Kleptomania is the inability to resist the urge to steal items, usually for reasons other than personal use or financial gain. First described in 1816, kleptomania is classified in psychiatry as an impulse-control disorder. Some of the main characteristics of the disorder suggest that kleptomania could be an obsessive–compulsive spectrum disorder, but also share similarities with addictive and mood disorders.Diagnostic and Statistical Manual of Mental Disorders IV. pp. 1211.
The disorder is frequently under-diagnosed and is regularly associated with other psychiatric disorders, particularly anxiety disorders, eating disorders, alcohol and substance abuse. Patients with kleptomania are typically treated with therapies in other areas due to the comorbid grievances rather than issues directly related to kleptomania.
Over the last 100 years, a shift from psychotherapeutic to psychopharmacological interventions for kleptomania has occurred. Pharmacological treatments using selective serotonin reuptake inhibitors (SSRIs), mood stabilizers and opioid receptor antagonists, and other antidepressants along with cognitive behavioral therapy, have yielded positive results. However, there have also been reports of kleptomania induced by SSRIs.
Signs and symptoms Some of the fundamental components of kleptomania include recurring intrusive thoughts, impotence to resist the compulsion to engage in stealing, and the release of internal pressure following the act. These symptoms suggest that kleptomania could be regarded as an obsessive–compulsive type of disorder.
People diagnosed with kleptomania often have other types of disorders involving mood, anxiety, eating, impulse control, and drug use. They also have great levels of stress, guilt, and remorse, and privacy issues accompanying the act of stealing. These signs are considered to either cause or intensify general comorbid disorders. The characteristics of the behaviors associated with stealing could result in other problems as well, which include social segregation and substance use. The many types of other disorders frequently occurring along with kleptomania usually make clinical diagnosis uncertain.Hollander, Eric; Stein, Dan (2006). Clinical Manual of Impulse-Control Disorders. 1st ed. Arlington: American Psyschiatric Publishing Inc. p. 223-4.
There is a difference between ordinary theft and kleptomania: "ordinary theft (whether planned or impulsive) is deliberate and motivated by the usefulness of the object or its monetary worth," whereas with kleptomania, there "is the recurrent failure to resist impulses to steal items even though the items are not needed for personal use or for their monetary value."
Cause Initial models of the development of kleptomania came from the field of psychoanalysis. These have been replaced by cognitive-behavioral models, which supplement biological ones based mostly on pharmacotherapy treatment studies.
Psychoanalytic and psychodynamic approach Several explanations of the mechanics of kleptomania have been presented. A contemporary social approach proposes that kleptomania is an outcome of consumerism and the large quantity of commodities in society. Psychodynamic theories depend on a variety of points of view in defining the disorder. Psychoanalysts define the condition as an indication of a defense mechanism deriving in the unconscious ego against anxiety, prohibited intuition or desires, unsettled struggle or forbidden sexual drives, dread of castration, sexual excitement, and sexual fulfillment and orgasm throughout the act of stealing."From stack-firing to pyromania: medico-legal concepts of insane arson in British, US and European contexts, c. 1800-1913". Part I. History of Psychiatry. 2010; 21: 243-260 The psychoanalytic and psycho-dynamic approach to kleptomania granted the basis for prolonged psychoanalytic or psycho-dynamic psychotherapy as the core treatment method for a number of years. Like most psychiatric conditions, kleptomania was observed within the psycho-dynamic lens instead of being viewed as a bio-medical disorder. However, the prevalence of psychoanalytic approach contributed to the growth of other approaches, particularly in the biological domain.Levy, Sidney (2007). "Challenging the Philosophical Assumptions of Marketing". Journal of Macro-marketing. 27: 7-14.
Many psychoanalytic theorists suggested that kleptomania is a person's attempt "to obtain symbolic compensation for an actual or anticipated loss", and feel that the key to understanding its etiology lies in the symbolic meaning of the stolen items. Drive theory was used to propose that the act of stealing is a defense mechanism which serves to modulate or keep undesirable feelings or emotions from being expressed. Some French psychiatrists suggest that kleptomaniacs may just want the item that they steal and the feeling they get from theft itself.
