The Interface borderline personality disorder, this

diagnosis is particularly suggestive

among stalkers. In this edition of The
Interface, we examine the possible
association between stalking
behavior and borderline personality
disorder. Five studies report
prevalence rates of borderline
personality disorder among stalkers,
with four reporting rates between 4
and 15 percent (i.e., a small
minority). However, three of these
studies represent forensic
populations and one consists of
patients who stalked their
psychiatrists. In contrast, in the
remaining sample of stalkers, where
being charged with a crime was not
an inclusion criterion, the prevalence
of borderline personality disorder
was considerably higher at 45
percent. These data suggest that in
less forensically focused samples of
stalkers, rates of borderline
personality are likely to be
substantially higher, but
confirmatory data is lacking.

Fatal Attraction Syndrome: KEY WORDS

borderline personality, stalking

Stalking Behavior and INTRODUCTION

Who can forget the terrifying
Borderline Personality character Alex Forrest (Glenn Close)
in the movie Fatal Attraction (1987),
as she stalked, tormented, and
by Randy A. Sansone, MD, and Lori A. Sansone, MD threatened her married, one-night-
stand lover, Dan Gallagher (Michael
Psychiatry (Edgemont) 2010;7(5):42–46 Douglas)? Or the freakish and rage-
ridden Evelyn Draper (Jessica
This ongoing column is dedicated to the challenging clinical interface between psychiatry and
Walter), who is spurned by Dave
primary care—two fields that are inexorably linked. Garver (Clint Eastwood), which
results in near death for both Dave
and his girlfriend in the movie Play
ABSTRACT Department of Justice, eight percent Misty for Me (1971)? Or even Darian
Stalking, which consists of chronic of women and two percent of men Forrester (Alicia Silverstone), the
nuisance behaviors by an offender have been victimized at some time in young 14-year-old girl who develops
that result in deleterious emotional their lives by stalkers. Stalking could a perilous infatuation with Nick Eliot
and/or physical effects on a victim, is be viewed as an illogical or irrational (Cary Elwes) in The Crush (1993)?
experienced by a significant minority preoccupation with another What do all of these exemplary
of individuals in the community. individual. Because of the unusual movies share in common? They each
According to the United States and intense attachment dynamics in have a lead character who stalked

