Canadian Psychiatric Association

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Guest Editorial
Women’s Mental Health: Focus on Sexual and Reproductive Issues
Ruth Dickson
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In Review
Female Sexual Disorders: Psychiatric Aspects
Robert Taylor Segraves
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Managing Bipolar Disorder During Pregnancy: Weighing the Risks and Benefits
Adele C Viguera, Lee S Cohen, Ross J Baldessarini, Ruta Nonacs

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Review Papers
The Role of Estrogen in Schizophrenia: Implications for Schizophrenia Practice Guidelines for Women

Sophie Grigoriadis, Mary V Seeman

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Should Psychologists Be Granted Prescription Privileges? A Review of the Prescription Privilege Debate for Psychiatrists
Kim L Lavoie, Richard P Fleet

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Original Research
Experiments In Change: Pretrial Diversion of Offenders With Mental Illness

R S Swaminath, J D Mendonca, C Vidal, P Chapman

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Prevalence and Correlates of Elder Abuse and Neglect in a Geriatric Psychiatry Service
Stephen Vida, Richard C Monks, Pascale Des Rosiers

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Brief Communciation
Occupational Effects of Stalking
Karen M Abrams, Gail Erlick Robinson

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Gender-Role Conflict and Suicidal Behaviour in Adolescent Girls
Leora Pinhas, Harriet Weaver, Pier Bryden, Nagi Ghabbour, Brenda Toner

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Book Reviews
(PDF - all reviews)

Comprehensive Care of Schizophrenia: A Textbook of Clinical Management

Drug Addiction and Drug Policy: The Struggle to Control Dependence

At the Side of Torture Survivors: Treating a Terrible Assault on Human Dignity


Letters to the Editor

Gabapentin Treatment of Impulsive-Aggressive Behaviour

Assessing and Managing Compulsive Scratching in Schizophrenia With Chronic Renal Failure

Using the Rating Scale for Psychotic Symptoms to Characterize Delusions Expressed in a Schizophrenia Patient With “Internet Psychosis”

The Ward Changes Address: An Entire Hospital Department Moves to a Modern Building

Sildenafil Citrate for Female Orgasmic Disorder

Suicide Among Immigrants to Canada From the Indian Subcontinent

Fire Fetishism in a Female Arsonist?

Brief Communication

Occupational Effects of Stalking

Karen M Abrams, MD, FRCPC1, Gail Erlick Robinson, MD, DPsych, FRCPC2

 

Objective: This case report and discussion describe the psychiatric and social consequences of being a stalking victim, with particular focus on its impact on the victim’s occupation.

Method: Data were gathered from the assessment and arbitration hearing of a female employee who lost her job while being stalked. Computerized literature searches were used to identify relevant papers from psychiatric and legal journals.

Results: This case illustrates many of the common features of stalking. The female victim was harassed by a male after a failed intimate relationship. The victim suffered from depression, anxiety, guilt, shame, helplessness, humiliation, and posttraumatic stress disorder (PTSD). The stalking affected her psychological, interpersonal, and occupational functioning. Consequently, she was fired for poor work performance and poor attendance.

Conclusion: Stalking may affect a victim’s ability to work in several ways. The criminal behaviours often interfere directly with work attendance or productivity and result in the workplace becoming an unsafe location. Further, stalking may indirectly affect a person’s ability to work through the many adverse emotional consequences suffered.

Can J Psychiatry 2002;47:468–472)

Clinical Implications

  • Stalking has serious mental health consequences.
  • Stalking can affect not only victims’ psychological states and interpersonal relationships but impact greatly on their occupational functioning.
  • Therapists need to be aware of the severe and wide-ranging consequences of criminal harassment.

Limitations

  • This article refers to a specific case of criminal harassment.
  • Research on the consequences of criminal harassment is still limited.