Cognitive–behavioral models Cognitive–behavioral models have been replacing psychoanalytic models in describing the development of kleptomania. Cognitive–behavioral practitioners often conceptualize the disorders as being the result of operant conditioning, behavioral chaining, distorted cognitions, and poor coping mechanisms.Gauthier & Pellerin, 1982.Kohn & Antonuccio, 2002. Cognitive-behavioral models suggest that the behavior is positively reinforced after the person steals some items. If this individual experiences minimal or no negative consequences (punishment), then the likelihood that the behavior will reoccur is increased. As the behavior continues to occur, stronger antecedents or cues become contingently linked with it, in what ultimately becomes a powerful behavioral chain. According to cognitive-behavioral theory (CBT), both antecedents and consequences may either be in the environment or cognitions. For example, Kohn and Antonuccio (2002) describe a client's antecedent cognitions, which include thoughts such as "I'm smarter than others and can get away with it"; "they deserve it"; "I want to prove to myself that I can do it"; and "my family deserves to have better things". These thoughts were strong cues to stealing behaviors. All of these thoughts were precipitated by additional antecedents which were thoughts about family, financial, and work stressors or feelings of depression. "Maintaining" cognitions provided additional reinforcement for stealing behaviors and included feelings of vindication and pride, for example: "score one for the 'little guy' against the big corporations". Although those thoughts were often afterward accompanied by feelings of remorse, this came too late in the operant sequence to serve as a viable punisher. Eventually, individuals with kleptomania come to rely upon stealing as a way of coping with stressful situations and distressing feelings, which serve to further maintain the behavior and decrease the number of available alternative coping strategies.
Biological models Biological models explaining the origins of kleptomania have been based mostly on pharmacotherapy treatment studies that used selective serotonin reuptake inhibitors (SSRIs), mood stabilizers, and opioid receptor antagonists.
Some studies using SSRIs have observed that opioid antagonists appear to reduce the urge to steal and mute the "rush" typically experienced immediately after stealing by some subjects with kleptomania. This would suggest that poor regulation of serotonin, dopamine, or natural opioids within the brain are to blame for kleptomania, linking it with impulse control and affective disorders.
An alternative explanation too based on opioid antagonist studies states that kleptomania is similar to the "self-medication" model, in which stealing stimulates the person's natural opioid system. "The opioid release 'soothes' the patients, treats their sadness, or reduces their anxiety. Thus, stealing is a mechanism to relieve oneself from a chronic state of hyperarousal, perhaps produced by prior stressful or traumatic events, and thereby modulate affective states."
Diagnosis Disagreement surrounds the method by which kleptomania is considered and diagnosed. On one hand, some researchers believe that kleptomania is merely theft and dispute the suggestion that there are psychological mechanisms involved, while others observe kleptomania as part of a substance-related addiction. Yet others categorize kleptomania as a variation of an impulse control disorder, such as obsessive–compulsive disorder or eating disorders.
According to the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision (DSM-IV-TR), a frequent and widely used guide for the diagnosis of mental disorders, the following symptoms and characteristics are the diagnostic criteria for kleptomania: repeated inability to defend against urges to steal things that are not essential for private use or for their economic value; escalating sense of pressure immediately prior to performing the theft; satisfaction, fulfillment or relief at the point of performing the theft; the theft is not executed to convey antagonism or revenge, and is not in reaction to a delusion or a fantasy; and the thieving is not better accounted for by behavior disorder, a manic episode, or antisocial personality disorder.
Skeptics have decried kleptomania as an invalid psychiatric concept exploited in legal defenses of wealthy female shoplifters. During the twentieth century, kleptomania was strongly linked with the increased prevalence of department stores, and "department store kleptomaniacs" were a widely held social stereotype that had political implications.
Comorbidity Kleptomania seems to be linked with other psychiatric disorders, especially mood swings, anxiety, eating disorders, and alcohol and substance use. The occurrence of stealing as a behavior in conjunction with eating disorders, particularly bulimia nervosa, is frequently taken as a sign of the harshness of the eating disorder.
A likely connection between depression and kleptomania was reported as early as 1911. It has since been extensively established in clinical observations and available case reports. The mood disorder could come first or co-occur with the beginning of kleptomania. In advanced cases, depression may result in self-inflicted injury and could even lead to suicide. Some people have reported relief from depression or manic symptoms after theft.
It has been suggested that because kleptomania is linked to strong compulsive and impulsive qualities, it can be viewed as a variation of obsessive–compulsive spectrum disorders, together with pathological gambling, compulsive buying, pyromania, nailbiting, and trichotillomania. This point achieves support from the unusually higher cases of obsessive–compulsive disorder (OCD) in close relatives of patients with kleptomania.
Substance use disorder Kleptomania and drug addictions seem to have central qualities in common, including: recurring or compulsive participation in a behavior in spite of undesirable penalties; weakened control over the disturbing behavior; a need or desire condition before taking part in the problematic behavior; and a positive pleasure-seeking condition throughout the act of the disturbing behavior.