S P E C I A L A R T I C L E

Assessing and Managing the Risks in

the Stalking Situation
Paul E. Mullen, MB, BS, DSc, Rachel Mackenzie, BApplSc, PhD,
James R. P. Ogloff, JD, PhD, Michele Pathé, MD, Troy McEwan, BA, and
Rosemary Purcell, PhD

Stalking is a common social problem, often driven by psychiatric disorder in its perpetrators and productive of
psychological and social damage in its victims. Assessing and managing the risks in the stalking situation is a task that
frequently falls on the mental health professional. The concerns of risks in the stalking situation are not confined
to violence but include psychosocial damage, chronicity, and recurrence, and, for the stalker, arrest and incar-
ceration. This article outlines a structured approach to assessment and management involving domains based on
the relationship between stalker and victim, the type of motivation driving the stalking, the stalker’s risk profile,
the victim’s risk profile, and finally, the legal and mental health context. The assessment is closely linked to
management strategies to counter specific ascertained risks and future hazards. These strategies will be limited, or
facilitated, according to the current legal and mental health contexts that have a critical impact on the stalking
situation.

J Am Acad Psychiatry Law 34:439 –50, 2006

Actuarial risk assessment began with attempts to de- Stalking is a social problem that, because it is often
rive correlations that could contribute to evaluating associated with psychiatric disorder in its perpetra-
the probabilities of future criminality across a wide tors and is productive of psychological distress in its
range of offenders and contexts. Subsequent devel- victims, is encountered by a wide range of mental
opments in the risk assessment literature have been health professionals. Clinical management in the
directed toward applying clinical and nomothetic stalking situation demands a risk assessment deter-
data, as well as probabilistic data, to more tightly mined primarily by the characteristics of the stalker
defined groups such as sex offenders, perpetrators of and, to a lesser extent, by the victim’s characteristics
domestic violence, and mentally disordered inpa- and behavior.7–11 Risk assessments by mental health
tients.1– 6 This article fits within this emerging liter- professionals should contribute to management ap-
ature and is directed to applying the knowledge and proaches that reduce the ascertained risk. This need
principles of risk assessment to the stalking situation. is just as true for those whose role is in preparing
reports for courts and tribunals, as such evaluations
influence not only whether mandated treatment oc-
Dr. Mullen is Professor of Forensic Psychiatry, Monash University, curs, but its likely nature. Few stalkers seek help vol-
and Clinical Director, Victorian Institute of Forensic Mental Health, untarily, and only a minority fit criteria for compul-
Victoria, Australia. Dr. Mackenzie is Lecturer, Monash University,
and Clinical Psychologist, Victorian Institute of Forensic Mental sory mental health treatment. As a result, many are
Health. Dr. Ogloff is Professor of Clinical Psychology, Monash Uni- managed on orders imposed by courts or parole
versity, and Director, Psychological Services, Victorian Institute of
Forensic Mental Health. Dr. Pathé is Senior Lecturer, Monash Uni- boards. The ethics justification for such a clinical
versity and Consultant Forensic Psychiatrist, Victorian Institute of practice derives from the benefits accruing first to the
Forensic Mental Health. Ms. McEwan is Doctoral Student of Clinical
Psychology, Monash University. Dr. Purcell is Research Fellow, De- stalker and secondarily to the victim.
partment of Psychiatry, The University of Melbourne, Parkville, Vic- Risk assessment in stalking situations is currently
toria, Australia. Address correspondence to Paul E. Mullen, MB, BS,
DSc., Thomas Embling Hospital, Locked Bag 10, Fairfield, Victoria limited by a lack of prospective studies of represen-
3078, Australia. E-mail: [email protected] tative samples. Clinicians and the legal decision-

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 Managing Risks in Stalking Situations

