Evidence-Based Reviews

What stalking victims need to restore their mental and somatic health

Current Psychiatry. 2015 June;14(6):43-47

References

1. Meloy JR, Gothard S. Demographic and clinical comparison of obsessional followers and offenders with mental disorders. Am J Psychiatry. 1995;152(2):258-263.
2. Tjaden P, Thoennes N. Stalking in America: findings from the National Violence Against Women Survey. National Institute of Justice and Centers for Disease Control and Prevention. https://www.ncjrs.gov/pdffiles/169592.pdf. Published April 1998. Accessed March 25, 2015.
3. Spitzberg BH. The tactical topography of stalking victimization and management. Trauma, Violence, & Abuse. 2002;3(4):261-288.
4. McFarlane J, Willson P, Lemmey D, et al. Women filing assault charges on an intimate partner: criminal justice outcome and future violence experienced. Violence Against Women. 2000;6(4):396-408.
5. Melton HC. Stalking in the context of domestic violence: findings on the criminal justice system. Women & Criminal Justice. 2004;15:33-58.
6. Davies KE, Frieze IH. Research on stalking: what do we know and where do we go? Violence Vict. 2000;15(4):473-487.
7. Melton HC. Stalking in the context of intimate partner abuse: in the victims’ words. Feminist Criminology. 2007;2(4):346-363.
8. Spence-Diehl E. Intensive case management for victims of stalking: a pilot test evaluation. Brief Treatment Crisis Intervention. 2004;4(4):323-341.
9. Brewster MP. An exploration of the experiences and needs of former intimate stalking victims: final report submitted to the National Institute of Justice. West Chester, PA: West Chester University; 1997.
10. Logan TK, Shannon L, Cole J, et al. The impact of differential patterns of physical violence and stalking on mental health and help-seeking among women with protective orders. Violence Against Women. 2006;12(9):866-886.
11. Johnson MC, Kercher GA. Identifying predictors of negative psychological reactions to stalking victimization. J Interpers Violence. 2009;24(5):866-882.
12. Kuehner C, Gass P, Dressing H. Increased risk of mental disorders among lifetime victims of stalking—findings from a community study. Eur Psychiatry. 2007;22(3):142-145.
13. Basile KC, Arias I, Desai S, et al. The differential association of intimate partner physical, sexual, psychological, and stalking violence and post-traumatic stress symptoms in a nationally representative sample of women. J Traumatic Stress. 2004;17(5):413-421.
14. Kamphuis JH, Emmelkamp PM. Traumatic distress among support-seeking female victims of stalking. Am J Psychiatry. 2001;158(5):795-798.
15. Kraaij V, Arensman E, Garnefski N, et al. The role of cognitive coping in female victims of stalking. J Interpers Violence. 2007;22(12):1603-1612.
16. Bennett Cattaneo L, Cho S, Botuck S. Describing intimate partner stalking over time: an effort to inform victim-centered service provision. J Interpers Violence. 2011;26(17):3428-3454.
17. Spence-Diehl E, Potocky-Tripodi M. Victims of stalking: a study of service needs as perceived by victim services practitioners. J Interpers Violence. 2001;16(1):86-94.
18. Galeazzi GM, Buc˘ar-Ruc˘man A, DeFazio L, et al. Experiences of stalking victims and requests for help in three European countries. A survey. European Journal of Criminal Policy Research. 2009;15:243-260.
19. McEwan T, Purcell R. Assessing and surviving stalkers. Presented at: 45th Annual Meeting of American Academy of Psychiatry and the Law; October 2014; Chicago IL.
20. Cattaneo LB, Goodman LA. New directions in IPV risk assessment: an empowerment approach to risk management. In: Kendall-Tackett K, Giacomoni S, eds. Intimate partner violence. Kingston, NJ: Civic Research Institute; 2007:1-17.
21. Goodman LA, Epstein D. Listening to battered women: a survivor-centered approach to advocacy, mental health, and justice. Washington DC: American Psychological Association; 2008.
22. Cattaneo LB, Goodman LA. Through the lens of jurisprudence: the relationship between empowerment in the court system and well-being for intimate partner violence victims. J Interpers Violence. 2010;25(3):481-502.
23. Zweig JM, Burt MR. Predicting women’s perceptions of domestic violence and sexual assault agency helpfulness: what matters to program clients? Violence Against Women. 2007;13(11):1149-1178.

