Kleptomania
What is Kleptomania?
This is disorder in which the individual repeatedly gives in to the impulse to steal for no great gain, when he or she has sufficient money to pay for the item and no need for what is stolen.
Official Diagnosis
The official criterion of the DSM IV-TR are that:
- The individual is unsuccessful in resisting impulses to steal things that are not needed
- The individual experiences gratification, relief or pleasure when carrying out the theft
- The individual experiences a rise of tension immediately prior to the act of stealing
- The act is not an expression of anger or some other emotion nor is it the the result of delusion
- the stealing is not better accounted for by another mental disorder such as Conduct Disorder, Anti-Social Personality, or the Manic Phase of a manic-depressive illness.
Prevalence
Studies of shoplifters suggest that perhaps fewer than 5% would fulfill the DSM-IV criteria for kleptomania but given that many sufferers tend to be exceptionally secretive about their behaviour, the percentage in the general population may be higher. Most reported cases of kleptomania have been female.
Manifestation
Most kleptomaniacs do not steal for personal gain and often have enough money to buy the item they steal. Moreover, they are very aware of the criminal nature of the act. Some have been able to identify specific triggers to their urge to steal. In addition to the feeling of increasing tension and pressure to steal, followed by immediate pleasure or relief, they often also experience guilt and shame subsequently as well.
The stealing may be episodic or more chronic in nature. Further, there may be periods of long remission between the episodes.
Many individuals who suffer from kleptomania develop self-control strategies in an effort to refrain from the act. They may avoid shopping malls, for instance, go shopping only when accompanied by other individuals, or sometimes stop going shopping at all. They may socially isolate themselves in an attempt to eliminate the opportunities to steal.
Onset is usually in mid-adolescence and continues, on average, for about two decades into adulthood. Since many who suffer from kleptomania do not seek professional assistance, the exact history of the disorder is not clearly known.
Co-Morbidity
Research has indicated that kleptomania is strongly associated with mood disorders (especially depression), anxiety disorders, eating disorders, substance abuse, and other impulse control disorders. Results of some recent research of a small group of strictly defined kleptomaniacs is leading some experts to suggest that kleptomania may be, in fact, a variant of a mood disorder.
Treatment
Clinical studies of kleptomania suggest that it follows a chronic course but most of the research on treatment is difficult to evaluate as it is not applied to strictly defined cases. Behavioural strategies have been reported as successful though the soundest research points to promising results with the use of anti-depressant medication. The serotonergic group of drugs such as Fluoxetine and Trazodone have been reported to produce varying degrees of remission and Naltrexone, an opioid antagonist, has recently been found to be effective in the treatment of a small group of strictly defined kleptomaniacs.
Further Reading
Cupchick, W. and Atcheson, D. (1983). Shoplifting: An occasional crime of the moral majority. Bulletin of the American Academy of Psychiatry and Law, 11, 343-354.
Fishbain, D.A. (1987). Kleptomania as risk-taking behavior in response to depression. American Journal of Psychotherapy, 41, 598-603.
Glover, J.H. (1985). A case of kleptomania treated with covert sensitization. British Journal of Clinical Psychology, 24, 203-204.
Goldman, M. J. (1991). Kleptomania-making sense of the nonsensical. American Journal of Psychiatry, 148, 986-996.
Grant, J.E. & Kim, S.W. (2002). Clinical characteristics and associated psychopathology of 22 patients with kleptomania. Comprehensive Psychiatry, 43, 378-384.
Grant, J.E. & Kim, S.W. (2002). An open-label study of Naltrexone in the treatment of kleptomania. Journal of Clinical Psychiatry, 63, 349-356.
Guidry, L.S. (1975). Use of covert punishing contingency in compulsive stealing. Journal of Behavior Therapy and Experimental Psychiatry, 6, 169.
McElroy, S., Pope, H., Hudson, J., Keck, P., & White, K. (1991). Kleptomania: A report on 20 cases. American Journal of Psychiatry, 148, 652-657.
McElroy, S., Keck, P., Pope, H., Smith, J.N., & Strakowski, S. (1994). Compulsive buying: A report of 20 cases. Journal of Clinical Psychiatry, 55, 242-248.
Other Resources:
Therapy for Sexual Impulsivity: The Paraphilias and Paraphilia-Related Disorders. Martin Kafka, MD, Psychiatric Times (on-line)
© Stephen Hucker, MB,BS, FRCP(C), FRCPsych 2003, 2004,2005
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