makers do not, however, have the luxury of deferring There is a conflict between the stalker’s desires and
action until such evidence emerges. They must, for the victim’s interests, but they are at one in being at
the present, depend on integrating knowledge from risk of damage from the stalking situation. There can
stalking research, borrowing from the systematic be a tragic symmetry between the victim forced to
studies of risk in other areas, and drawing on clinical live an increasingly restricted life in a state of constant
experience. The paper begins with a discussion of the fear and the stalker’s devoting all his or her time and
areas of risk for both stalking victims and stalkers resources to a futile and ultimately frustrating pur-
before proceeding to the development of a Stalking suit. Both the victim’s and the perpetrator’s lives can
Risk Profile. Areas that need further research are be laid waste. This is not to argue for equivalence
highlighted. between victim and perpetrator. In stalking, there are
real victims and real perpetrators; one offends and
the other is offended against. However, they share
Types of Risk the chance of disaster. These perspectives, which en-
When stalking first came to prominence, it was the compass the risks to stalkers and victims, have the
perceived link with violence that led to its criminal- advantage for health professionals of minimizing the
ization. Given this context, it is no surprise that the ethical dilemma concerning whose interests one is
risk assessment literature on stalking has focused al- serving: the patient’s or the victim’s.
most exclusively on assault. Most victims are not, in
fact, assaulted.12–14 Stalking, however, inflicts psy-
chological and social damage as a result of chronic Risk of Continued or Recurrent Stalking
fear and intimidation, irrespective of the presence or The longer stalking has lasted, the longer it is
absence of actual assault.9,15–18 Stalking victims also likely to persist. Nearly 50 percent of stalking sit-
usually want to know whether their harassment will uations amount to a short burst of intrusive behav-
ever end or, if it has stopped, whether it will recur. ior lasting only a few days and not extending be-
The assessment and management of risk should re- yond two weeks.19 This form of harassment is
flect these concerns. typically perpetrated by a stranger. In contrast,
Risk to victims of stalking encompasses three stalkers who persist for longer than two weeks usu-
areas: ally continue for many months. Persistence is re-
1. Whether the stalking will continue, or, if it has portedly high in workplace stalking and among
stopped, will recur; professionals pursued by ex-patients and cli-
2. Whether the victim will suffer significant psy- ents.20 –24 Those who continue to stalk over many
chological and/or social damage, which may include years are in our experience either pursuing a quest
suicidal ideation or behavior; for intimacy, often driven by erotomanic delu-
3. Whether the stalking will escalate to physical sions, or are ex-partners unwilling to abandon the
and/or sexual assault. lost relationship.
Assessing and managing the stalker requires a pri- The only published study investigating recidivism
mary focus on the risks presented to the victim, reported almost half of the sample reoffended, with
though it has to be kept in mind that stalkers are at most returning to stalking within 12 months.25 The
risk from their own behavior. Stalkers usually see study’s methodology would suggest that most, if not
their problems in terms either of the recalcitrance all, of the subjects had stalked their victims for longer
and ill will of the victims or of third parties intruding than two weeks. Most likely to reoffend were the
to prevent the realization of their desires. Only the personality disordered, particularly if they were also
occasional stalker can see beyond the current fixation substance abusers. An unexpected finding was that
to the dangers inherent in the continuing pursuit. In those with delusional disorder, despite their reputa-
reality, stalkers face several risks, including: tion for persistence, were less likely to reoffend. This
1. That their stalking will continue and become an could be explained by the more obviously mentally ill
all-consuming preoccupation undermining their so- receiving treatment and even hospitalization during
cial and psychological functioning; the follow-up period. Further research is needed to
2. That their actions will attract condemnation explore the factors that are related to persistence and
from their peers and, eventually, criminal sanctions. recurrence.

