Cases That Test Your Skills

Stalked by a ‘patient’

Current Psychiatry. 2012 October;11(10):40-44

References

1. Mullen PE, Pathé M, Purcell R, et al. Study of stalkers. Am J Psychiatry. 1999;156(8):1244-1249.

2. Sandberg DA, McNiel DE, Binder RL. Stalking threatening, and harassing behavior by psychiatric patients toward clinicians. J Am Acad Psychiatry Law. 2002;30(2):221-229.

3. McIvor R, Potter L, Davies L. Stalking behavior by patients towards psychiatrists in a large mental health organization. Int J Soc Psychiatry. 2008;54(4):350-357.

4. Mullen PE, Pathé M. Stalking. Crime and Justice. 2002;29:273-318.

5. Bird S. Strategies for managing and minimizing the impact of harassment and stalking by patients. ANZ J Surg. 2009;79(7-8):537-538.

6. Sinwelski SA, Vinton L. Stalking: the constant threat of violence. Affilia. 2001;16(1):46-65.

7. Meloy JR. Commentary: stalking threatening, and harassing behavior by patients—the risk-management response. J Am Acad Psychiatry Law. 2002;30(2):230-231.

8. Resnick PJ. Stalking risk assessment. In: Pinals DA, ed. Stalking: psychiatric perspectives and practical approaches. New York, NY: Oxford University Press; 2007:61–84.

9. Dietz PE. Defenses against dangerous people when arrest and commitment fail. In: Simon RI, ed. American Psychiatric Press review of clinical psychiatry and the law. 1st ed. Washington, DC: American Psychiatric Press; 1989:205–219.

10. Hilliard J. Termination of treatment with troublesome patients. In: Lifson LE, Simon RI, eds. The mental health practitioner and the law: a comprehensive handbook. Cambridge, MA: Harvard University Press; 1998:216–224.

11. Paterick TJ, Paterick BB, Paterick TE. Implications of Good Samaritan laws for physicians. J Med Pract Manage. 2008;23(6):372-375.

12. MacKenzie RD, James DV. Management and treatment of stalkers: problems options, and solutions. Behav Sci Law. 2011;29(2):220-239.

13. Fremouw WJ, Westrup D, Pennypacker J. Stalking on campus: the prevalence and strategies for coping with stalking. J Forensic Sci. 1997;42(4):666-669.

14. Nicastro AM, Cousins AV, Spitzberg BH. The tactical face of stalking. Journal of Criminal Justice. 2000;28(1):69-82.

15. Spitzberg BH. The tactical topography of stalking victimization and management. Trauma Violence Abuse. 2002;3(4):261-288.

16. Pathé M, MacKenzie R, Mullen PE. Stalking by law: damaging victims and rewarding offenders. J Law Med. 2004;12(1):103-111.

17. Lion JR, Herschler JA. The stalking of physicians by their patients. In: Meloy JR. The psychology of stalking: clinical and forensic perspectives. San Diego, CA: Academic Press; 1998:163–173.

Promoting litigation carries significant risk.¹⁶ Being a defendant in pro se litigation may be emotionally and financially stressful. This approach may be desirable if the psychiatrist’s institution is willing to offer substantial support. For example, an institution may provide legal assistance—including helping to defray the cost of litigation—and litigation-related scheduling flexibility. An attorney may serve as a boundary between the victim and the pro se litigant’s sometimes ceaseless, time-devouring, anxiety-inducing legal maneuvers.

Counterthreats. Warning a stalker that he or she will face severe civil and criminal consequences if his or her behavior continues can make clear that his or her conduct is unacceptable.¹⁷ Such warnings may be delivered verbally or in writing by a legal representative, law enforcement personnel, a private security agent, or the victim.

Issuing a counterthreat can be risky. Stalkers with antisocial or narcissistic personality features may perceive a counterthreat as narcissistically diminishing, and to save face will escalate their stalking in retaliation. Avoid counterthreats if you believe the stalker might be psychotic because destabilizing such an individual—such as by precipitating a short psychotic episode—may increase unpredictability and diminish their responsive to interventions.

Clinical Point

Counterthreats can be risky with stalkers with antisocial or narcissistic personality features or psychotic individuals

Ms. I’s contact with the resident lasted approximately 20 months, slightly less than the average 26 months reported in a survey of mental health professionals.³ Because stalkers are unpredictable, the psychiatric resident remains cautious.

Related Resources

National Center for Victims of Crime. Stalking resource center. www.victimsofcrime.org/our-programs/stalking-resource-center.
Mullen PE, Pathé M, Purcell R. Stalkers and their victims. New York, NY: Cambridge University Press; 2009.

Disclosure

The authors report no financial relationship with any company whose products are mentioned in this article or with manufacturers of competing products.