Stalking by Patients Not Limited to Mental Health Clinicians

Deborah Brauser

May 17, 2012

May 17, 2012 (Philadelphia, Pennsylvania) — Although stalking in varying degrees is becoming more prevalent for healthcare professionals, most clinicians are unsure of how to deal with it, new research shows.

Results of a survey of more than 500 medical professionals, including mental health practitioners, showed more than 20% report they have been stalked. However, only 18% of the respondents said they had received adequate training in what to do in these situations.

Presented here at the American Psychiatric Association's (APA's) 2012 Annual Meeting, the findings also revealed that almost one half of the respondents said they did not know whether their workplace had a policy in place for dealing with harassment by patients.

"We wanted to look at the rate of stalking physicians in general because that hadn't really been done before in the United States," lead author Kathleen C. Dougherty, MD, associate professor of psychiatry at Penn State University College of Medicine in Hershey and chair of the Department of Psychiatry at Lancaster General Health, told Medscape Medical News.

Dr. Kathleen Dougherty

The investigators note that patients with mental disorders sometimes "seek greater connection with those treating them, to an unwelcome degree." However, this problem is not confined to just mental health professionals.

"Increasingly, medical colleagues are calling on us to help out with out-of-control patients who intrude upon their personal lives and space," the researchers noted.

"Medicine is a helping profession, and we want to give people the benefit of the doubt. But we also need to be careful and be aware of keeping boundaries," said Dr. Dougherty.

Worldwide Problem

A study published in 2011 found that 14.9% of the 1190 participating physicians in Canada had been stalked during their medical career. A current or former patient was responsible for 12.2% of these incidents; someone connected to a patient was responsible for the remaining occurrences.

Two studies published in 2005 showed that 19.5% of 830 randomly selected psychologists in Australia reported a lifetime prevalence of stalking, and 11% of 361 participating mental health professionals in Italy reported being stalked.

For the current study, the researchers sought to assess incidence of stalking among US physicians in general — and not only of mental health professionals.

Dr. Dougherty reported that in 2009, when the study was conducted, the reported lifetime risk of stalking was approximately 8.3% for all women in the United States and 12.5% for college-aged women. The risk was approximately 2.2% for all men in the United States.

Investigators sent electronic links leading to an anonymous external survey site to active medical professionals at 2 large hospital centers in Pennsylvania. Site A was a university hospital in a rural setting in a town with a population of about 13,000. Site B was a university hospital in a city with a population of more than 1 million.

Of the 2793 total individuals approached, 21.4% filled out the surveys and were considered "responders." At Site A, there was a 26.24% response rate, which included 34.4% of the potential staff members and 17% of the potential residents.

At Site B, there was an 18.1% response rate, which included 26.1% of the potential staff members and only 9.9% of the potential residents.

Results showed that 38.7% of all respondents reported having experienced some sort of unwanted behavior or harassment during their medical careers. These behaviors included the following:

  • 23.4% reported receiving unsolicited phone calls

  • 21.4% reported receiving unsolicited letters, faxes, or email

  • 20.9% reported unwanted approaches at work or at home

  • 12.4% reported malicious gossip, rumors, or false reports

A Harassed Bunch

Other common unwanted behaviors that were reported included being followed or spied upon or receiving offensive material.

"We are a harassed bunch," said Dr. Dougherty. "However, for purposes of this study, we wanted to also look specifically at stalking."

The investigators defined stalking as physical behaviors that were repeated, outside of the norm, unwelcome and intrusive, and caused fear or concern.

"This is not a psychiatric diagnosis; it is a behavior or a collection of behaviors. And in all 50 states, stalking is a crime," said Dr. Dougherty.

When asked how many times they had been the victim of stalking behaviors, 48.3% of Site A responders and 29.2% of Site B responders said it had happened 3 or more times.

However, the investigators note that this response could have been about multiple patients.

When all responders were then asked to focus on just 1 of their patients, 20.6% reported that these individual patients had stalked them more than 3 times.

Of the 123 stalked responders, 49.6% reported receiving unsolicited letters, faxes, or email; 48.8% reported receiving unsolicited telephone calls; and 35% reported experiencing unwanted approaches.

