Evidence-Based Reviews

What stalking victims need to restore their mental and somatic health

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Victims’ mood, anxiety, and posttraumatic stress symptoms require prompt care



The obsessive pursuit of another has long been described in fiction and the scientific literature, but was conceptualized as “stalking” only rela­tively recently—first, under the guise of celebrity stalking and, later, as a public health issue recognized as affecting the general population. A useful working definition of stalking is “… the willful, malicious, and repeated fol­lowing of and harassing of another person that threatens his/her safety.”1

Stalking victims report numerous, severe, life-changing effects from being stalked, including physical, social, and psychological harm. They typically experience mood, anxi­ety, and posttraumatic stress symptoms that require prompt evaluation and treatment.

Prevalence and other characteristics
Stalking and its subsequent victimization are common. Here are statistics:
• in the United States, approximately 1 million women and 370,000 men are stalked annually
• women are 3 times more likely to be stalked than raped2
• lifetime prevalence of stalking victimization is 20% (women, 23.5%; men, 10.5%)
• 75% of stalking victims are women
• 77% of stalking emerges from a prior acquaintance, including 49% that originated in a romantic relationship
• 33% of stalking encounters eventually lead to physical violence; slightly >10% of encounters lead to sexual violence
• stalking persists for an extended period; on average, almost 2 years.3

Penalties. Stalking can result in interven­tion by the criminal justice system. Legal sanctions levied on the perpetrator vary, depending on (among other variables) the severity of stalking; type of stalking; motive of the stalker; and the strength of incriminating evidence. Surprisingly, the outcome of the perpetrator’s prosecution (arrest, conviction, length of sentence) is unrelated to whether the victim reported continued stalking at follow-up.4,5

What are the symptoms and the dam­age? Given the intrusive nature of stalking behaviors and the extended period during which stalking persists, victims typically experience harmful psychological effects that range from subclinical symptoms to overt psychiatric disorders.

Stalking can have a profound impact on the victim and result in numerous psycho­logical symptoms that become the focus of clinical attention. The typically chronic nature of stalking probably plays a signifi­cant role in its contributions to its victims’ psychological distress.6 Melton7 found that the most common adverse effect of stalk­ing was related to the emotional impact of being stalked—with victims feeling scared, depressed, humiliated, embarrassed, dis­trustful of others, and angry or hateful.

Stalking victims report traumatic stress, hypervigilance, excessive fear, and anxiety coupled with disruptions in employment and social interactions.8 Many report hav­ing become highly distrustful or suspicious (44%); fearful (42%); nervous (31%); angry (27%); paranoid (36%); and depressed (21%). In general, victims have elevated scores on the Trauma Symptom Checklist.9

Stalking in the setting of intimate part­ner abuse is associated with harmful out­comes for the victim. These include repeat physical violence, psychological distress, and impaired physical or mental health, or both.3,7,10

Stalking victims who are female; had a prior relationship with the stalker; have experienced a greater variety of stalking behaviors; are divorced or separated; and have received government assistance were found to be more likely to experience mul­tiple negative outcomes from stalking.11

Effects on mental health. Stalking victims have a higher incidence of mental disorders and comorbid illnesses compared with the general population,12 with the most robust associations identified between stalking victimization, major depressive disorder, and panic disorder. Stalking contributes to symptoms of posttraumatic stress disor­der,13 and there is an association between posttraumatic stress and poor general health.14 Stalking victims report higher cur­rent use of psychotropic medications.12

Victims who blame themselves for being stalked report a significantly higher severity of depression, anxiety, and post­traumatic stress symptoms. Those who ruminate more about the stalking expe­rience, or who explicitly emphasize the terror of stalking to a greater extent, also report a significantly higher severity of symptoms.15

Spitzberg3 reported that stalking victim­ization has several possible effects on vic­tims (Table 1).

Coping by movement. Victims might attempt to cope with stalking through sev­eral means,2 including:
• moving away—trying to avoid contact with the stalker
• moving with—negotiating a more acceptable form of relationship with the stalker
• moving against—attempting to harm, constrain, or punish the stalker
• moving inward—seeking self-control or self-actualization
• moving outward—seeking the assis­tance of others.

The degree of a victim’s symptoms corre­lates partially with the severity of stalking. However, other variables play a crucial role in explaining the level of distress among stalking victims15; these include the types of coping strategies adopted by victims. Self-blame, catastrophizing, and rumination are significantly associated with malad­justment; on the other hand, positive reap­praisal—thoughts of attaching a positive meaning to the event, in terms of personal growth—is associated with greater psycho­logical adjustment.

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