Kleptomania is a complex and often misunderstood disorder characterized by an irresistible urge to steal items that typically have little value to the individual who is stealing. This disorder is classified in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5-TR) as an impulse control disorder, not elsewhere classified. Individuals with kleptomania experience recurrent episodes of stealing, which are not motivated by anger, vengeance, or a delusional belief, nor are they committed to express anger or vengeance, to achieve personal gain, or in response to a delusion or a hallucination. The act of stealing is typically not planned and is not a response to an immediate need or financial pressure (Grant & Kim, 2007).

People presenting with kleptomania often feel an increasing sense of tension before the theft and relief or gratification during or immediately after the theft (Grant, 2006). The items stolen are not taken for personal use or monetary value, and often, the individual will secretly return or give away the stolen items. Despite these feelings of relief, the disorder is usually accompanied by significant distress or impairment in social, occupational, or other important areas of functioning. Individuals with kleptomania often go to great lengths to conceal their thefts and may feel shame, guilt, self-loathing, or fear of arrest following the act. The repetitive nature of stealing can have significant legal and personal consequences, affecting relationships and social standing (Grant et al., 2005).

It is not uncommon for kleptomania to co-occur with mood disorders, anxiety disorders, eating disorders, or other impulse-control disorders, which can complicate the clinical picture (Odlaug & Grant, 2010). Understanding kleptomania requires a nuanced approach that considers both psychological and behavioral aspects, as well as potential co-morbidities that may influence the presentation and progression of the disorder.

Diagnostic Criteria

Kleptomania is identified in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, Text Revision (DSM-5-TR) as a disorder characterized by a recurrent failure to resist impulses to steal items that one generally does not need for personal use or monetary value. The diagnostic criteria for kleptomania include an increasing sense of tension before the theft and feelings of pleasure, gratification, or relief when committing the theft. The stealing is not committed to expressing anger or vengeance and is not in response to a delusion or a hallucination. Moreover, the behavior is not better accounted for by conduct disorder, a manic episode, or antisocial personality disorder (American Psychiatric Association, 2023).

In the research literature, kleptomania is often discussed as a comorbid psychiatric disorder. Individuals with kleptomania frequently have co-occurring mood disorders, anxiety disorders, eating disorders, substance use disorders, and other impulse control disorders. The high rate of comorbidity suggests that kleptomania may be related to dysfunction in neural pathways governing impulse control and reward (Grant & Kim, 2002). Neurobiological studies often focus on the role of the serotoninergic system in impulse control disorders, suggesting that dysregulation in this neurotransmitter system could be a factor contributing to the pathophysiology of kleptomania (Grant, 2006).

Treatment approaches for kleptomania often involve cognitive-behavioral therapy (CBT), which is used to help patients identify and challenge their distorted beliefs about stealing and to develop alternative responses to the urge to steal. Selective serotonin reuptake inhibitors (SSRIs) have also been used to treat kleptomania, supporting the hypothesis that serotonergic dysfunction may be implicated in the disorder (Grant et al., 2009).

Comorbidities

Kleptomania is a complex impulse control disorder that frequently coexists with a variety of other psychiatric conditions, complicating both its diagnosis and treatment. Mood disorders, particularly depression and bipolar disorder, are commonly reported among individuals with kleptomania. These comorbid mood disorders may share underlying dysregulation of neurotransmitters, such as serotonin, which plays a role in both mood regulation and impulse control (Schreiber et al., 2011). Anxiety disorders are also prevalent in those with kleptomania, with some studies suggesting that the anxiety may be both a precursor and a consequence of impulsive stealing (Dannon, 2002).

Substance use disorders represent another significant comorbidity, with individuals often using substances to cope with the guilt and shame associated with their stealing behavior (Grant et al., 2010). Additionally, kleptomania has been linked to eating disorders, particularly binge-eating disorder, where the loss of control over eating may parallel the loss of control over stealing (McElroy et al., 1992). Attention-deficit/hyperactivity disorder (ADHD) is also more frequently observed in those with kleptomania, which may be attributed to shared deficits in self-regulatory mechanisms (Grant, 2008).

