What Is… Kleptomania

In this series, I dig a little deeper into the meaning of psychology-related terms. This week’s term is 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 a fellow blogger, so I wanted to take a closer look.

DSM-5 Diagnosis

In the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), 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 committing the theft
• 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 a 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 don’t come from moral flaws or weaknesses. Most people with kleptomania feel shame and guilt after completing a theft.

Incidence

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.

The condition is likely under-diagnosed, as people are often too embarrassed to seek treatment. It usually begins in adolescence, and it’s two to three times as common in females than in males. Often people will have certain triggers, either internal or environmental, for their urges to steal.

Treatment

A variety of medications have shown some benefits 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. These are all used off-label, as the FDA hasn’t approved any medication specifically for use in kleptomania. Psychotherapy is also used to treat the condition. A combination of medication and psychotherapy may be the most effective.

Possible explanations

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.

There may be a neuropsychiatric basis (i.e. structural/functional changes in the brain), as kleptomania has been observed following head injuries.

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 executive functioning (higher-level decision-making).

Legal implications

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 legal precedent as to whether kleptomania may be 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 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 the what is… series in the Psychology Corner.

References

• Blum, A.W., & Grant, J.E. (2017). Behavioral addictions and criminal responsibility. The Journal of the American Academy of Psychiatry and the Law, 45(4), 464-471.
• Grant, J.E. (2002). Kleptomania: Emerging therapies target mood, impulsive behavior. Current Psychiatry, 1(8), 45-49.
• Grant, J.E., & Odlaug, B.L. (2007). Kleptomania: Clinical characteristics and treatment. Brazilian Journal of Psychiatry, 30(S1).
• Talih, F.R. (2011). Kleptomania and potential exacerbating factors.& Innovations in Clinical Neuroscience, 8(10), 35-39