440 The Journal of the American Academy of Psychiatry and the Law
 Mullen, MacKenzie, Ogloff, et al.

Risk of Psychological and Social Damage being of minority race, with no significant differ-
The longer the stalking lasts, the greater the po- ences between male and female stalkers. These find-
tential damage to the victim.19 The degree of fear and ings are consistent with outcomes of previous stud-
intimidation induced in the victim appears to be of ies.7,36,37 Risks of assault are also reported to increase
significance, irrespective of whether a physical assault when the stalker has prior criminal convictions or a
occurs, though these are not entirely independent history of substance abuse.13,38 Psychotic illness in
variables.9 Studies have failed to demonstrate a clear the stalker reportedly decreases the risk of vio-
relationship between psychological damage and the lence.7,13,25,39,40 Care must be taken, however, as
nature of the prior relationship. Clinically, however, there is suggestive evidence that, when very serious or
distress and disruption to victims are usually most fatal violence occurs, it may involve a different pat-
obvious in ex-intimates pursued by their rejected tern of risk factors with no association with either
partners, perhaps because of the higher levels of vio- substance abuse or prior convictions.41,42 McFarlane
lence and intimidation combined with the complex- and her colleagues43 investigated the prevalence of
ity as well as the intensity of feelings stirred up in this stalking in cases of attempted and successful femicide
situation.26,27 The rate of suicidal ideation in stalk- and estimated that more than 75 percent were
ing victims is high, but the number who progress to stalked before the attack. While the evidence avail-
suicide is unknown.17 able indicates that a very low percentage of stalkers
kill their victims,8 a high percentage of those who
have killed or attempted to kill women have stalked
Risk of Threat and Violence them beforehand. This apparent paradox may be ex-
Between 30 and 40 percent of stalking victims are plained by the dramatic difference between the base
explicitly threatened.14,16,17 Not unexpectedly, this rate of stalking and that of homicide. The relative
figure is higher among stalkers referred by the court dearth of information concerning stalking-related
for forensic evaluation, with more than 60 percent of homicide and other serious violent offenses indicates
such stalkers issuing threats.13,28,29 There is, in addi- a need for further research.
tion, the threat implicit in such behaviors as follow- As with other areas in which risk of violence is
ing, maintaining surveillance, and repeatedly ap- considered, the question of the availability and pres-
proaching.11 Explicit threats made by stalkers can be ence of weapons arises. In stalking cases, research
regarded as either instrumental, in that they are suggests that there is a wide degree of variability in
intended to manipulate the victim through fear, or the reported presence of weapons, such as guns and
spontaneous affective/reactive outbursts.30 The knives.7,40 Moreover, in some situations, objects
victims most likely to be threatened are ex-inti- other than knives and guns are used as weapons.
mates.8,29,31 In most stalking situations, except Physical injuries in stalking cases occur rarely (i.e., in
where the target is a public figure, the presence of less than 15% of cases) and, when present, weapons
threats increases the risk of a progression to vio- are infrequently used.12,14
lence.7,32–34 Even though most stalkers do not carry
out their threats, all threats should be taken seriously, Clinical Information Base
as they are distressing in and of themselves, and not Initial assessments of stalkers usually occur in the
enough is known to differentiate the empty threats context of pre-sentence or parole board evaluations.
from harbingers of assault. Victims may be encountered in a wider range of con-
Fear of violence is justified among victims of stalk- texts, many seeking help from general rather than
ing, as from 10 to 33 percent are assaulted.3,10 Phys- forensic mental health professionals. Stalkers fre-
ical assaults against victims are usually spontaneous quently lack insight into their behavior and tend to
acts that inflict bruises, abrasions, and lacera- deny, minimize, and rationalize their actions. Vic-
tions.13,14,16 Ex-intimates are the victim group at tims often minimize the experience of stalking and
greatest risk of assault.7,14,15,17,28,35 Rosenfeld and overemphasize their own responsibility for the ha-
Harmon10 reported that the variables associated with rassment, which should be of no surprise to anybody
violence in their sample were: the stalker’s being an experienced in working with victims in other con-
ex-intimate; less than 30 years of age having less than texts. Conversely, the problem of false claims of
a high school education; making prior threats; and stalking victimization cannot be entirely ignored.44

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 Managing Risks in Stalking Situations

It is essential to assess collateral information from careful consideration of several domains of risk fac-
such sources as witness statements, victim impact tors. The Stalking Risk Profile attempts to build on
reports, judges’ sentencing remarks, and profession- the work of Kropp and colleagues11 by employing a
al-to-professional contacts, confidentiality allowing. structured professional judgment approach to risks
Attempts to contact the victim when assessing the in the stalking situation.
stalker, or the stalker when assessing the victim are, in The Stalking Risk Profile incorporates five
our opinion, best avoided. However skillfully man- domains:
aged, such contacts tend to be experienced by the 1. The nature of the relationship between the
victim as the professional’s acting as an agent of the stalker and the victim;
stalker and by the stalker as support for his beliefs 2. The stalker’s motivations;
that this is a misunderstanding within a mutual rela- 3. The psychological, psychopathological, and so-
tionship rather than a unilateral imposition of un- cial realities of the stalker;
wanted attention. We will address this matter further 4. The psychological and social vulnerabilities of
when we discuss the consideration of the victim’s the victim;
psychological and social vulnerabilities. 5. The legal and mental health context in which
A psychiatric and psychological evaluation is per- the stalking is occurring.
formed on all stalkers seen in our service.41,45 As part
of the assessment, we employ a battery of standard- Domain One: Relationships in Stalking
ized tests that evaluates the individual’s cognitive Stalking is a drama played out between two people
function, his or her experience and expression of an- in a relationship of conflict and dissonance, albeit on
ger, personality traits, self-image, acceptance of be- occasion a relationship constructed entirely in the
havioral responsibility, and interpersonal attachment stalker’s fancies and fantasies. Pathé9 suggested that
style.41,45–50 The areas addressed in the clinical in- the potential relationships between stalker and vic-
terview and psychological testing relate to concerns tim can be that of prior intimates, friends and neigh-
based on the theoretical factors pertaining to stalking bors, casual acquaintances, professional contacts,
(e.g., attachment) and other important consider- workplace contacts, strangers encountered in day-to-
ations (e.g., cognitive capacity, anger/aggression, and day interactions, strangers who are public figures and
personality). celebrities, and secondary victims who have become
Information gaps are inevitable, particularly when entangled in the stalking because of their actual, or
interviewing victims whose stalkers have not yet been supposed, relationship to the primary victim. Those
brought before the courts. In many cases of persistent victim types are not mutually exclusive; for example,
stalking, however, the victim is likely to know from workplace and professional stalking usually involves
direct knowledge, or by repute, something about the non-intimate acquaintances. A more parsimonious
factors central to the stalker’s risk profile. Extrapola- division has been proposed into acquaintances, inti-
tions about the victim’s risk profile based entirely on mate and non-intimate, and strangers, who are either
the stalker’s account are hazardous but fortunately public figures or encountered in everyday interac-
one can often obtain victim impact reports and vic- tions.52 Research is needed to examine whether this
tim statements. compressed victim typology is sufficient for risk as-
A final caveat: risk in the stalking situation de- sessment purposes.
pends on the interaction, over what can be a long Ex-intimates are the stalking victims most likely to
time, of a range of potentially fluctuating and inter- be threatened and assaulted. A history of domestic
related factors. Risk changes as situations and people violence and/or jealousy before separation have been
change. This is good news for the possible efficacy of reported, in some but not all studies, to increase the
management approaches directed at reducing risk. It risk of violence in this group.12,34,53,54 At the other
is bad news for the stability of any given risk assess- extreme, stranger stalkers present the lowest risk of
ment that in practice must be repeatedly updated.51 assaulting their victims. Those who stalk celebrities
to whom they have little if any access are unlikely to
Stalking Risk Profile be able to perpetrate an assault, even if they have been
As already noted, the proper assessment and man- threatening and intend their victim harm. The dra-
agement of risks in the stalking situation requires the matic differences between the risks of assault for ex-

