Kleptomania

Definition

Kleptomania is an impulse control disorder characterized by a recurrent failure to resist stealing.

Description

Kleptomania is a complex disorder characterized by repeated, failed attempts to stop stealing. It is often seen in patients who are chemically dependent or who have a coexisting mood, anxiety, or eating disorder. Other coexisting mental disorders may include major depression, panic attacks, social phobia, anorexia nervosa, bulimia nervosa, substance abuse, and obsessive-compulsive disorder. People with this disorder have an overwhelming urge to steal and get a thrill from doing so. The recurrent act of stealing may be restricted to specific objects and settings, but the affected person may or may not describe these special preferences. People with this disorder usually exhibit guilt after the theft.

Detection of kleptomania, even by significant others, is difficult and the disorder often proceeds undetected. There may be preferred objects and environments where theft occurs. One theory proposes that the thrill of stealing helps to alleviate symptoms in persons who are clinically depressed.

Causes

The cause of kleptomania is unknown, although it may have a genetic component and may be transmitted among first-degree relatives. There also seems to be a strong propensity for kleptomania to coexist with obsessive-compulsive disorder, bulimia nervosa, and clinical depression.

Symptoms

The handbook used by mental health professionals to diagnose mental disorders is the Diagnostic and Statistical Manual of Mental Disorders. Published by the American Psychiatric Association, the DSM contains diagnostic criteria and research findings for mental disorders. It is the primary reference for mental health professionals in the United States. The 2000 edition of this manual (fourth edition, text revision), known as the DSM-IV-TR, lists five diagnostic criteria for kleptomania:

• • Repeated theft of objects that are unnecessary for either personal use or monetary value.
• • Increasing tension immediately before the theft.
• • Pleasure or relief upon committing the theft.
• • The theft is not motivated by anger or vengeance, and is not caused by a delusion or hallucination.
• • The behavior is not better accounted for by a conduct disorder, manic episode, or antisocial personality disorder.

Demographics

Studies suggest that 0.6% of the general population may have this disorder and that it is more common in females. In patients who have histories of obsessive-compulsive disorder, some studies suggest a 7% correlation with kleptomania. Other studies have reported a particularly high (65%) correlation of kleptomania in patients with bulimia.

Diagnosis

Diagnosing kleptomania is usually difficult since patients do not seek medical help for this complaint, and initial psychological assessments may not detect it. The disorder is often diagnosed when patients seek help for another reason, such as depression, bulimia, or for feeling emotionally unstable (labile) or unhappy in general (dysphoric). Initial psychological evaluations may detect a history of poor parenting, relationship conflicts, or acute stressors—abrupt occurrences that cause stress, such as moving from one home to another. The recurrent act of stealing may be restricted to specific objects and settings, but the patient may or may not describe these special preferences.

Treatments

Once the disorder is suspected and verified by an extensive psychological interview, therapy is normally directed towards impulse control, as well as any accompanying mental disorder(s). Relapse prevention strategies, with a clear understanding of specific triggers, should be stressed. Treatment may include psychotherapies such as cognitive-behavioral therapy and rational emotive therapy. Recent studies have indicated that fluoxetine (Prozac) and naltrexone (Revia) may also be helpful.

Prognosis

Not much solid information is known about this disorder. Since it is not usually the presenting problem or chief complaint, it is frequently not even diagnosed. There are some case reports that document treatment success with antidepressant medications, although as with almost all psychological disorders, the outcomes vary.

Prevention

There is little evidence concerning prevention. A healthy upbringing, positive intimate relationships, and management of acutely stressful situations may lower the incidence of kleptomania and coexisting disorders.

BOOKS

Tasman, Allan, Jerald Kay, and Jeffrey A. Lieberman, eds. Psychiatry. 1st ed. Philadelphia: W. B. Saunders Company, 1997.

Laith Farid Gulli, M.D.