Insight Into Kleptomania

What is Kleptomania?

Kleptomania (Klep-toe-MAY-knee-uh) is a well-known impulse-control disorder characterised by the recurrent failure to resist impulses to steal items even though the items are not needed for personal use or for their monetary value. The individual experiences a rising sense of tension before the theft and feels pleasure, gratification, or relief when committing the theft. The stealing is not committed to express anger or vengeance. It is also not done in response to a delusion (false belief) or hallucination (false sensory experience).

The stealing is not better accounted for by Conduct Disorder, Antisocial Personality Disorder or a Manic Episode.

The objects are stolen despite the fact that they are typically of little value to the individual, who could have afforded to pay for them, and who often gives them away or discards them. Occasionally the individual may hoard the stolen objects or surreptitiously return them.

Although individuals with this disorder will generally avoid stealing when immediate arrest is probable (e.g. in full view of a police officer), they usually do not pre-plan the thefts or fully take into account the chances of arrest. The stealing is done without assistance from, or collaboration with, others. 

How Does Kleptomania Differ From Shoplifting?

Kleptomania should be distinguished from ordinary acts of theft or shoplifting. Ordinary theft (whether planned or impulsive) is deliberate and is motivated by the usefulness of the object or its monetary worth. Some individuals, especially adolescents may steal as a dare, as an act of rebellion, or as a rite of passage.

One of the symptoms of Kleptomania that differentiates it from shoplifting is the fact that people suffering from Kleptomania do not hold a grudge against the person from whom they are stealing. They do not steal for personal gain, but because they find it almost impossible to control their urge. People with Kleptomania do not target a particular individual or a shop for a specific reason. They steal to alleviate their anxiety.

Kleptomania is exceedingly rare, whereas shoplifting is relatively common.

Note: Kleptomania should be distinguished from inadvertent stealing that may occur as a result of dementia (forgetfulness and cognitive decline).

Sometimes individuals will try to simulate the symptoms of Kleptomania to avoid criminal prosecution. Of course this is not as easy as one thinks (see ‘Kleptomania as a Legal Defence’ below). 

Associated Features and Disorders

Individuals with Kleptomania experience the impulse to steal as ego-dystonic (unacceptable to the person’s ideal conception of self) and are aware that the act is wrong and senseless. The person frequently fears being arrested and often feels depressed or guilty about the thefts.

Left untreated, the disorder can cause legal, family, career and personal difficulties.

Kleptomania may be associated with other disorders such as mood disorders, anxiety disorders, eating disorders (particularly Bulimia Nervosa) and personality disorders.

Kleptomania may result in or be associated with:

• Arrest
• Imprisonment
• Depression
• Alcohol and substance abuse
• Eating disorders
• Anxiety
• Compulsive gambling or shopping
• Suicidal thoughts or behavior
• Social isolation

Who Suffers from Kleptomania?

Kleptomania appears to be more common in females than males. 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.

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 individuals suffering from Kleptomania in their late 70s.

We don't know if Kleptomania has a genetic component, but some studies suggest that people suffering from Kleptomania have parents or close relatives with substance abuse problems, obsessive-compulsive disorder and/or mood disorders.

How Common is Kleptomania?

According to the American Psychiatric Association, Kleptomania is a rare condition that appears to occur in fewer than 5% of identified shoplifters. However, because many people with Kleptomania never seek treatment, or they're simply jailed after repeated thefts, many cases of Kleptomania may never be diagnosed. 

How is the Condition Likely to Progress?

There is little systematic information on the course of Kleptomania, but three typical courses have been described:

1. Sporadic with brief episodes and long periods of remission;
2. Episodic with protracted periods of stealing and periods of remission;
3. Chronic (long term) with some degree of fluctuation.

This disorder may continue for years, despite multiple convictions for shoplifting.

What Causes Kleptomania?

Unfortunately, as is the case with most mental disorders, the cause of Kleptomania isn't known. There are a variety of theories which suggest different possible causes and each theory probably has some truth to it. More research is needed to better understand all of these possible causes.