The more stalking a victim experiences (and, presumably, experiences greater distress), the greater the variety of coping strategies she (he) employs.¹⁶

How should stalking victims be treated?
Stalking victims are an underserved population. Practitioners often are unsure how to address stalking; furthermore, available treatments can be ineffective.

There is a great deal of variability in what professionals who work with stalking victims believe is appropriate practice. Services provided to victims vary widely,¹⁷and the field has not yet come to a consensus on best practices.¹⁶

Proceed case by case. Practitioners must understand the nuances of each case to consider what might work at a particular point in time, and information from victims can help guide decision-making.16 Evidence suggests that stalking victims can feel frustrated in their attempt to seek help, particularly from the criminal justice system; it is possible that such bad experiences may dissuade them from seeking help later.^5,8,18 It is worth noting that, as the frequency of stalking decreases for any given victim, her (his) perception of safety increases and distress diminishes.¹⁶

Few communities have attempted to address systemically the problem of stalking. Existing anti-stalking programs have focused on the criminal justice aspects of intervention,⁸ with less emphasis on treating victims.

Some stalking victims rely on friends and family for support and assistance, but research shows that most reach out to agencies for assistance and, generally, seek help from multiple sources.¹⁸ Typically, stalking victims are served by 2 types of victim service organizations:
• specialized, small, private and nonprofit agencies (eg, domestic violence shelters, rape crisis centers, victims’ rights advocacy organizations)
• small units housed in police departments and prosecutors’ offices.¹⁷

Note: When victims seek services at criminal justice agencies, they may be feeling particularly unsafe and distressed. This underscores the importance of co-locating victim service providers and criminal justice agencies.¹⁶

Stalking victims might benefit from multi-disciplinary team consultation, including input from psychiatric, psychotherapeutic, and law enforcement or security professionals. Key priorities for practitioners to address with stalking victims are given in Table 2.¹⁹

Stalking behavior does not significantly decrease when victims are in contact with victim services.16 Practitioners can integrate this prospect into their understanding of stalking when they work with victims: That is, it is likely that the problem will not go away quickly, even with intervention.

Victims’ needs remain great and broad-based. Spence-Diehl et al¹⁷ conducted a survey of service providers for stalking victims, evaluating the needs of those victims and the response of their communities. Some of their recommendations for better meeting victims’ needs are in Table 3.¹⁶

Keeping victims at the center
Several authors have written about the need to return to a victim-centered model of care. This approach (1) puts the victim’s understanding of her (his) situation at the center of victim assistance work and (2) views service providers as consultants in the decision-making process.^20,21The victim-centered approach to treatment, in which the client has a greater voice and degree of control over interventions, is associated with positive outcomes.^22,23

At the heart of a client-centered model of victim assistance is the provider’s ability to listen to a victim’s story and respond in a nonjudgmental manner. This approach honors the victim’s circumstances and her personal understanding of risk.²¹

Bottom Line
Stalking victims are a distinctive population, experiencing numerous emotional, physical, and social effects of their stalking over an extended period. Services to treat this underserved population need to be further developed. A multifaceted approach to treating victims incorporates psychological, somatic, and practical interventions, and a victim-centered approach is associated with better outcomes.

Related Resources
• Harmon RB, O’Connor M. Forcier A, et al. The impact of anti-stalking training on front line service providers: using the anti-stalking training evaluation protocol (ASTEP). J Forensic Science. 2004;49(5):1050-1055.
• Spitzberg BH, Cupach WR. The state of the art of stalking: taking stock of the emerging literature. Aggression and Violence Behavior. 2007;12(1):64-86.

Disclosure
The author reports no financial relationships with any company whose products are mentioned in this article or with manufacturers of competing products.

What stalking victims need to restore their mental and somatic health

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