138 Kleptomania (312.32)

A kleptomaniac is not someone who shoplifts on occasion or who steals because they are in need. Kleptomania is defined as the repeated failure to resist the impulse to steal, even when the item is not taken for personal use or for its monetary value (Bayer, 2000). It involves the desire to steal more than the need for the item (Bayer, 2000). A person with kleptomania feels gratification and relief while he or she steals. After stealing, the person is likely to give away, throw away, hoard, or return the items he or she took (Bayer, 2000). People with this impulse-control disorder realize that stealing is wrong and may feel guilty about their behavior, but they are unable to stop themselves from performing the act.

Kleptomania is not an expression of an emotion, an act of rebellion, or an antisocial gesture (Bayer, 2000). Furthermore, it is not a part of a delusional or hallucinogenic experience (Bayer, 2000). Kleptomaniacs do not usually plan the theft ahead of time, and they rarely steal with help from other people (Bayer, 2000). Comorbid disorders may include mood disorders, eating disorders, and anxiety disorders (Bayer, 2000). Getting caught in the act can cause serious legal, social, and occupational problems for people with this disorder. However, kleptomania may persist for years, regardless of apprehension and conviction (Bayer, 2000).

Unlike ordinary stealing, kleptomania is quite rare. According to the DSM-IV, only about 5% of shoplifters are kleptomaniacs. This disorder afflicts more women than men, unlike intermittent explosive disorder, pathological gambling, and pyromania.

Because it is rare and not well-studied, researchers have not yet agreed upon the most effective treatment for kleptomania (Bayer, 2000). Most people with the disorder are likely to keep it a secret and not seek treatment unless they are caught, due to the shame that they feel (Bayer, 2000). It seems that the most effective treatment usually involves a combination of therapies, including medication, psychotherapy, and behavior modification (Bayer, 2000).

DSM-IV-TR criteria

• A. Recurrent failure to resist impulses to steal objects that are not needed for personal use or for their monetary value.
• B. Increasing sense tension immediately before committing the theft.
• C. Pleasure, gratification, or relief at the time of committing the theft.
• D. The stealing is not committed to express anger or vengeance and is not in response to a delusion or a hallucination.
• E. The stealing is not better accounted for by a conduct disorder, a manic episode, or antisocial personality disorder.

Associated features

Kleptomania is an irresistible impulse to steal, stemming from an emotional disturbance rather than economic need. It is frequently observed in patients who are “chemically dependent” or who also have mood, anxiety, or eating disorders. It is possible that people with kleptomania could also be dealing with major depression, panic attacks, social phobia, anorexia nervosa, bulimia nervosa, substance abuse, and obsessive-compulsive disorder. People with this disorder get a thrill from stealing and randomly have an overwhelming urge to do so. They often feel guilty after committing theft and surreptitiously return the stolen items. If the items, usually of lesser importance, are not returned, they are hoarded, discarded, or given away. In less severe instances of kleptomania, things are borrowed and not returned. Kleptomania is not to be confused with the regular act of stealing. Whether planned or impulsive, a normal thief steals for the objects value or usefulness. Many times they are teenagers or gang members that view theft as a rite of passage, form of rebellion, or commit them just for a dare or for social acceptance; this should not be diagnosed as kleptomania.

Child vs. adult presentation

It is difficult to assess the differences in presentation of kleptomania among children and adults. This is because it is virtually impossible to distinguish if children are stealing because of a disorder or if it is because they do not know any better. Kleptomania typically presents itself during late adolescence or early adulthood. It is rare for kleptomania to manifest itself during a person’s early childhood or late in their life.

Gender and cultural differences in presentation

Kleptomania occurs slightly more often in males than in females. No information is available regarding cultural differences in the presentation of kleptomania.

Epidemiology

Studies suggest that approximately 0.6% of the general population that may have this disorder. Studies also suggest that it is more prominent in females. Other studies, interestingly, have found high comorbidity rates (65%) of kleptomania in patients with bulimia. Also, approximately 0.7% of patients also have a history of obsessive-compulsive disorder.

Course

The DSM-IV-TR identifies three courses of kleptomania:

1. sporadic stealing with brief episodes and long periods of remission
2. episodic stealing with protracted periods of stealing and periods of remission
3. chronic stealing, in which the individual steals constantly, with some degree of fluctuation

The disorder may continue for years, despite convictions for shoplifting.

Etiology

• One theory suggests that receiving the thrill of stealing can aid in alleviating symptoms in people who are clinically depressed. Individuals with kleptomania never seek aid in the act of theft and never plan to steal with others present. There may be favored objects or environments where thefts occur, but detection of kleptomania, even by family, is difficult. Consequently, the problem mostly goes undetected.
• There is no known cause for kleptomania. It is possible that it is genetically related, especially from first-degree relatives. There also tends to be an inclination for kleptomania to coexist with OCD, bulimia nervosa, and clinical depression.

Empirically supported treatments

• Actually finding a diagnosis is typically difficult given that patients do not seek medical help for this complaint. It is also difficult to detect during initial psychological assessments. It is most commonly addressed when one comes in for other reasons such as depression, bulimia, or emotional instability. They may prefer certain objects and settings, but these may not be described by the patient. Initial psychological evaluations may reveal a past of inadequate parenting, conflicting relationships, or a point of severe stressors such as having to make a move from one home to another.
• Treatments will vary concerning this disorder. It begins with an extensive psychological assessment. The patient then undergoes therapy that targets impulse control and any and all coexisting mental disorders. They gain a comprehensible understanding of their specific triggers in order to prevent relapse. Psychotherapies, such as cognitive-behavioral therapy and rational-emotive therapy, are included in the treatment.
• Several medications have been shown to work, but effectiveness depends on other mental disabilities the individual may have. Antidepressants, such as Prozac, are the most commonly used medications to treat kleptomania. These are serotonin re-uptake inhibitors. Side-effects often occur, so patients should consult doctor if any occur. Mood stabilizers can also be used to stabilize the individual’s mood. These are meant to keep the patient from having rapid or uneven mood changes that may trigger them to steal. An example of this includes lithium, which is shown to be somewhat helpful. Benzodiazepines can also be used, but the effectiveness often varies from person to person. Individuals may eaisily become dependent on the drug. These medications are central nervous system depressants, also known as tranquilizers. Examples of these include Xanax and Klonopin. Lastly, there are addiction medications such as Revia, an opioid antagonist that is most commonly prescribed for kleptomania. This drug blocks the part of the brain that feels pleasure during certain addictive behaviors, reducing the patient’s urge to steal.