Stalking: The Veiled Epidemic
By Ryan S. Shugarman, MD |
July 7, 2009
Dr Shugarman is a forensic psychiatry fellow at the University of Pittsburgh School of Medicine/Western Psychiatric Institute and Clinic. Following graduation, he will be employed as a forensic psychiatrist at Saint Elizabeths Hospital in Washington, DC. He reports no conflicts of interest concerning the subject matter of this article.
Jonathan is a bright but fairly shy 19-year-old who met Melanie, a fellow classmate, in the sixth grade. Over the next several years, Jonathan and Melanie rarely spoke, but by the age of 17, his feelings toward her had intensified, and he professed his love for her in a poem. Melanie’s response was met with surprise, however, when she referred to him as a “stalker” and requested that he refrain from contacting her again. Though disheartened and confused by her reaction, Jonathan remained undeterred and persisted in sending her letters that simultaneously expressed his apologies and pled for her affection, despite being suspended from school for such conduct. Jonathan admitted to visiting Melanie’s home on one occasion to hand-deliver a letter but denied ever making threats or engaging in harming behavior.
With worsening depressive symptoms and eventual suicidal ideation, Jonathan was hospitalized for 10 days, where he was started on an antidepressant regimen and referred for outpatient treatment. While Jonathan realized that his all-consuming preoccupation with Melanie had contributed to his distress and adverse consequences, he nevertheless enjoyed fantasizing about her and could not accept either the inappropriateness of his actions or the possibility of not having Melanie as a part of his life. “I want to leave her alone, but there’s something inside that won’t let me,” he remarked.
According to the Mullen typology,5 Jonathan was classified as an intimacy-seeking stalker. He was deemed a significant risk for attempting to contact Melanie again but was thought to pose a low risk for committing any overt acts of violence. To target Jonathan’s depressive symptoms and possible ruminations, his antidepressant dosage was increased. Therapy goals included improving Jonathan’s insight into the distress caused to both him and to Melanie, exploring aspects of Jonathan’s life with which he was dissatisfied, identifying short- and long-term goals, and teaching him methods to tolerate distress. With treatment, Jonathan’s preoccupation with Melanie decreased considerably.
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