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her coveted victim—and each stalker cannot discern from these data the impressions of Sheridan et al,2
suffered from borderline personality underlying psychopathology of the stalking exists in other countries as
disorder (BPD). offenders. In this edition of The well. However, at this juncture,
While movie portrayals tend to Interface, we discuss the possible studies are limited. In an Australian
dramatize the characters and their role of BPD as an underlying community sample, 23 percent of
behaviors, stalking is not an psychopathology in stalking participants reported having ever
uncommon behavior. For example, in behavior—a troubling behavior that experienced brief harassment or
a 2006 community survey, the United may be encountered in either a protracted stalking.5 In a study from
States Department of Justice psychiatric or primary care setting. Austria, Stieger et al6 determined
(Bureau of Justice Statistics) that the lifetime prevalence of
investigated stalking behavior among STALKING BEHAVIOR: BROAD stalking in a community sample was
United States citizens through the PREVALENCE DATA 11 percent. According to the findings
National Crime Victimization Survey: Stalking behavior is defined by of the 1998 British Crime Survey, 12
Stalking Victimization Supplement.1 Sheridan et al2 as chronic nuisance percent of United Kingdom
In this cohort of more than 65,000 behaviors by an offender that result participants reported a lifetime
participants ages 18 years or older, in deleterious emotional and/or history of being stalked.7 Finally, in a
the 12-month prevalence of physical effects on a victim. These German study by Kuehner et al,8 11
victimization by stalking was 1.4 per authors report that the lifetime percent of participants reported
every 100 persons. The most prevalence of being stalked is being stalked at some point in their
frequent behaviors reported by between 12 and 16 percent among lives. While the majority of
affected participants were unwanted women and 4 and 7 percent among international lifetime prevalence
telephone calls and messages (63%) men, and that the behavioral rates hover around 11 to 12 percent,
unwanted letters and e-mails (30%), patterns of offenders appear fairly there may be some variability in
being the brunt of rumors spread by consistent over various samples from these data based upon investigators’
the perpetrator (29%), being different countries. We now take a definitions of stalking as well as the
followed or spied upon (25%), closer examination of the likelihood interpretation of stalking by
getting unexpectedly confronted by of being stalked. participants (e.g., brief nuisance
the perpetrator (22%), being waited United States studies on behaviors versus bona-fide stalking
for (20%), and receiving unwanted prevalence. In addition to the behavior).
presents (9%). While most victims recent study by the United States
reported being stalked for a year or Department of Justice, Tjaden and ASSOCIATIONS OF STALKING
less, 10 percent acknowledged Thoennes surveyed 8,000 women WITH BPD
continued victimization for five or and 8,000 men in the 1998 National The underlying psychopathologies
more years. Unexpectedly, in this Violence Against Women Survey.3 In of those who stalk others include
community sample, male participants this study, lifetime prevalence rates various Axis I diagnoses, such as
were equally likely to be stalked by of being stalked were eight percent schizophrenia, delusional disorder,
males or females, whereas female in women and two percent in men, bipolar disorder, substance-related
victims were more likely to be with 12-month prevalence rates at disorders, and major depression.
stalked by males (67%). Victims one percent and 0.4 percent, However, for the remainder of this
most commonly believed that they respectively. article, we will focus on possible
were stalked because of retaliation, In addition to the preceding two associations between stalking and
anger, or spite (37%); control issues studies, Bjerregaard examined BPD. Why is this association of
(33%); and/or the mental or victimization by stalking in a sample noteworthy relevance? Recall that the
emotional instability of the of college students.4 In this cohort at Diagnostic and Statistical Manual
perpetrator (23%). a large public university, the lifetime of Mental Disorders, Fourth
What do these data indicate? prevalence of being stalked was 25 Edition, Text Revision (DSM-IV-TR)
Being victimized in the United States percent in women and 11 percent in describes BPD as characterized by, “a
by stalking behavior is not men. Somewhat surprisingly, six pattern of unstable and intense
uncommon, manifests through a percent of participants indicated that interpersonal relationships” coupled
variety of different contact they were currently being stalked. with “frantic efforts to avoid real or
behaviors, and is likely to occur for a International studies on imagined abandonment.” Indeed, the
number of reasons. However, we prevalence. In keeping with the paradoxical over- and under-

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TABLE 1. Prevalence of BPD among various samples of stalkers

PREVALENCE OF BPD
SAMPLE/METHOD
FIRST AUTHOR YEAR OF STUDY COMMENT
DESCRIPTION
NUMBER (%)

Recollections of psychiatrists of
UK psychiatric patients;
McIvor16 2008 6/41 (15%) patients who stalked them; BPD
retrospective survey
most common Axis II diagnosis

US females; retrospective
cases of mental health and
law-enforcement BPD most common Axis II
Meloy17 2003 10/22 (45%)
professionals; diagnosis
charges/conviction not
necessary

Australian females; forensic BPD equally common as

Purcell18 2001 6/40 (15%)
mental health clinic dependent personality

Archival files of 25 US
forensic subjects, who Diagnoses assigned at the time
Kienlen 19
1997 2/25 (8%)
underwent previous of forensic evaluation
psychiatric assessment

Persons criminally charged

with stalking between 1987 Diagnoses undertaken by
Harmon 20
1995 2/48 (4%)
and 1994 in New York forensic psychiatry clinic staff
County Criminal Court

KEY: BPD = borderline personality disorder

attachment style of these patients is In another United Kingdom study Australian study, Mullen et al11
well known by clinicians and seems to by Whyte et al,10 investigators examined 145 stalkers who were
provide a fertile substrate for the examined personality dysfunction in a referred to a forensic psychiatry
evolution of stalking behavior. consecutive sample of 362 admissions center for treatment. In this cohort,
to a high-security hospital. In this 51 percent had a primary diagnosis of
STALKING AND PERSONALITY sample, nine percent of participants personality disorder, with the majority
DISORDERS were classified as stalkers. Most of falling into the Cluster B category.
Several studies have examined the these individuals suffered from However, there was no description of
prevalence of Axis II disorders among psychosis and Axis II disorders—but the frequency of individual
the perpetrators of stalking, but have again, the authors did not specify the personality disorders within this
not specified the explicit type of profile of individual personality cluster.
personality disorder. For example, in disorders. In a United States study,
a United Kingdom study of 85 stalkers Rosenfeld12 examined 148 court-
who were referred to a forensic STALKING AND CLUSTER B referred stalking offenders. He found
service, James and Farnham9 found ASSOCIATIONS that 52 percent of these individuals
that 24 percent evidenced some type In the next group of studies, fell into the diagnostic categories of
of Axis II disorder, but the authors did investigators identified Cluster B borderline, antisocial, and narcissistic
not describe the explicit prevalence associations with stalking behavior, traits or disorders, but no individual
rates for the individual personality without any further Axis II prevalence percentages were
disorders. clarification. For example, in an reported in the article.