Generally the thinking today is that it is not just one factor that causes a mental disorder, but a number of factors working together.This explanation is called the Diathesis – Stress Model/Theory and is commonly accepted to be the most comprehensive explanation of the cause of mental disorders. To read more about the Diathesis – Stress Model/Theory please read my article‘Understanding Mental Disorders'. 

 According to the Diathesis–Stress Model, a biological or genetic vulnerability or predisposition (diathesis) interacts with the environment and life events (stressors) to precipitate (trigger) behaviours or psychological disorders. The behaviour or mental disorder is then maintained by a number of other factors.

Possible causes of Kleptomania include:

1. Long-Term, Predisposing Factors

Heredity- Having a first-degree blood relative, such as a parent or sibling, with Kleptomania or obsessive-compulsive disorder may increase your risk of Kleptomania. 

Being Female - Approximately two-thirds of people with known Kleptomania are women. 

2. Biological Factors

Chemical imbalances in the central nervous system - 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 behaviours.

Kleptomania also may be related to addictive disorders, and stealing may cause the release of dopamine (another neurotransmitter). Dopamine causes pleasurable feelings, and some people seek this rewarding feeling over and over again.

Medical conditions that can cause disorders – People with Kleptomania often have other mental illnesses, such as bipolar disorder, anxiety disorder, eating disorders, substance abuse or personality disorders. 

Head trauma or brain injuries - People who've experienced a head trauma may develop Kleptomania.

3. Short-Term, Precipitating (Triggering) Factors

Conditioning – the Cognitive-Behavioral view of the disorder is that it is the result of conditioning.  The behaviour 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.

Other mental disorders – People with Kleptomania often have other mental illnesses, such as bipolar disorder, anxiety disorder, eating disorders, substance abuse or personality disorders.

4. Maintaining Causes

Mistaken beliefs – According to Cognitive-Behavioral Theory (CBT), individuals with Kleptomania have a range of mistaken beliefs 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 behaviour. All of these thoughts were precipitated by additional thoughts about family, financial, and work stressors or feelings of depression.

‘Maintaining’ cognitions provide additional reinforcement for stealing behaviour and include feelings of vindication and pride, for example: "score one for the 'little guy' against the big corporations". Although those thoughts are often accompanied afterwards by feelings of remorse, this comes 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.

What can I do to Help Myself if I Think I Have Kleptomania?

Although humiliation, embarrassment or fear may make it difficult for someone to seek treatment for Kleptomania, it's important that they get help. Kleptomania is difficult to overcome on one’s own. 

A mental health provider will probably ask you a number of questions to try to understand your symptoms and how they're affecting your life, such as:

• At what age did you first experience an irresistible urge to steal?
• How often do you experience the urge to steal?
• Have you ever been caught or arrested for stealing?
• How would you describe your feelings before, during and after you steal something?
• What kinds of items do you steal? Are they things you need?
• From whom do you steal?
• What do you do with the items you steal?
• Does anything in particular seem to trigger your urge to steal?
• How would you say your urge to steal is affecting your life, including school, work and personal relationships?
• Have any of your close relatives had a problem with compulsive stealing, or with other mental health conditions such as depression, addiction or obsessive-compulsive disorder?
• Have you been treated for any other mental health problems, including eating disorders? If yes, what treatments were most effective?
• Do you use alcohol or illegal drugs? How often?
• Are you currently being treated for any other medical conditions?

How is Kleptomania Treated?

Many people with Kleptomania live lives of secret shame because they're afraid to seek mental health treatment. This is unfortunate because, although there's no cure for Kleptomania, treatment may help to end the cycle of compulsive stealing.

 There is no standard treatment approach for Kleptomania as its cause is still not fully understood.  There are, however, a range of treatment approaches which include psychotherapy, medication (Pharmacotherapy) and support groups. A person suffering from Kleptomania may, therefor, have to try several types of treatment to find something that works well for them.