442 The Journal of the American Academy of Psychiatry and the Law
 Mullen, MacKenzie, Ogloff, et al.

Figure 1. Establishing stalker type on the basis of limited information from the victim.

intimates and strangers, particularly those who are compass, to a greater or lesser extent, the stalker’s
public figures, account for a significant amount of motivations.11,38,55–59 In this article, we employ the
variance in this area. typology of Mullen and colleagues.13 Assignment of
Although no systematic data yet exist on relation- stalkers to their probable type can occur even with
ship and the other types of risk, related research and the limited information usually available to victims
our clinical impressions suggest some broad general- (Fig. 1). Considerable research shows that the ty-
izations. Persistence seems higher among ex-inti- pologies of stalkers have important implications for
mates and lowest among strangers, with the excep- understanding the stalker, his or her behavior, and
tion of the small minority fixated on public figures. motivations.7,8,10 –12 Thus, the starting point of any
The social and psychological damage in our experi- assessment of risk in stalking situations requires a
ence is greatest among those stalked by ex-intimates careful consideration of the type of stalker.
and those pursued by work or professional contacts. The rejected stalker commences stalking after the
Recurrence in the same relationship is highest in ex- breakdown of an important relationship that was
intimates but recurrence with a new victim is highest usually, but not exclusively, sexually intimate in na-
in those who have pursued strangers. ture. The stalking reflects a desire for either reconcil-
Domain Two: Motivation of Stalkers iation or revenge for rejection or a fluctuating mix-
On the basis of our clinical experience, we believe ture of both. The stalking is sustained, at least in part,
the stalker’s motives, which both initiate and sustain by becoming a substitute for the lost relationship.
the pursuit, to be central to risk assessment. Several The intimacy seeker desires a relationship with
stalker classifications have been proposed that en- someone who has engaged his or her affection and

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 Managing Risks in Stalking Situations

