disorder interacts with stalking in the following ways:

In a significant minority of stalking cases, the behaviour occurs as a direct result of psychotic symptoms, usually in the form of paranoid or erotomanic delusional beliefs about the victim(s). In these cases the stalking behaviour is likely to resolve if the disorder underlying the behaviour is successfully treated. Pharmacological treatments may take time to come into effect or only serve to attenuate rather than fully resolve the delusional beliefs. Ideally the stalking should to be managed through practical and psychological interventions in addition to psychopharmacology. At times this may require use of mental health provisions or criminal legislation if the behaviour cannot be managed and presents a significant risk to victims. Where psychotic symptoms are present research has shown that stalking is likely to be highly persistent unless effective treatment and management strategies are implemented.
For a larger proportion of stalkers, mental disorder is present and contributes to the onset and maintenance of stalking behaviour, however the relationship is indirect or complicated by other factors. For these individuals, remediation of symptoms is often beneficial, both in reducing the stalking behaviour and in improving the stalker’s overall quality of life. However, treatment of the mental disorder alone is unlikely to be sufficient to stop the stalking and addition, more criminogenically relevant, interventions may be indicated.
The remainder of stalkers do not suffer from a mental disorder that plays any role in producing stalking behaviour. We hypothesise that these individuals might hold particular attitudes and beliefs that are supportive of stalking, and/or lack specific skills that mean that when confronted with the desire to change their interpersonal situation in some way, they use stalking as a strategy rather than a more socially appropriate behaviour.

The prevalence of mental disorder within the population of stalkers who attract attention from the criminal justice and mental health systems means that professionals within these systems need to be looking for and responding to mental disorder where it is present. A number of authors have advocated for routine psychiatric assessment of stalkers presenting to courts and in some jurisdictions this is possible via specialist assessment and treatment services that focus on the problem behaviour and can provide referrals to general mental health services where appropriate.

While this section has focussed on the role of mental illness in stalking behaviour, it is insufficient to only consider mental disorder when working with a stalker. Stalking is a complex, multiply-determined behaviour and we believe strongly that understanding the context in which the behaviour began is an integral part of a comprehensive assessment of any stalker. The vast majority of individuals who stalk do not behave in this way most of the time and, in fact, their behaviour is usually restricted to a specific victim in a specific context. The role of contextual factors such as relationship breakdown, unemployment, perceived failure or embarrassment, and social isolation all play a central role in the commencement and perpetuation of stalking. These types of factors, and how they impact upon and are interpreted by the stalker needs to be given equal weight to mental disorder when considering the reasons that the stalking may have developed and is continuing.

References

Albrecht, B., Spivak, B., Daffern, M., & McEwan, T. E. (2022). The temporal relationship between mental health service use and stalking perpetration. Australian and New Zealand Journal of Psychiatry, 56(12), 1642-1652. https://doi.org/10.1177/00048674211072449

McEwan, T.E. & Strand, S. (2013). The role of psychopathology in stalking by adult strangers and acquaintances. Australian and New Zealand Journal of Psychiatry, 47, 546-555.

Nijdam-Jones, A., Rosenfeld, B., Gerbrandij, J., Quick, E., & Galietta, M. (2018). Psychopathology of stalking offenders: examining the clinical, demographic, and stalking characteristics of a community-based sample. Criminal Justice and Behavior, 45, 712-741. https://doi.org/10.1177/0093854818760643