Medication (Pharmacotherapy)

There is not enough scientific research on the use of psychiatric medications to treat Kleptomania, but certain medications seem to be helpful. The best medication for each individual depends on their overall situation and other conditions they may have - such as depression or obsessive-compulsive disorder. Often the individual will benefit from taking a combination of medications to see what works best with the fewest side effects. Keep in mind that it may take several weeks to notice the full benefits of the medication.

It is important for the individual to constantly talk to his / her doctor or mental health provider if they are bothered by side effects. The doctor may be able to switch medications or change the dosage. Many side effects eventually go away.

Medications generally prescribed include:

• Antidepressants. Selective serotonin reuptake inhibitors (SSRIs) are commonly used to treat Kleptomania. These include fluoxetine (Prozac, Prozac Weekly), paroxetine (Paxil, Paxil CR), fluvoxamine (Luvox, Luvox CR) and others.
• Mood stabilisers. These medications are meant to even out your mood so that you don't have rapid or uneven changes that may trigger urges to steal. One mood stabilizer used to treat Kleptomania is lithium (Lithobid).
• Anti-seizure medications. Although originally intended for seizure disorders, these medications have shown benefits in certain mental health disorders, possibly including Kleptomania. Examples include topiramate (Topamax) and valproic acid (Depakene, Stavzor).
• Addiction medications. Naltrexone (Revia, Vivitrol), known technically as an opioid antagonist, blocks the part of your brain that feels pleasure with certain addictive behaviours. It may reduce the urges and pleasure associated with stealing.

Psychotherapy

Cognitive Behavioural Therapy (CBT) has become the psychotherapy of choice for Kleptomania. In general, CBT helps you identify unhealthy, negative beliefs and behaviours and replace them with healthy, positive ones. Cognitive Behavioural Therapy may include the following techniques to help someone overcome the urge to steal: 

• Covert sensitisation: 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 desensitisation: The patient undergoes relaxation therapy and learns to substitute relaxing feelings for the urge to steal.

Other forms of therapy, such as psychodynamic therapy, family therapy or marriage counselling, may also be helpful.

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 provider or reach out to a trusted support group.

Like drug treatments, these cognitive behavioural therapies have achieved mixed results. There needs to be more controlled behavioural, neurological and pharmacological studies for Kleptomania. A major problem is that many of these behaviours occur so rarely in the general population that getting enough subjects to obtain convincing scientific evidence may be difficult.

Support Groups

People with Kleptomania may benefit from participating in self-help groups based on 12-step programmes. Even if you can't find a group specifically for Kleptomania, some research indicates benefits of attending Alcoholics Anonymous or other addiction meetings. Such groups don't suit everyone's tastes, so ask your mental health provider about alternatives.

Support for Loved Ones

If your loved one is being treated for Kleptomania, make sure you understand the details of his or her 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 affected person 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.

If you know someone suffering from Kleptomania, please try and ensure that they receive adequate help, as soon as possible.

Kleptomania as a Legal Defence

Legal defences ­for shoplifting by claiming Kleptomania are difficult. First, a defence lawyer must argue that the accused stole for no financial gain, revenge, anger or dare. Next, a rigorous psychiatric evaluation must be performed… and the criteria to meet an actual diagnosis are strict.

Even if Kleptomania is diagnosed, in America the U.S. Justice Department excludes it (along with pyromania and other impulse control disorders) from possible defence, according to the Americans with Disabilities Act.

It basically comes down to the question of the individual's responsibility for his or her actions versus ‘insanity’ -- this issue has long been tossed around in the judiciary and psychiatric worlds.

In South Africa, the law requires intent as a basic element in any crime. So, a person stealing must have the intent to steal. Such intent might not be present in the case of automatism, or mistake or certain other instances. I doubt whether a person assailed by urges would escape culpability, as the court must surely hold that, urge or not, if they knew it was wrong, they had a choice. Take the example of rape – an offender can never escape liability for forcing his attentions on another on the basis that he was driven by an irresistible urge. Theft must be viewed in the same light.

“When I see someone rich,
Both my thumbs start to itch
Only to find some peace of mind,
We have to pick-a-pocket or two.”

Fagin - From the musical 'Oliver' by Lionel Bart