who he or she is convinced already does, or will, new relationship. Intimacy seekers are persistent,
reciprocate that love despite obvious evidence to the prone to recidivism with the same victim, and rarely
contrary. This group targets strangers, professional assault, but if they fixate on those to whom they can
contacts, and acquaintances. They are prominent gain direct access, they are at best a nuisance and at
among celebrity stalkers. The stalking is sustained by worst a source of considerable psychological and so-
the intrusions becoming, in the mind of the stalker, cial stress. Health professionals should be particularly
manifestations of a mutual relationship, often the wary of this group because, when thwarted, they can
only relationship in an otherwise empty life. make mischievous and damaging complaints.24 The
The incompetent suitor also engages in stalking to resentful create considerable disruption and distress
establish a relationship; however, unlike the intimacy in their victims’ lives by a combination of harassment
seeker, he or she is simply seeking a date or a sexual and veiled threats but rarely assault or persist for long
encounter. This group comprises the socially and in- periods. In the predatory, the risk is focused on the
terpersonally inept who often combine a sense of high probability of assault. In addition, the typology
entitlement to a relationship with an indifference to interacts with diagnosis; for example, the presence of
their targets’ feelings. They usually gain few satisfac- a psychotic illness with persecutory delusions is likely
tions from their approaches and so they usually rap- to increase the risk of violence in the resentful, prob-
idly abandon the pursuit. Unfortunately, they are ably because of heightened fear and anger. But a psy-
prone to turning their unwanted attentions to new chotic illness associated with erotomanic delusions
victims. may well decrease the risk of violence in intimacy
The resentful stalker sets out to frighten and in- seekers, as they know, evidence to the contrary not-
timidate the victim to exact revenge for an actual or withstanding, that they are loved and eventually suc-
supposed injury. The harassment is sustained by the cess will be theirs.
satisfaction the stalker obtains from the sense of Domain Three: Stalker’s Psychological,
power and control. This group frequently issues Psychopathological, and Social Status
overt and covert threats but rarely resorts to physical Domain three requires the consideration of a
violence, though again, there are rare and terrible range of risk factors emanating from the stalker’s psy-
exceptions—for example, several workplace massa- chological, psychopathological, and social status. In
cres have been the culmination of a campaign of keeping with contemporary approaches to violence
resentful stalking.20 risk assessment generally,1 it is useful to review these
The predatory stalker’s behavior, when the pursuit considerations with respect to the historical, current
is preparatory to an assault, usually sexual, involves clinical, and future hazards.
information gathering, rehearsal and/or fantasizing
about the attack, and voyeuristic gratification. The Consideration of Historical Risk Factors
stalking is covert so as not to alert the victim to the The historical or static risk factors of relevance to
impending attack, but some predatory stalkers derive the stalker are a mixture of specific and general risk
pleasure from making the victim aware of being factors present in the stalker’s history that are likely
watched without revealing his or her own (the stalk- to increase the level of risk of ongoing stalking and
er’s) identity. Although this applies to only a small related harm. As discussed previously, when consid-
percentage of stalkers, some elements of such preda- ering the risks in the stalking situation, one must be
tory stalking are not uncommon among those who mindful of the range of possible risks, including, for
commit serious sexual offenses.8 example, the risk of violence. Therefore, the general
These stalking types are not always mutually ex- factors considered cover the usual areas of concern in
clusive, but the typology can provide a useful frame violence risk assessments: history of violence, prior
of reference for clinicians, at least until a classifica- antisocial conduct, substance abuse, psychiatric his-
tion based on a better empirical base emerges. Our tory, personality disorder, and social and relational
experiences suggest the typology is broadly associated instability. In addition, consideration of factors such
with various levels of risk in each of the areas of as whether the stalker has used weapons in the past or
concern. The rejected are at high risk in all areas, has access to weapons is important, depending on the
whereas the incompetent are at risk largely for mak- specific situation. In assessing the range of general
ing threats and for recurrence of the behavior in a risk factors, we find it useful to use elements of struc-

