Kleptomania

Medical quality assurance by Dr. Albrecht Nonnenmacher, MD at June 17, 2016
StartDiseasesKleptomania

Kleptomania or compulsive stealing is marked by an overwhelming urge to steal items that are not typically very useful or valuable. It involves a failure to resist stealing that is recurrent and compulsive in nature. There is contention over how to best classify kleptomania as a symptom or subcategory of mental disorders and further research needs to be done into what causes it and how to treat it.

Contents

Definition & Facts

The term kleptomania was first used by a French physician in 1938. It describes a condition in which an individual experiences the urge to steal without any financial or functional incentive. It is estimated to affect between 0.3% to 0.6% of the population. Kleptomania affects women more than men, and it usually begins to affect a patient in his or her late teens. Approximately 64% of people with kleptomania have been arrested for shoplifting.

Though kleptomania isn't recognized as an addiction or as a distinct disorder, it may be categorized as a pattern of behavior under the umbrella of an impulse control disorder or a depressive disorder. Some researchers argue that kleptomania is actually on the obsessive-compulsive spectrum of disorders because it involves both impulsive behavior as well as compulsive behavior. 63% of people with kleptomania also have compulsive hoarding.

Individuals with kleptomania differ from others who steal in that they don't exhibit signs of premeditation. The individual will often steal relatively inexpensive items, such as underwear, food, or cosmetic products. Additionally, people with kleptomania aren't motivated by anger or revenge. A person with kleptomania will not execute a grand heist or rob a convenience store at gun point.

Symptoms & Complaints

The primary symptom of kleptomania is the act of stealing. The stolen items are frequently thrown out or hoarded. When people with kleptomania steal, the act is accompanied by strong feelings of anxiety or tension that build up until the theft is successful. A sensation of relief and release of pressure is felt after the theft. It can be compared to a “high” obtained from substance use. It's common for the individual to feel guilt and shame which prompts a continuation of the cycle.

Causes

The causes of kleptomania are still largely unknown but are likely influenced by a variety of societal factors, biological factors, and psychological factors. Biological origins may involve structural abnormalities of the brain involving the limbic system and the frontal lobe. Hormonal imbalances may play a role. As with other mental illnesses, it's also possible that there is a hereditary component associated with kleptomania, particularly in respect to immediate blood relatives.

Kleptomania is known to be related to other mental disorders, particularly mood disorders and substance-related disorders. This comorbidity is especially prevalent among bulimics. Bulimia is an eating disorder that involves a compulsive desire to eat food in excess, followed by purging. Kleptomania is typically not linked to disorders where aggressive behavior is common such as antisocial personality disorder. Depression is a mood disorder commonly linked to kleptomania.

Diagnosis & Tests

Because much controversy remains over how the disorder is classified with various arguments put forth that it is alternatively a type of addiction, obsessive-compulsive disorder, or impulse control disorder, its diagnostic criteria is in flux. Kleptomania is also difficult to diagnose because patients are often ashamed of their behavior and do not seek treatment. Many are only diagnosed after being forced to see a mental health professional as a legal consequence of shoplifting.

Nevertheless, individuals with symptoms of kleptomania may be evaluated through a psychiatric assessment or psychological evaluation by a certified counselor or psychiatrist. Such tests for mental disorders involve a great deal of questioning, and it's important for patients to be as honest as possible to get the most accurate results. A full diagnosis may not be possible until a patient has had a series of sessions with their counselor.

Treatment & Therapy

There is no course of treatment that has been empirically proven to treat kleptomania. Because of how frequently kleptomania is comorbid with other mental disorders, treatment will address all coexisting and diagnosable mental disorders - typically with a combination of therapy and medication.

Cognitive behavioral therapy is the most common form of treatment for kleptomania and other mental disorders. This method involves a series of sessions with a counselor, including one-on-one sessions and may include group meetings. The goal of each meeting is to identify a patient's negative or destructive thinking patterns, coping mechanisms, and behaviors and to then find positive alternatives. Through therapy, people can learn how to combat negative impulses and regain control of their lives and behaviors.

The patient will often engage in exercises like writing in a journal, and positive behavior will be reinforced during therapy. The success of any therapy session is dependent on the doctor gaining the trust of the patient so that they have someone to open up to and confide in.

The FDA has not yet approved a drug to treat kleptomania. Nevertheless, various studies have been done to evaluate the efficacy of certain pharmacological treatments. Studies have found positive results when treating patients with kleptomania with opioid antagonists such as naltrexone. This drug reduces the high or sense of gratification that an individual experiences while stealing thus reducing the individual's desire to steal.

Antidepressants such as fluoxetine (a selective serotonin reuptake inhibitor), trazodone (a serotonin antagonist and reuptake inhibitor), or tranylcypromine (a monoamine oxidase inhibitor) have also been tested as medications to treat kleptomania though their efficacy is not proven. Other studies have found no positive effect using selective serotonin reuptake inhibitors such as escitalopram to treat kleptomania.

Prevention & Prophylaxis

Because its causes are poorly understood and highly complex, kleptomania, like other mental disorders, is not easily preventable.