What is a kleptomaniac

Kleptomania is an impulse control disorder in which an individual experiences recurrent episodes of compulsive stealing to steal items not needed for personal use or monetary value. Stealing commonly occurs in the form of shoplifting. The compulsions to steal are ego dystonic and upsetting to the patient ¹. If you have an impulse control disorder, you have difficulty resisting the temptation or drive to perform an act that’s excessive or harmful to you or someone else. Many people with kleptomania live lives of secret shame because they’re afraid to seek mental health treatment. Usually help is sought only when confronted by the legal consequences of the impulsive behaviors. Although there’s no cure for kleptomania, treatment with medication or talk therapy (psychotherapy) may help to end the cycle of compulsive stealing.

Since its introduction into the psychiatric lexicon as a diagnostic term in 1838 ², kleptomania has been the subject of intense controversy and debate. In question is whether it represents a medical disorder or a form of illegal and deviant behavior more akin to sociopathy. The Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition – Text Revision,  (DSM-IV-TR) ³ includes kleptomania with the impulse control disorders not elsewhere classified, alongside pathological gambling, trichotillomania (compulsive hair pulling), pyromania (compulsive fire setting) and intermittent explosive disorder. Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition – Text Revision defines kleptomania as a recurrent failure to resist impulses to steal objects that are not needed for personal use or for their monetary value. Like other impulse control disorders, kleptomania is characterized by an anxiety-driven urge to perform an act that is pleasurable in the moment but causes significant distress and dysfunction. Careful attention should be given to distinguishing kleptomania from antisocial personality disorder. Unlike the latter disorder, kleptomania is characterized by the presence of guilt and remorse and the lack of theft motives such as monetary gain, personal use, stealing to impress someone, or stealing to support a drug habit ¹.

Table 1. Diagnostic criteria for kleptomania

The prevalence of kleptomania in the general population is approximated at 0.6 percent. In those arrested for shoplifting, the prevalence of kleptomania is 3.8 to 24 percent. The female to male ratio is estimated at 3:1. The onset is usually in adolescence, and the average age for presentation for treatment is 35 years for women and 50 years for men ⁴, ⁵.

Kleptomania is rarely brought to medical attention voluntarily. Patients usually present for treatment by legal mandate due to repeated shoplifting. Men are more likely to be sent to prison instead of being referred to treatment ⁵.

Kleptomania and other impulse control disorders seem to be more prevalent among those with psychiatric disorders. In a study of 204 psychiatric patients admitted for inpatient treatment, 31 percent of the patients were identified with a current impulse control disorder and 7.8 percent with kleptomania ⁶. A report that identified 11 patients with kleptomania compared them to a group of patients with alcoholism and to a group of non-psychotic psychiatric patients. The patients with kleptomania had significantly higher levels of impulsivity that distinguished them from both comparison groups. The patients with kleptomania were also found to have high rates of substance abuse and mood disorders ⁷.

The pathophysiology of kleptomania is unknown. Psychoanalytic theories link compulsive stealing to childhood trauma and neglectful or abusive parents, and stealing may symbolize repossessing the losses of childhood ⁵. Kleptomania has also been linked to psychosexual issues such as sexual repression and suppression ⁵. Neuropsychiatric factors are also thought to play a role in kleptomania. The disorder appears to be highly associated with mood disorders and anxiety spectrum disorders ⁸. Reports of kleptomania responding to selective serotonin reuptake inhibitors (SSRIs) suggests a common pathophysiology with mood and anxiety disorders ⁹.

Kleptomania may also be regarded as a form of addictive behavior and has been shown to be associated with other substance use disorders (e.g., alcohol and nicotine) ⁷. Naltrexone, an opiate antagonist used to treat addictive behaviors, has been shown to reduce kleptomania symptoms ¹⁰. A double-blind, placebo-controlled study of 25 patients who were administered naltrexone showed significant improvement in kleptomania ¹¹. Topiramate, an anticonvulsant drug, has been shown to be effective in impulse control disorders, and recently topiramate demonstrated efficacy in treating binge eating ¹². Again, this has been extrapolated to kleptomania with encouraging results in small case series ¹³. Additionally, there are case reports in the literature documenting kleptomania responding to lithium, valproate, trazodone, and electroconvulsive therapy ⁹.

Impulse control disorders can present as neuropsychiatric sequelae of head trauma and traumatic brain injury ¹⁴. New onset kleptomania has been reported in two cases of closed head trauma ¹⁵. Brain disorders, such as epilepsy ¹⁶ and frontotemporal dementia ² have been reported to cause kleptomania. Kleptomania has also been reported as paradoxical side effect of SSRIs in three patients ¹⁷.

