KLEPTOMANIA

Shoplifting in the United States costs retailers approximately $10 billion annually
[source: Grant]. Professional thieves do some of the damage, but amateur
shoplifters do the most. Most amateur shoplifters steal for personal use rather
than resale, but a small percentage feels a compulsive need to steal. An
addiction to stealing items not for personal use or monetary gain characterizes a
behavior known as kleptomania.
While shoplifting has been a problem for centuries, kleptomania was first
described as a psychological disorder in the early 1800s and has been only
intermittently recognized by the American Psychiatric Article System Association
as a type of mental illness since the 1950s. Psychiatrists continue to debate
whether kleptomania is a distinct mental illness or a manifestation of some other
psychological disorder. Although there has been little research on the
neurobiology of kleptomania, some studies have provided biological clues, and
some have attempted pharmacological treatment of this condition.
There are many reasons for shoplifting: resale, supporting a drug habit, personal
use and "just for the thrill of it." However, most of these reasons fit stealing, but
not kleptomania. Kleptomania is characterized by an impulsive need to steal, and
many kleptomaniacs are first discovered in the act of shoplifting. The American
Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders
(DSM-IV) has outlined the following criteria for a diagnosis:
1. The individual repeatedly fails to resist the impulse to steal items that are
not needed for personal use or monetary value.
2. The individual experiences tension before stealing.
3. The individual's tension is relieved or gratified by the act of the theft.
4. The theft is not due to anger, revenge, delusions, hallucinations or
impaired judgment (dementia, mental retardation, alcohol intoxication,
drug intoxication).
5. Other psychological disorders can't account for the individual's stealing
behavior (like manic episodes and antisocial behaviors).
In this article, we'll examine what kleptomania is, how often it occurs, who suffers
from it, what might cause it and how it can be treated.
Kleptomania Characteristics
With the diagnosis criteria in mind, kleptomania as a true condition occurs in a
rather small percentage of the population. While no true estimate of the general

population is available, scientists estimate that kleptomania occurs in 5 to 10

percent of psychiatric patients [source: Grant].
Kleptomania tends to occur in women more than in men. However, there may be
some gender bias in this finding because women who steal tend to get
psychiatric evaluations, while men who steal tend to go to prison [source: Grant].
Similarly, there doesn't appear to be any one social group in which kleptomania is
rampant
Kleptomania usually begins in the teens or 20s. By the time patients present
themselves to psychiatrists, women are usually in their mid- to late 30s, while
men are in their 50s. There have been reports of kleptomaniacs in their late 70s.
We don't know if kleptomania has a genetic component, but some studies
suggest that kleptomaniacs have parents or close relatives with substance abuse
problems, obsessive-compulsive disorder and/or mood disorders.
Kleptomaniacs usually steal items that they could otherwise afford (like shampoo,
clothing and sunglasses). They don't go into stores with the intent to steal, but
they become tense with the prospect of theft and might not steal when there is a
high probability of getting caught. The theft itself generally relieves the tension,
but it leads to intense feelings of guilt, embarrassment, anxiety and remorse.
Kleptomaniacs may hoard the stolen items, give them away, dispose of them or
clandestinely return them.
Often, the stealing behavior of kleptomania occurs along with other psychological
disorders, like obsessive-compulsive, personality and mood disorders. This
observation has led some psychiatrists to question whether kleptomania is
indeed a true psychological disorder or a manifestation of some other
psychological disorder. Generally, kleptomania has been classed with other
impulse control disorders, such as pathological gambling, pyromania and
trichotillomania (chronic hair-pulling). Impulse control disorders are those where
the individuals cannot resist the impulse to commit some behavior, criminal or
otherwise. The addictive nature of kleptomania, as well as other impulse control
disorders, has provided some insights for possible causes and treatments.
Kleptomania Causes and Treatment
There have been no rigorous or conclusive studies on the neurological basis of
kleptomania. However, some have provided clues about its possible causes and
locations within the nervous system. Here are some possible causes noted by
psychiatrist Jon Grant of the University of Minnesota School of Medicine [source:
Grant].

A defect in a molecule that transports the neurotransmitter serotonin (see

How Antidepressants Work)

Head trauma: damage to circuits between the orbital and frontal lobes of
the brain, or low blood flow to the temporal lobe

Decreases in the fine structure of white matter (axons and dendrites) in

the frontal lobe. This could alter information flow between the frontal lobe
and the thalamus/limbic system.

Taken together, these studies point toward the front of the brain, particularly
connections involved in information exchange with the limbic system (which
controls moods, emotions and desires).
Neuroscientists have implicated serotonin in addiction and depression. And
impulse control disorders do resemble addictive behaviors. So, impulse control
disorders may use the same neurotransmitter pathways -- and could possibly be
treated by drugs that alter serotonin transport and reuptake.
Selective serotonin reuptake inhibitors (SSRI) like fluoxetine (Prozac),
paroxetine (Paxil) and fluvoxamine (Luvox) have been used to treat kleptomania,
but case reports of these treatments have demonstrated mixed results. Some
have reported success in relieving kleptomania symptoms, while others have not
indicated any effects at all [source: Grant].
Likewise, attempts to treat kleptomania with lithium (a mood stabilizer) or
naltrexone (an opioid antagonist -- used to treat heroin and morphine addictions)
have been inconclusive.
With the lack of clear neurobiology and pharmacological evidence for
kleptomania, psychiatrists have used cognitive behavioral therapies [source:
Grant].

Covert sensitization: When the patient feels the urge to steal, he must
imagine negative consequences until the impulse goes away.

Aversion therapy: When the patient feels the urge to steal, he holds his
breath until it is slightly painful. Eventually, he associates the unpleasant
feelings with the urge, and the impulse to steal diminishes.

Systemic desensitization: The patient undergoes relaxation therapy and

learns to substitute relaxing feelings for the urge to steal.

Like drug treatments, these cognitive behavioral therapies have achieved mixed
results. Clearly, there needs to be more controlled behavioral, neurological and
pharmacological studies for kleptomania, as well as other impulse control
disorders. But a major problem is that many of these behaviors occur so rarely in
the general population that getting enough subjects to obtain convincing
scientific evidence may be difficult.
Sources

ABC News Primetime. "Addicted to Stealing: Inside a Shoplifter's Mind." July

10, 2007. http://abcnews.go.com/Primetime/story?id=1190720&page=1

Adler, J. "The Thrill of Theft." Newsday, Feb. 25, 2002.

http://www.diogenesllc.com/thrilltheft.pdf

BehaveNet clinical Capsule, DSM-IV Kleptomania.

http://www.behavenet.com/capsules/disorders/kleptomaniadis.htm

Dell'Osso, B et al. "Epidemiologic and clinical updates on impulsecontrol

disorders: a critical review." Eur Arch Psychiatry ClinNeurosci.256 (8), 464475, 2006. http://www.pubmedcentral.nih.gov/articlerender.fcgi?
tool=pubmed&pubmedid=16960655

Forensic Psychiatry. Kleptomania.

http://www.forensicpsychiatry.ca/impulse/kleptomania.htm

Gazzinga, MS, and MS Steven. "Neuroscience and the Law." Scientific

American Mind. April 15, 2005. http://www.sciam.com/article.cfm?
id=neuroscience-and-the-law&print=true

Grant, JE and BL Odlaug. "Kleptomania: Clinical Characteristics and

Treatment." Rev Bras Psyquiatr, 2007.
http://www.scielo.br/pdf/rbp/nahead/art02.pdf

http://health.howstuffworks.com/mental-health/mentaldisorders/kleptomania3.htm