444 The Journal of the American Academy of Psychiatry and the Law
 Mullen, MacKenzie, Ogloff, et al.

tured professional judgment risk assessment schemes 2. Attitude toward victim (any capacity for em-
such as the HCR-201 and the Spousal Assault Risk pathic concern is reassuring except in the resentful
Assessment.4 When used, such measures can be con- whose behavior is reinforced by a knowledge that
sidered a necessary but not sufficient consideration of they are causing suffering);
risk. If violence risk measures suggest high levels of 3. State trait anger (violent behavior is associated
risk of violence, it may be true that regardless of the with both poor control of anger and by failure to
details in the stalking situation, the stalker may be at acknowledge angry emotions);
risk of violent behavior. However, it is not sufficient 4. Level of social competence (giving up stalking is
merely to rely on violence risk assessment schemes, as in many cases dependent on the ability to move on to
they do not take into account the factors specific to new relationships);
the stalking situation. The stalking-specific elements 5. Presence of deviant sexual arousal patterns (of
to be considered are: specific relevance to predatory stalking);
1. History of previously stalking others (prior pat- 6. Poor verbal skills (makes management even
terns of behavior are likely to be repeated); more difficult as well as predisposing to physical
2. Number and nature of stalking methods (the rather than verbal expressions of feelings and
more versatile, the more likely to persist and inflict frustrations);
damage); 7. Locus of behavioral control (externalizers ap-
3. Breaches of restraining, intervention or court pear more likely to recidivate).
orders (these increase all types of risk);
Consideration of Future Hazards
4. Trespass and other illegal intrusive activities
such as hacking into victim’s computer (alerts to Building on the information obtained in consid-
probability of further illegal and potential violent ering historical and current clinical risk factors of
intrusions and of itself increases impact on the both a general and stalking-specific nature, we then
victim); consider the future hazards that are likely to exist. As
5. Whether the frequency and intrusiveness of with other areas of behavior, the past risk factors and
stalking is escalating or waning. current clinical functioning with respect to risk con-
tribute to an understanding of the factors that are
likely to be of concern in the future, and the extent to
Consideration of Current Clinical Risk Factors
which the factors are likely to be of concern. Again,
As with the historical risk factors, the current clin- this encompasses general and stalking-specific risk
ical risk factors are divided into those relevant when factors, though there is considerable overlap between
considering general risk for violence and related the two, with the stalking-specific carrying more
harm, and those specific to the stalking situation. weight. They include:
Again, measures such as the HCR-201 are useful, but 1. Likely future contact with the victim (for exam-
not sufficient, for the consideration of general clini- ple, shared child custody or work environment, that
cal risk variables. The general factors include current will, unless adequately managed, predispose to per-
mental state, substance abuse problems, treatment sistence and recurrence);
responsiveness, lack of insight, and negative atti- 2. Feasibility of plans for avoiding stalking
tudes. While factors such as mental illness and the recidivism;
presence of personality disorder are considered with 3. Underlying triggers to stalking unresolved (for
historical risk factors, care must given to the deter- example, stalker living in proximity to victim or re-
mination of the extent to which such factors are of taining extensive memorabilia of lost relationship);
concern currently. 4. Continuing social instability and unemploy-
The stalking-specific current clinical factors to be ment (unstructured and spare time invites a return to
considered consist of: the preoccupations and ultimately the renewed stalk-
1. Attachment style (those dismissive of intimacy ing of the victim);
in our experience are more likely to be violent, 5. Social isolation (reduces the chances of devel-
whereas a secure attachment style, often claimed by oping nondeviant attachments as well as reducing the
intimacy seekers, frequently indicates a loss of con- all important feedback from friends and family about
tact with reality that is predictive of persistence); the unacceptable nature of the stalker’s behavior);

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 Managing Risks in Stalking Situations

Table 1 The Stalker’s Clinical Risk Factors and Future Hazards Specific to the Stalking Situation
Risk Factor Management Possibilities
Clinical
Attitudes toward, and beliefs about, the victim that Appropriate legal interventions; CBT* and focused psychotherapies aimed at
sustain stalking such areas as abandoning love, accepting loss, confronting
misperceptions
The conviction that the stalker is right to engage in Enhancing victim empathy; confronting false attributions using CBT
stalking
The refusal to engage in any therapy, or conform to Ultimately confronting stalker with consequences (e.g. through breaching
legally imposed restrictions on access to the victim parole, referring back to court, etc.); employing motivational interviewing
strategies to assist the stalker to appreciate the need for intervention
Social incompetence Social skills training, therapies aimed at enhancing self-efficacy
Paraphilia Sex offender program incorporating CBT with or without pharmacotherapy,
as indicated
Future hazards
Likely future contact with the victim Every effort should be made to enforce a total ban on direct contact or
direct communications
Lack of a feasible set of plans for avoiding a recurrence Ensure structured plan around avoiding provocations and using protections
of stalking against stalking; CBT to assist the stalker to overcome the compulsion
to stalk
The underlying precipitants remain unresolved Focused psychotherapy aimed at the areas identified in the formulation;
social skills training for the inept; assistance abandoning the relationship;
the treatment of paraphilias using CBT with or without pharmacotherapy,
as indicated
Continuing instability to obtain residence and/or Assistance obtaining housing; career counseling and active employment
employment rehabilitation as indicated and appropriate
Continuing social isolation Use of clubs, day centers, recreational counseling, domestic pets
Likely low level of compliance with legal restraints on Ensure knowledge of consequences of breaches and never collude,
contact with victim implicitly or explicitly, with avoiding those consequences
Likely low level of cooperation with any treatment Use of compulsory community treatment orders either imposed by court or
program as part of mental health legislation
*CBT, cognitive behavioral therapy.