Various psychotherapeutic techniques alone and in combination with psychotropic medications have been reported to improve compulsive stealing ⁵. Desensitization was effective in a small study of three patients with impulse control disorders: two shop-lifters and one binge eater.21 In a study of 28 patients with compulsive buying (a condition closely related to impulse control disorders), cognitive behavioral therapy (CBT) was found to be effective in reducing the compulsions to buy.

Kleptomania complications

Left untreated, kleptomania can result in severe emotional, family, work, legal and financial problems. For example, you know stealing is wrong but you feel powerless to resist the impulse, so you may be wracked by guilt, shame, self-loathing and humiliation. And you may be arrested for stealing. You may otherwise lead a moral, upstanding life and be confused and upset by your compulsive stealing.

Other complications and conditions associated with kleptomania may include:

• Other impulse-control disorders, such as compulsive gambling or shopping
• Alcohol and substance misuse
• Personality disorders
• Eating disorders
• Depression
• Bipolar disorder
• Anxiety
• Suicidal thoughts, suicide attempts and suicide.

Kleptomania causes

What causes kleptomania

The cause of kleptomania is not known. Several theories suggest that changes in the brain may be at the root of kleptomania. More research is needed to better understand these possible causes, but kleptomania may be linked to:

• Problems with a naturally occurring brain chemical (neurotransmitter) called serotonin. Serotonin helps regulate moods and emotions. Low levels of serotonin are common in people prone to impulsive behaviors.
• Addictive disorders. Stealing may cause the release of dopamine (another neurotransmitter). Dopamine causes pleasurable feelings, and some people seek this rewarding feeling again and again.
• The brain’s opioid system. Urges are regulated by the brain’s opioid system. An imbalance in this system could make it harder to resist urges.

Risk factors for kleptomania

Kleptomania is considered uncommon. However, some people with kleptomania may never seek treatment, or they’re simply jailed after repeated thefts, so some cases of kleptomania may never be diagnosed. Kleptomania often begins during the teen years or in young adulthood, but can start in adulthood or later. About two-thirds of people with known kleptomania are women.

Kleptomania risk factors may include:

• Family history. Having a first-degree relative, such as a parent or sibling, with kleptomania, obsessive-compulsive disorder, or an alcohol or other substance use disorder may increase the risk of kleptomania.
• Having another mental illness. People with kleptomania often have another mental illness, such as bipolar disorder, anxiety disorder, an eating disorder, substance use disorder or a personality disorder.

Kleptomania prevention

Because the cause of kleptomania isn’t clear, it’s not yet known how to prevent it with any certainty. Getting treatment as soon as compulsive stealing begins may help prevent kleptomania from becoming worse and prevent some of the negative consequences.

Kleptomania symptoms

Kleptomania symptoms may include:

• Inability to resist powerful urges to steal items that you don’t need
• Feeling increased tension, anxiety or arousal leading up to the theft
• Feeling pleasure, relief or gratification while stealing
• Feeling terrible guilt, remorse, self-loathing, shame or fear of arrest after the theft
• Return of the urges and a repetition of the kleptomania cycle

Features

People with kleptomania typically exhibit these features or characteristics:

• Unlike typical shoplifters, people with kleptomania don’t compulsively steal for personal gain, on a dare, for revenge or out of rebellion. They steal simply because the urge is so powerful that they can’t resist it.
• Episodes of kleptomania generally occur spontaneously, usually without planning and without help or collaboration from another person.
• Most people with kleptomania steal from public places, such as stores and supermarkets. Some may steal from friends or acquaintances, such as at a party.
• Often, the stolen items have no value to the person with kleptomania, and the person can afford to buy them.
• The stolen items are usually stashed away, never to be used. Items may also be donated, given away to family or friends, or even secretly returned to the place from which they were stolen.
• Urges to steal may come and go or may occur with greater or lesser intensity over the course of time.

Kleptomania diagnosis

When you decide to seek treatment for symptoms of possible kleptomania, you may have both a physical and psychological evaluation. The physical evaluation can determine if there may be any medical causes triggering your symptoms.

Kleptomania is diagnosed based on your signs and symptoms. Because it’s a type of impulse control disorder, to help pinpoint a diagnosis, your doctor may:

• Ask questions about your impulses and how they make you feel
• Review a list of situations to ask if these situations trigger your kleptomania episodes
• Have you fill out psychological questionnaires or self-assessments
• Use the criteria in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), published by the American Psychiatric Association.

The existing literature indicates that kleptomaniacs often report lack of self-esteem, a difficult childhood and marital conflicts ¹⁸, which may just be one of the manifestations of borderline personality disorder ¹⁹ and score poorly on socialization but well on impulsivity and novelty seeking ²⁰.