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[ t h e i n t e r f a c e ]

STALKING AND BORDERLINE clinical features). Variation in BPD victims in our psychiatric and
PERSONALITY FEATURES prevalence may also be explained by primary care practices.
In addition to stalker studies that sample type. Explicitly, in
have determined prevalence rates for populations with greater forensic THE STALKING RESOURCE
only Cluster B disorders, in several implications and in the sample of CENTER
studies, investigators have identified patients who stalked their The National Center for the
borderline personality features, but psychiatrist, there are seemingly Victims of Crime Stalking Resource
not specified explicit prevalence lower rates of BPD (4–15%). In Center can be accessed at
rates. For example, in a controlled contrast, in the only population that http://www.ncvc.org/src/Main.aspx or
study of self-referred stalkers, Lewis was characterized by “charges or reached at 1-800-FYI-CALL. The
et al13 found that offenders scored conviction not necessary,” there were Stalking Resource Center has useful
significantly higher on borderline relatively higher rates of BPD (45%). information for victims, statistics on
personality features. This difference may suggest that stalking, resources, and products,
In addition, in a sample of 292 stalkers who wind up in mental and a related newsletter.
college students, Spitzberg and health treatment and in forensic
Veksler14 found that 46 percent settings are more likely to suffer REFERENCES
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Eur Psychiatry. 2007;22:142–145. mourning variant. Dissert Abstr AUTHOR AFFILIATIONS: Dr. R. Sansone is a
9. James DV, Farnham FR. Stalking Int. 1998;58:6821B. professor in the Departments of Psychiatry
and serious violence. J Am Acad 16. McIvor RJ, Potter L, Davies L. and Internal Medicine at Wright State
Psychiatry Law. 2003;31:432–439. Stalking behaviour by patients University School of Medicine in Dayton,
10. Whyte S, Petch E, Penny C, Reiss towards psychiatrists in a large Ohio, and Director of Psychiatry Education at
D. Who stalks? A description of mental health organization. Int J Kettering Medical Center in Kettering, Ohio;
patients at a high security hospital Soc Psychiatry. 2008;54:350–357. Dr. L. Sansone is a family medicine physician
with a history of stalking behaviour. 17. Meloy JR, Boyd C. Female stalkers (government service) and Medical Director of
Crim Behav Ment Health. and their victims. J Am Acad the Primary Care Clinic at Wright-Patterson
2008;18:27–38. Psychiatry Law. 2003;31:211–219. Air Force Base. The views and opinions
11. Mullen PE, Pathe M, Purcell R, 18. Purcell R, Pathe M, Mullen PE. A expressed in this column are those of the
Stuart GW. Study of stalkers. Am J study of women who stalk. Am J authors and do not reflect the official policy
Psychiatry. 1999;156:1244–1249. Psychiatry. 2001;158:2056–2060. or the position of the United States Air Force,
12. Rosenfeld B. Recidivism in stalking 19. Kienlen KK. Birmingham DL, Department of Defense, or US government.
and obsessional harassment. Law Solberg KB, et al. A comparative
Hum Behav. 2003;27:251–265. study of psychotic and ADDRESS CORRESPONDENCE TO:
13. Lewis SF, Fremouw WJ, Del Ben K, nonpsychotic stalking. J Am Acad Randy A. Sansone, MD, Sycamore Primary
Farr C. An investigation of the Psychiatry Law. 1997;25:317–334. Care Center, 2115 Leiter Road, Miamisburg,
psychological characteristics of 20. Harmon RB, Rosner R, Owens H. OH 45342; Phone: (937) 384-6850; Fax:
stalkers: empathy, problem-solving, Obsessional harassment and (937) 384-6938; E-mail:
attachment, and borderline erotomania in a criminal court Randy.sansone@khnetwork.org.
personality features. J Forensic population. J Forensic Sci.
Sci. 2001;46:80–84. 1995;40:188–196.

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