6. Level of future compliance with restrictions on Domain Four: Victim’s Psychological and Social
access to victim; Vulnerabilities
7. A willingness to accept that stalking indicates that As stated earlier, stalking involves a dyad of perpe-
the stalker has a problem that requires treatment. trator and victim. In most cases, though not all, the
Consideration of the historical and current clinical victim knows the perpetrator. Thus, a consideration
hazards presents a comprehensive picture of the of future stalking risk necessarily must include an
stalker’s overall psychological, psychopathological, examination of the victim and the victim’s psycho-
and social status. Moreover, the information forms logical and social vulnerabilities. As the focus of this
the basis for judging the extent to which the stalker’s article is on the assessment and management of fu-
makeup is indicative of an increased level of ongoing ture risk in the stalking situation, we briefly note the
risk for general or stalking-specific behavior. range of factors that must be considered when eval-
The areas of clinical risk factors and future haz- uating ongoing risks in the stalking situation. The
ards are, we believe, best conceptualized in terms proper assessment and treatment of stalking victims
of the risk and its associated reduction strategy. To is much more involved and cannot be covered in
emphasize that essential association, brief exam- adequate detail here.9
ples of some of the risk factors and management Stalking laws among jurisdictions vary in several
strategies we employ and find effective are tabu- dimensions, including whether the victim must have
lated in tandem (Table 1). The range of factors and experienced fear. Some stalking statutes use an objec-
options provided are not exhaustive and are in- tive standard in which the stalker’s actions are judged
tended to provide clinicians and services with an against whether he or she would reasonably cause
idea of the range of risk factors and strategies avail- fear. In other jurisdictions, statutes require that the
able for helping to address them. victim either feared for his or her own safety or for the

446 The Journal of the American Academy of Psychiatry and the Law
 Mullen, MacKenzie, Ogloff, et al.

Table 2 The Clinical Risk Factors and Future Hazards in the Victim That Aggravate Risks Presented by Stalkers
Risk Factors Potential Management
Clinical
Unwillingness to make use of legal protection Advice and practical assistance in accessing police and other legal protection,
advocacy when indicated
Unwillingness to engage in therapy and take advice Encouragement to join stalking survivor groups and provision of information
about stalking
Future hazards
Anything that will compel ongoing contact with the Strongly encourage total ban on direct contact or direct communication;
stalker (e.g. joint custody of children, shared work provide direction for services to assist with managing any potential
environment) for contact
Initiating contact with the stalker, out of guilt or just Counseling and information on stalking; stalking survivor groups; reinforcing
an inability to leave well enough alone, or through no direct contact, no direct communications
misguided efforts to negotiate an end to the
harrassment
Continuing to reject the use of legal protection and Counseling to restore confidence in services and to provide active advocacy
therapeutic support, or abandoning the services that with law enforcement agencies and increased security
have previously failed
Becoming caught up in attempting to fight back rather Information and counseling on hazards of this approach; counseling aimed at
than reduce risk managing anger more constructively

safety of others (e.g., family members). Given the In Table 2 we set out the relevant clinical risk
difference in how the statutes operate and whether factors and future hazards pertaining to victims’ psy-
they are based on a subjective or objective appraisal of chological and social vulnerabilities. As with stalkers,
fear, clinicians require various information about the such dynamic risk factors and hazards are considered
victim. In all cases in which such information is avail- in tandem with examples of potential management
able, though, the clinician requires a good under- strategies.
standing of the nature of the behavior and its effect
on the victim. Domain Five: Legal and Mental Health Context
We have mentioned that in our experience it is The risks in stalking are critically dependent on
unwise for the clinician who is assessing the stalker to the social and legal context in which the behavior
contact the victim and that it is equally unwise for the occurs. Laws and practices vary broadly across coun-
clinician who is working with the victim to contact tries and within jurisdictions. Thus, the protection
the stalker. This does not mean that we do not be- available to victims and the legal practices and op-
lieve it is critical for information about the victim to tions for dealing with stalkers vary accordingly. Sim-
be obtained and made available to the clinician. In ilarly, the mental health laws, available services, and
our work this information comes most often in vic- practice conventions affect the services available to
tim impact statements, records of police interviews stalkers and victims. It is impossible, therefore, to
with victims, and clinical reports of victims who have discuss in detail the specific legal protection for vic-
been assessed and/or treated. tims and the level of mental health services available
As with stalkers, we have found that it is useful to to victims and perpetrators. Clinicians must famil-
consider the historical, current clinical, and future iarize themselves with the stalking laws and the men-
hazards relevant to the victim. Significant among tal health laws and services available in the jurisdic-
them is the historical or static risk factors of rele- tions in which they work. As there is often a distance
vance. These represent a mixture of general and spe- between written laws and practice, they must under-
cific vulnerabilities in the victim. The general involve stand how, in practice, stalkers are dealt with and
preexisting vulnerabilities to depressive and anxiety exactly what legal sanctions and services are em-
reactions as well as the levels of interpersonal and ployed. Clearly, when considering the risk of future
social support available. The specific factors pertain stalking, clinicians must be able to have a good un-
to victims’ current and past experience of stalking derstanding of the methods and strategies available
behaviors and the nature of the relationships to their for dealing with the stalker. Similarly, stalking victim
tormenters. support services are important in ensuring that stalk-