Personality disorders, especially borderline and antisocial personality disorders, can be comorbid with kleptomania. These disorders are characterized by impulsivity and instability in interpersonal relationships, self-image, and affect, which may be intertwined with the impulsive and often self-damaging actions seen in kleptomania (Baylé et al., 2000). The presence of these comorbidities requires a comprehensive treatment approach that addresses all aspects of an individual's mental health.

Treatment and Interventions

Treatment for kleptomania often involves a combination of psychotherapy, pharmacotherapy, and support groups. Cognitive-behavioral therapy (CBT) is considered a primary psychotherapeutic approach, focusing on identifying and changing the thoughts and behaviors associated with the urge to steal. Techniques such as covert sensitization, which pairs the thought of stealing with a negative consequence, and habit reversal training, which teaches individuals to recognize urges and replace the problematic behavior with a more acceptable one, are commonly employed in CBT for kleptomania (Grant et al., 2010).

Pharmacotherapy can include the use of selective serotonin reuptake inhibitors (SSRIs), which are thought to help reduce impulsivity and obsessive thoughts associated with kleptomania. The efficacy of SSRIs in treating kleptomania has been supported by several clinical case studies and open-label trials (Grant & Kim, 2002). Other medications, such as mood stabilizers and opioid receptor antagonists, have been explored due to their effectiveness in treating impulse control disorders more broadly. However, their use in kleptomania is based on limited evidence and is poorly established (Grant et al., 2008).

Support groups, akin to those used in substance abuse treatment, provide a space for individuals to share experiences and coping strategies and to receive peer support. These groups can be an essential adjunct to professional treatment, offering long-term support and helping to reduce the stigma and isolation that individuals with kleptomania may experience (Presta et al., 2002).

Treatment plans for kleptomania must be individualized, taking into account any comorbid conditions. They may require the concurrent treatment of associated disorders, such as depression or substance abuse, to be most effective. It is also critical that treatment providers consider the legal implications of kleptomania and work with clients to manage these aspects proactively (Kohn & Antonuccio, 2002).

Summary

Kleptomania presents significant diagnostic challenges due to its secretive nature and the stigma attached to stealing behaviors. Historically perceived as merely a criminal or moral failing, kleptomania has evolved in the medical and public consciousness to be recognized as a legitimate psychiatric disorder. This shift reflects a broader trend toward a more compassionate and inclusive understanding of impulse control disorders (Grant et al., 2010). The change in perspective is partly due to increased awareness and research into the neurobiological underpinnings of the disorder, which has begun to delineate the complex interplay of genetic, neurochemical, and environmental factors involved in its manifestation (Grant et al., 2010).

The disorder's onset in late adolescence or early adulthood can disrupt the formation of stable relationships and the establishment of a coherent sense of identity. The compulsion to steal, followed by intense shame and fear of legal consequences, can lead to social isolation and strained relationships with family and friends. This, in turn, can significantly impair the individual's self-esteem and confidence, potentially triggering or exacerbating comorbid conditions such as mood and anxiety disorders (Grant et al., 2005; Presta et al., 2002).

Kleptomania's impact is not limited to the psychological health of the individual; it extends to societal and economic dimensions, highlighting the necessity for effective and accessible treatment options. Cognitive-behavioral therapy and pharmacotherapy have shown promise in mitigating the symptoms of kleptomania, with research pointing towards the benefits of SSRIs, mood stabilizers, and opioid receptor antagonists. However, large-scale treatment studies are still required to establish best practices and ensure that those affected receive the help they need to overcome the challenges posed by this disorder (Grant et al., 2010).

In summary, while the understanding and treatment of kleptomania have come a long way, it remains a disorder fraught with challenges, both in diagnosis and in the comprehensive management of its multifaceted impact on individuals and society at large.

References

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Dannon, P. N. (2002). Kleptomania: An impulse control disorder? International Journal of Psychiatry in Clinical Practice, 6(1), 3-7.

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Presta, S., Marazziti, D., Dell'Osso, L., Pfanner, C., Pallanti, S., & Cassano, G. B. (2002). Kleptomania: Clinical features and comorbidity in an Italian sample. Comprehensive Psychiatry, 43(1), 7-12.

Schreiber, L., Odlaug, B. L., & Grant, J. E. (2011). Impulse control disorders: Updated review of clinical characteristics and pharmacological management. Frontiers in Psychiatry, 2, Article 1.