Two additional observations also are notable when trying to characterize people who write letters: (1) A high percentage of people who stalk a celebrity suffer a psychotic disorder5,6; (2) 4 letter-writers traveled, and 1 relocated, to the murderer’s state of incarceration to attend his hearings and be closer to him.
This study has limitations:
• categorization of letters is inherently subjective and the categories themselves were created by the researchers
• the nature and categorization of such letters might vary considerably with the age and sex of the violent criminal; our findings in this case are not generalizable.
Last, researchers who plan to study writers of letters to incarcerated criminals should consider sending a personality test and other questionnaires to those writers to understand this population better.
Treatment considerations
Psychiatrists treating patients who seek a romantic attachment with a violent person should consider psychotherapy as a means of treating possible character pathology. The desire for romance with a violent criminal was greater among repeat writers (20%) than in initial letters (15%), suggesting that people who have a strong inclination to associate with a violent person might benefit from exploring romantic feelings in therapy. Specifically, therapists would be wise to explore with such patients the possibility that they experienced violence or verbal abuse in childhood or adulthood.
To the extent that evidence of prior abuse exists, a diagnosis of posttraumatic stress disorder (PTSD) might be appropriate; specialized therapy for men and women with a history of abuse might be indicated. It is important to provide validation for patients who are victims when they describe their abuse, and to stress that they did nothing to provoke the violence. Furthermore, investigation of why the patient feels drawn romantically toward a violent criminal is helpful, as well as an examination of how such behavior is self-defeating.
There might be value in having patients keep a journal in lieu of actually sending letters; there is evidence that “journaling” can reduce substance use recidivism.7 This work can be performed in conjunction with group or individual psychotherapy that addresses any history of abuse and subsequent PTSD.
Many patients are reluctant to discuss their romantic feelings toward a violent criminal until the psychiatrist has established a strong doctor−patient relationship. Last, clinicians should not hesitate to refer these patients to a therapist who specializes in domestic violence.
Related Resource
• Marazziti D, Falaschi V, Lombardi A, et al. Stalking: a neurobiological perspective. Riv Psichiatr. 2015;50(1):12-18.
Disclosures
The authors report no financial relationships with any company whose products are mentioned in this article or with manufacturers of competing products.