Kleptomaniacs have high rates of substance abuse and mood disorders ²¹, as well as anxiety disorders ²². The extent to which obsessive compulsive disorder (OCD) and kleptomania co-occur is not well understood. Rates of co-occurring OCD in samples of kleptomaniacs have ranged from 6.5% ²² to 60% ²³. A recent study ²⁴ reported that kleptomaniacs who seek treatment have a higher prevalence of personality disorders compared to a nonclinical population.

Early literature suggested that kleptomania particularly affected women of high social and economic status so much so that scientists assumed its aetiology as stemming from the female reproductive system. It is not that scientists did not describe cases of male and lower class kleptomaniacs in the 19th century, but the evidence made no headway as the media was more interested in socially prominent women thieves who used kleptomania as a defence in court trials. Newer studies have also shown a female preponderance ²⁵, with an early age of onset of stealing in females ²³ and people with comorbid personality disorders ²⁶.

Kleptomania treatment

Although fear, humiliation or embarrassment may make it hard for you to seek treatment for kleptomania, it’s important to get help. Kleptomania is difficult to overcome on your own. Without treatment, kleptomania will likely be an ongoing, long-term condition.

Treatment of kleptomania typically involves medications and psychotherapy, or both, sometimes along with self-help groups. However, there’s no standard kleptomania treatment, and researchers are still trying to understand what may work best. You may have to try several types of treatment to find what works well for you.

Medications

There’s little scientific research about using psychiatric medications to treat kleptomania. And there is no FDA-approved medication for kleptomania. However, certain medications may help, depending on your situation and whether you have other mental health disorders, such as depression or substance misuse.

Your doctor may consider prescribing:

• An addiction medication called naltrexone, an opioid antagonist, which may reduce the urges and pleasure associated with stealing
• An antidepressant — specifically a selective serotonin reuptake inhibitor (SSRI):
  • Fluoxetine (Prozac), most commonly used
  • Fluvoxamine (Luvox)
  • Paroxetine (Paxil)
  • Sertraline (Zoloft)
• Other medications or a combination of medications

If medication is prescribed, ask your doctor, mental health professional or pharmacist about potential side effects or possible interactions with any other medications.

Psychotherapy

A form of psychotherapy called cognitive behavioral therapy helps you identify unhealthy, negative beliefs and behaviors and replace them with healthy, positive ones. Cognitive behavioral therapy may include these techniques to help you control kleptomania urges:

• Covert sensitization, in which you picture yourself stealing and then facing negative consequences, such as being caught
• Aversion therapy, in which you practice mildly painful techniques, such as holding your breath until you become uncomfortable, when you get an urge to steal
• Systematic desensitization, in which you practice relaxation techniques and picture yourself controlling urges to steal

Avoiding relapses

It’s not unusual to have relapses of kleptomania. To help avoid relapses, be sure to stick to your treatment plan. If you feel urges to steal, contact your mental health professional or reach out to a trusted person or support group.

Coping and support

You can take steps to care for yourself with healthy coping skills while getting professional treatment:

• Stick to your treatment plan. Take medications as directed and attend scheduled therapy sessions. Remember, it’s hard work and you may have occasional setbacks.
• Educate yourself. Learn about kleptomania so that you can better understand risk factors, treatments and triggering events.
• Identify your triggers. Identify situations, thoughts and feelings that may trigger urges to steal so you can take steps to manage them.
• Get treatment for substance abuse or other mental health problems. Your substance use, depression, anxiety and stress can feed off each other, leading to a cycle of unhealthy behavior.
• Find healthy outlets. Explore healthy ways to rechannel your urges to steal or shoplift through exercise and recreational activities.
• Learn relaxation and stress management. Try such stress-reduction techniques as meditation, yoga or tai chi.
• Stay focused on your goal. Recovery from kleptomania can take time. Stay motivated by keeping your recovery goals in mind and reminding yourself that you can work to repair damaged relationships and financial and legal problems.

Support for loved ones

If your loved one is being treated for kleptomania, make sure you understand the details of the treatment plan and actively support its success. It may be helpful to attend one or more therapy sessions with your loved one so that you’re familiar with the factors that seem to trigger the urge to steal and the most effective ways to cope.

You may also benefit from talking with a therapist yourself. Recovering from an impulse control disorder is a challenging, long-term undertaking — both for the person with the disorder and those closest to him or her. Make sure you’re taking care of your own needs with the stress-reduction outlets that work best for you, such as exercise, meditation or time with friends.

Self-help groups

People with kleptomania may benefit from participating in self-help groups based on 12-step programs. Even if you can’t find a group specifically for kleptomania, you may benefit from attending Alcoholics Anonymous or other addiction meetings. Such groups don’t suit everyone’s tastes, so ask your mental health professional about alternatives.

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