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 Managing Risks in Stalking Situations

ing victims receive treatment and support to assist The integration process is first and foremost a
them in dealing with the potential for ongoing stalk- needs analysis and the formulation of a management
ing behavior.9 plan for identified risks. The nature of the relation-
Strong anti-stalking legislation is, we believe, the ship and the number of risk factors present will trans-
bedrock on which risk reduction for victims rests, late into the general level of risk the stalker repre-
though those laws have to be understood and sym- sents. Consideration of the specific risks, based on
pathetically applied by the police and judiciary. the information gathered, will enable the clinician to
More research is needed that explores the actual identify the specific areas of concern.
practices for dealing with stalkers and what op- Second comes an assessment of whether the
tions are most effective. The best anti-stalking laws chances of serious harm to the victim are so immi-
include provision for the mandatory mental health nent, or so difficult to manage effectively, that the
assessment of all those convicted of stalking and initial intervention with the stalker should involve
for their compulsory treatment if indicated.60,61 control and containment via the powers of the men-
Sensibly, police forces would do well to have units tal health legislation or criminal courts. Again, clini-
that deal with stalking offenses. Serving in such units cians must be familiar with the legal and mental
should require officers to be trained to understand health contexts in which they work, and it must be
and appreciate the nature of stalking. Mental health considered in appraising the likelihood of managing
professionals must be trained, and, of equal impor- the risks identified. The level of urgency for interven-
tance, funded to provide appropriate services to vic- tions, the need for compulsory powers to ensure
tims and perpetrators. There should be a coordina- compliance, and even the practicality of the service’s
tion of services available in mental health and being involved at all in the case, have all to be evalu-
corrections, accompanied by community-based rein- ated as part of the process of formulation. Risk as-
tegration and management services. Sadly, to our sessments all too readily become essays in the gener-
knowledge no jurisdiction has yet reached the point ation of fear, with all identified factors increasing
of the active enforcement of good anti-stalking legis- apprehension. Stalkers can evoke disproportionate
lation, backed up by adequate mental health provi- fear, even in experienced forensic mental health pro-
sions for victims and stalkers. fessionals. Although several members of our staff
have been stalked, it has never been by anyone re-
ferred for stalking. That being said, appropriate mea-
Integration and Formulation sures and training to protect staff and their privacy
Consistent with the principles of structured pro- are essential.9,24
fessional judgment, the purpose of this approach is The formulation should, in our view, always be
not just to fit individuals into some category of level shared with the patient, except in those circum-
of risk, let alone apportion them a numerical risk stances in which their level of mental disorder makes
rating. Rather it is to consider on a case-by-case basis it impossible. Part of the therapeutic process is shar-
the risk factors and future hazards that exist so as to ing with stalkers and victims the assessment of what
improve management and prevent risks from being is driving the behavior, what the risks inherent in that
realized. If clinicians follow the process described behavior may be, and how best to manage the risks.
herein, they will have a good understanding of the
nature of the relationship between the stalker and the Conclusions
victim, the stalker’s motivations, the general psycho- Stalking is a complex behavior potentially associ-
logical, psychopathological, and social realities of the ated in the victim with psychological, social, and
stalker, the circumstances of the victim, and the legal physical damage, and in the stalker with risks of so-
and mental health context of the jurisdictions. cial and psychological disruption. The effective as-
Armed with this information, the clinician next com- sessment of risks in the stalking situation requires
mences a process of integrating the information to coming to grips with the actual risks inherent in the
arrive at a formulation for the stalker’s behavior and conduct as well as the nature of the stalker and victim
future risks and the likelihood that extant policies and the legal and mental health environment in
and services will be sufficient to ameliorate those which the drama unfolds. Only a detailed and flexi-
risks in the immediate and longer term. ble risk assessment process that takes the different

448 The Journal of the American Academy of Psychiatry and the Law
 Mullen, MacKenzie, Ogloff, et al.

forms of potential damage into account can provide a 18. Westrup D, Fremouw W, Thompson R, et al: The psychological
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450 The Journal of the American Academy of Psychiatry and the Law