Key Words: stalking, criminal harassment, posttraumatic stress disorder, women’s mental health, occupational stress

Résumé: Effets professionnels du harcèlement criminel


Stalking is now a criminal act throughout the US and Canada. Legally in Canada, it is referred to as “criminal harassment.” Generally, stalking is defined as the “willful, malicious, and repeated following or harassing of another person,” that threatens his or her safety (1). The term refers to repeated and often escalating unwanted intrusions and communications, including loitering nearby; following or surveying a person’s home, making multiple telephone calls or other forms of unwanted direct and indirect communications, spreading gossip, destroying personal property, harassing acquaintances or family members, sending threatening or sexually suggestive “gifts” or letters, and aggressive and violent acts. The behaviour terrorizes, intimidates, and controls the victim.

Roughly 90% of stalkers are men, and about 80% of victims are women (2,3). Women are significantly more likely than are men to be stalked by a current or former intimate partner (3). Most stalking victims are women who are being harassed by men who wish to either reestablish or initiate a relationship (3). The largest group of stalkers are ex-husbands or partners who refuse to accept that the relationship is over or who seek revenge for a perceived rejection or other infraction (4).

In 1997, the Center for Policy Research, the US Department of Justice, conducted the National Violence Against Women (NVAW) Survey and collected data from 8000 women and 8000 men and found the incidence and prevalence of stalking to be even higher than had been previously thought, affecting 1.4 million Americans yearly (2). Of these, 8% of women and 2% of men have been stalked at some point in their lives, equating to 8 million female and 2 million male lifetime victims in the US.

To date, there have been limited studies about the psychological consequences of stalking. Pathe and Mullen surveyed 100 Australian stalking victims and documented the adverse psychological impact of being stalked (5). Of these, 83% reported heightened anxiety, including panic attacks and hypervigilance. These women also reported sleep disturbances (74%), intrusive recollections or flashbacks (55%), appetite disturbance (48%), suicidal thoughts (24%), various somatic symptoms, and lowered levels of functioning. Nearly 40% met criteria for posttraumatic stress disorder (PTSD), with another 18% having the clinical features but not meeting the criteria of a stressor involving threatened or actual physical harm. Interestingly, they found a trend toward greater likelihood of posttraumatic stress symptoms in women who had a prior intimate relationship with their stalker.

Westrup and Fremouw studied 36 women who were undergraduate stalking victims, using the PTSD Scale, and the Symptom Checklist-90-R (SCL-90) (6). Stalked subjects experienced significantly more PTSD symptoms and had significantly greater severity of symptoms than did control subjects. The stalked subjects’ positive-symptom totals and distress indices from the SCL-90 were significantly greater than those of the control subjects and showed elevated subscales of depression, interpersonal sensitivity, and obsessive–compulsive symptoms.

Hall conducted a national telephone survey of 145 stalking victims and found that, following the crime, victims reported becoming more aggressive, paranoid, easily frightened, and cautious of others (3). Of the respondents, 83% reported that their personalities changed as a result of being stalked. In the NVAW study, about one-third of the women and one-fifth of the men sought psychological counselling as a result of the stalking victimization (2).

These studies support the information on victims from newspapers, magazines, therapists, victims’ organizations, victim impact reports, and the police. Stalking causes its victims to suffer severe emotional consequences. Clinically, it appears that women who are stalked may suffer from depression, anxiety, guilt, shame, helplessness, humiliation, and PTSD (7). In addition, society’s failure to understand the causes and consequences of stalking crimes results in victims who are often judged responsible for encouraging the stalking. As a result, they may face problems dealing with the legal system and problems with obtaining treatment (8).

The Hall study also reported the dramatic toll this crime has on victims’ lives. Many moved. Some changed their names, moved, or went “underground, leaving family and friends behind in order to escape the terror.” Several changed their appearance. Further, Hall noted that most victims experienced acts that were violent in nature. “That, along with the ominous threats and constant surveillance and intrusion into the victim’s lives, has long-term, damaging psychological effects. Living in fear takes a toll on the quality of human life”(3).