When asked their perception of why the behaviors took place, the top reasons given were that the stalker "just liked me and wanted to see me" or "felt I had wronged him/her." Only 6 of the responders thought the motivation was because the stalker had been in love with them. None said that it was because the stalker thought the clinician was in love with him/her.

"There are 2 main motivations for stalking clinicians that have been identified in the literature. One is the development of a romantic or childlike attachment with the hope of a relationship. The other is the resentful stalker type, which usually develops after a supposed injury or dereliction of duty," said Dr. Dougherty. "And these 2 are well represented in our study."

A total of 41 responders said their stalker was not mentally ill, 29 said they were, 27 said they were not sure, and 26 gave no answer or said "other."

Of those who thought their stalker was or may have been mentally ill, 16 of the responders said it was probably due to a personality disorder, 12 thought it was due to being psychotic, 12 thought it was due to having a mood disorder, and 4 attributed it to substance abuse.

As a result of the behaviors, 26.4% reported increasing their home security, 24.4% reported increasing their workplace security, 10.6% changed their home telephone number, and 10.6% reported considering quitting medicine entirely. Only 6% reported changing their work telephone number.

"You just don't change your work number. That's your profession and you stick with it," said Dr. Dougherty.

Clear Boundaries Needed

When asked to select all the ways they sought support, the vast majority reported turning to their work colleagues or supervisors for help (67%), followed by family/friends (48.8%) and the police (15.9%). Only 5.1% reported seeking help from a therapist or support group.

While 20.7% reported that their workplace had policies for dealing with harassment by patients and 33.3% reported that their workplace did not, 46% said they did not know if such policies existed.

Finally, 81.6% of the responders reported that their training did not adequately prepare them for dealing with these behaviors from patients.

"One respondent might have summed it up best: 'Training does not prepare us, life does,' " said Dr. Dougherty.

Interestingly, during the Q&A session that followed the presentation, about 10% of the audience members raised their hands when asked if anyone had ever been stalked before.

"Other studies have shown that what is most helpful is not keeping this a secret. It's making sure the people that you work with know that it's happening. This way they can alert you if they see something suspicious or can protect you," said Dr. Dougherty.

"For physicians in general, my recommendation is to not mix professional and private lives. Don't have your home address sitting around in your office or have pictures of your kids there," she added.

She noted that with the increased popularity of social media, including blogging, it has often become easier for clinicians to be tracked down.

"I think that with the Internet, it's gotten a lot easier to stalk people. It's the same behaviors that people have always had, but it's just a lot easier to look up personal data now. That's why it's important to think about putting up safeguards," said Dr. Dougherty.

"Stalking is just another aspect of physician safety that you have to consider."

Be Careful

"This topic is very interesting. And it was pointed out that it's much more widespread than I thought it was," session moderator David W. Preven, MD, from the Montefiore Medical Center and a clinical professor in the Department of Psychiatry and Behavioral Sciences at the Albert Einstein College of Medicine in the Bronx, New York, told Medscape Medical News.

"I've known several people that have been stalked. And I've wondered if there's something about the relationship between the practitioner and the prospective stalker that the practitioner doesn't pick up. Then it becomes a problem."

Dr. Preven, who was not involved with this study, reported that he was stalked once.

"This patient knew everything about me. She called my mother-in-law and my wife. She knew my birthday. It was sort of alarming. I finally stopped seeing her and the stalking did end," he said.

He noted that when several of his friends had been stalked, the police "were remarkably unresponsive." Thankfully, the stalking incidents finally just stopped.

"This is something that's very spooky. It's starting to get studied widely and goes beyond physicians. I'm sure lawyers and others get stalked as well," said Dr. Preven.

When asked if this is something that should become part of a resident's training, he said he was not sure what exactly that training would entail.

"Would that be something in the area of countertransference, where your reactions to the patient should be moderated? In some ways I think it's hard for psychiatrists to not be too confrontational, but on the other hand to not engender dependence," he said.

"I also think we need to be careful with some dependent-type patients who are easily hurt or feel rebuffed."

Dr. Dougherty and Dr. Preven have disclosed no relevant financial relationships.

The American Psychiatric Association's 2012 Annual Meeting. Abstract SCR19-2. Presented May 7, 2012.