What is… Kleptomania

Mental Health @ Home insights into psychology: kleptomania

In this series, I dig a little deeper into the meaning of psychology-related terms.  This week’s term: kleptomania

Yes, kleptomania is actually a legitimate psychiatric condition.  It wasn’t a condition I had anything more than passing familiarity with, but it came up in a conversation with Meg of Why Does bad advice happen to good people? so I wanted to take a closer look. 

In the Diagnostic and Statistical Manual of Mental Disorders (DSM), kleptomania falls in the category of “disruptive, impulse-control, and conduct disorders”, along with pyromania, conduct disorder, and oppositional defiant disorder.  The symptoms include:

  • recurrent failure at resisting impulses to steal items that are neither needed nor taken for their monetary value
  • there is a sense of building tension immediately before the theft
  • there are feelings of pleasure or gratification while the theft is being committed
  • the theft is not due to anger, seeking vengeance, psychosis, mania, antisocial personality, or other conditions

Unlike someone with antisocial personality disorder who might steal based on lack of regard for others, the urges to steal in kleptomania are experienced as ego dystonic, meaning the person finds the urges distressing and wishes they didn’t have them.  It’s not an issue of morality, in the same sense that OCD compulsive behaviours are not driven by moral flaws or weaknesses.  Most people with kleptomania feel shame and guilt after completing a theft.

Kleptomania is rare, only occurring in about 0.6% of the population, although it appears to be more common among people with another psychiatric condition, particularly mood, anxiety, or substance use disorders.  In terms of family history, people with kleptomania are more likely to have a family history of alcoholism.

It’s thought to be under-diagnosed, as people are often too embarrassed to seek treatment.  It usually begins in adolescence, and is two to three times as common in females than in males.  Often people will have certain triggers, either internal or environmental, that are associated with the urges to steal.

From a psychoanalytic perspective, kleptomania is seen as possibly representing sexual repression (although is there anything Freud wouldn’t link to sexual repression?) or trying to repossess childhood losses.  It’s also thought that there may be a neuropsychiatric basis (i.e. structural/functional changes in the brain), and it has been reported to occur following head injuries.

A variety of medications have shown some benefit in kleptomania, including SSRI antidepressants, naltrexone (used to decrease cravings in addictions), and the mood stabilizer/antiepileptic topiramate.  Atypical antipsychotics may be helpful as an add-on to SSRIs, although this hasn’t been clearly established.  All of these are used off-label, as there are no medications with FDA approval specifically for use in kleptomania.  Psychotherapy is also used.  A combination of medication and psychotherapy may be the most effective.

It has been suggested that a potential explanation for the poor decision-making in kleptomania may be related to serotonin dysfunction in the prefrontal cortex, the part of the brain that’s responsible for higher-level decision-making.

An article in The Journal of the American Academy of Psychiatry and the Law characterized kleptomania as a behavioural addiction (along the lines of gambling addiction).  It sounds like there’s no clear precedent as to whether the courts will consider kleptomania a mitigating factor that diminishes capacity (the mens rea or criminal intent aspect of a crime) when someone is charged with theft.  The article points out that not all theft is consistent with kleptomania, and this should be considered in determining the extent to which kleptomania may be responsible for particular criminal behaviours.

In terms of the criminal issue, it sounds like people with this diagnosis are pretty clear mentally outside of these impulsive urges to steal.  For me, it would matter what the person did during those periods of clear thinking.  Did they try to put measures in place to prevent further stealing?  Regardless of how effective such measures may or may not be, doing nothing seems kind of like aiding and abetting your impulses.

In my years of nursing I never came across a patient who was known to have kleptomania.  There are a number of other such relatively obscure diagnoses in the DSM and I find them absolutely fascinating.  The mind can do strange things.

 

What are your thoughts?

 

You can find the rest of my What Is series here.

Sources:

 

Mental Health @ Home Store: Mental Health Internet Resource Directory

 

The mental health internet resource directory has loads of useful websites. It’s available FREE on the Mental Health @ Home Store.

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18 thoughts on “What is… Kleptomania

  1. kachaiweb says:

    I’ve seen it happening due to stress more like an acting out but not as the main diagnosis. As it is not that common, we don’t hear a lot about it. The thing is that people will steal things that have no meaning to them nor do they need or want the item. In my understanding it is the act in itself. On this one I can believe in the Freudian theory, I don’t know but something being surpressed (that ‘urge’) can give a release when achieved (the act of stealing). I seems to me that this could be very well treated with psychotherapy but the challenge will be not only to change the bevior but the underlying ‘urge’. Fascinating I agree!

  2. Joshua Shea says:

    The way you explain it makes it extremely understandable considering the other impulse disorders out there. I hope at some point you’ll write about Oppositional Defiant Disorder. I feel like I encountered several genuine cases of that when I was in jail and I’ve always been interested in learning more. Your way of explaining seems a lot easier to understand than reading studies or having it too dumbed down by WebMD.

  3. mikeandkatybug says:

    We were extremely kleptomaniac as children. We would steal anything that was nailed down. Stores, gas stations, department stores, whatever. Of course all that stealing was an attempt at wanting to be caught. Very confusing as children.

  4. Paula Light says:

    Marie on Breaking Bad had it. The behavior would appear during times of extreme stress, such as when she had to put on a constant cheerful face to care for her grouchy convalescing husband. It seemed legit the way the writers portrayed her.

  5. Meg says:

    Great blog post!! It raised a lot of awareness for me, because I’d be more likely to think, “Bad person who’s stealing!” It’s helpful to know there can be psychological impulses that make someone want to steal, that they have to work really hard to override. Because now it seems much more sympathetic. Like, when I don’t override my desire to, say, eat junk food, I’m not breaking the law, so I have no worries; but with this issue, you could wind up getting arrested or in serious trouble! I’m glad you raised awareness of this, and I think it’s something that everyone who runs a shop or works in retail should think about. I guess some coping strategies could include buying everything you need online, picking up groceries curbside (Krogers offers this), and having a family member run every single nearby errand for little things. Huh. Anyway, I love your psychological concepts series!

    • ashleyleia says:

      Given how rare it is I think most people who are shoplifting are doing so for other reasons, but yeah, I’m sure that kind of advanced planning is an important part of managing for those who do have kleptomania.

  6. Luftmentsch says:

    I was never sure how real this was, so it’s good to read this. I believe it is also understood that troubled children and teenagers sometimes steal for non-financial reasons, as a cry for help, particularly if they do it in a way that makes it likely that they’ll get caught.

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