Specifically, several studies reported the consequences to the victim’s employment. Pathe and Mullen’s study of 100 victims found that stalking had a deleterious impact on their occupational functioning, with all but 6 reporting major lifestyle changes (5).

 

To avoid places the stalker might frequent, 82% of the victims had modified their usual activities as a result of being approached or followed, and 53% reported a decrease or cessation of work or school attendance. Hall noted that many had left jobs, which perhaps related to stalkers (54%) appearing at the workplace. The NVAW study reported that one-quarter of victims lost time from work, with 7% of those never returning (2). Absence from work occurred for various reasons, such as the emotional consequences of stalking, time needed to deal with the criminal justice system or mental health professionals, and a wish to avoid contact with the assailant. It is not uncommon for reduced productivity to cost victims their jobs. Also, a worker may be fired either because of the stalker’s constant appearance at work or owing to harassment of the employer. Many victims become isolated and deprived of support after employers and friends withdraw out of fear. Likewise, victims may cease communication either to protect employers and friends or out of a sense of shame (5,9).


Case Report

Ms K is a 37-year-old divorced woman living with her son, age 2½ years. She works for a temporary agency, having been fired from her previous job after 10 years as a flight attendant for a major US airline. Prior to the stalking, Ms K had always been emotionally healthy. She grew up in a loving, supportive, and nurturing environment. There was no history of emotional, physical, or sexual abuse and no family history of psychiatric illness or substance abuse. Her first marriage at age 19 years lasted 3½ years and ended as she realized her husband was somewhat controlling and unfaithful. She described her second husband in a positive light. They separated because they had drifted apart emotionally and ideologically but remained good friends. Ms K has a 2½ year-old son whom she adopted at age 8 weeks. She had never had any attendance or performance problems with this or with any other job.

In the fall of 1993, as her union of flight attendants prepared for a strike action, Ms K began to volunteer at the union headquarters and met Mr A. Ms K described this as a very stressful period during which flight attendants were uncertain of their future, with the implications of the strike. Also, she was separating from her husband. Ms K became closer to Mr A, who appeared quite caring, sympathetic, and understanding during that period of vulnerability. He held the same beliefs, was attentive, compassionate, and intelligent. His charming personality, charisma, manipulation, and intellect had won over many union members and led to his high-profile position. Following her separation from her husband, they began to date and had a passionate “fairy-tale” romance.

In the summer of 1994, Mr A was fired after failing a random drug test, testing positive for methamphetamine. Ms K believed his story that “he was set up.” Their relationship continued over the next 2 years, but gradually deteriorated as it became clearer to her that he was lying, manipulative, taking advantage of her financially, and unfaithful. She described him as emotionally abusive to the extent that she felt insecure and “paranoid.” Meanwhile, he continued to profess his obsessive “love” for her. Finally, in 1996 she tried to end the relationship.

At that time, Mr A began various repeated and escalating, intrusive, and intimidating acts of harassment. He made multiple telephone calls, sometimes leaving up to 20 long verbally abusive and vulgar messages on her answering machine. He even managed to find her on layovers and call her room at night. He was so manipulative that he managed to get through even when she had left specific instructions with the hotel operator to hold all her calls.

He promised to destroy Ms K’s life, threatening to plant drugs on her and then call the police. Mr A stole Ms K’s mail. He made an additional cardholder on her credit card, on which he used to cash-advance himself large sums of money. On multiple occasions, he followed her, watched her, or approached her. On one occasion, while she was driving with a male friend, he followed, yelling insults at her and threatening her acquaintance. On another occasion, when her ex-husband visited, Mr A repeatedly telephoned and then rang her doorbell. When Ms K called the police, she later found that he had talked (lied) his way out of the problem. Mr A called her mother that night threatening, “Nobody will ever have her; I will make sure of that.” On numerous occasions, he tried humiliating Ms K by calling her mother and relaying to her that Ms K was dealing drugs or was sleeping around. He also told her mother, “I’m gonna take her down . . . She will lose everything . . . She’ll never be with anybody else.”