KLEPTOMANIA

'Kleptomania' (Greek: ''κλέπτειν'', kleptein, "to steal", ''μανία'', "mania") is an inability or great difficulty in resisting impulses of stealing.
A person with this disorder is compelled to steal things, generally things of little or no value, such as pens, paper clips, small toys, or packets of sugar. Some may not be aware that they have committed the theft until later. The majority of kleptomaniacs sometimes have preferences to certain items (again, usually subconsciously); for example, batteries or television remote controls.
Kleptomania is distinguished from shoplifting or ordinary theft, as shoplifters and thieves generally steal for monetary value, or associated gains and usually display intent or premeditation, while people with kleptomania are not necessarily contemplating the value of the items they steal or even the theft until they are compulsed.
Although a kleptomaniac may steal uncontrollably without realization, judicial courts in the United Kingdom and United States generally do not accept kleptomania as an affirmative defense.
People with this disorder are likely to have a comorbid condition, specifically paranoid, schizoid or borderline personality disorder.^[1] Kleptomania can occur after traumatic brain injury and carbon monoxide poisoning.^[2][3]
Kleptomania is usually thought of as part of the obsessive compulsive disorder spectrum, although emerging evidence suggests that it may be more similar to addictive and mood disorders. In particular, this disorder is frequently co-morbid with substance use disorders, and it is common for individuals with kleptomania to have first-degree relatives who suffer from a substance use disorder.^[4]

Contents

Diagnosis

Treatments

Relationship to OCD

References

Diagnosis

The DSM-IV-TR lists the following five criteria for kleptomania:

★ Recurrent failure to resist impulses to steal objects that are not needed for personal use or for their monetary value.

★ Increasing sense of tension immediately before committing the theft.

★ Pleasure, gratification, or relief at the time of committing the theft.

★ The stealing is not committed to express anger or revenge and is not in response to a delusion or a hallucination.

★ The stealing is not better accounted for by conduct disorder, a manic episode, or antisocial personality disorder.

Treatments

Kleptomania has several different treatments. Cognitive-behavioral therapy is recommended as an adjuvant to medication.
Some medications that are used for people diagnosed with kleptomania are selective serotonin reuptake inhibitors, mood stabilizers and opioid antagonists.Dannon PN, Aizer A, Lowengrub K, (2006): Kleptomania: Differential Diagnosis and Treatment Modalities. ''Current Psychiatry Reviews''. '2'(2) 281-283. The only open-trial of medication for kleptomania showed naltrexone significantly reduced the intensity of urges to steal, stealing thoughts and stealing behavior.^[5] A similar three year follow-up of patients treated only with naltrexone showed a clinically significant reduction in kleptomanic behavior.^[6]

Relationship to OCD

Kleptomania is often thought of being a part of obsessive compulsive disorder, since the irresisteible and uncontrollable actions are similar to the frequently excessive, unnecessary and unwanted rituals of OCD. Some individuals with kleptomania demonstrate hoarding symptoms that resemble those with OCD.^[7].
Prevalence rates between the two disorders do not demonstrate a strong relationship. Studies examing the comorbidity of OCD in subjects with kleptomania have inconsistent results, with some showing a relatively high co-occurrence (45%-60%)^[8][9] while others demonstrate low rates (0%-6.5%).^[10][11] Similarly, when rates of kleptomania have been examined in subjects with OCD, a relatively low co-occurrence was found(2.2%-5.9%).^{[12] [5]}

References

1. Co-occurrence of personality disorders in persons with kleptomania: a preliminary investigation, Grant JE, , , J. Am. Acad. Psychiatry Law, 2004
2. Kleptomania after head trauma: two case reports and combination treatment strategies, Aizer A, Lowengrub K, Dannon PN, , , Clinical neuropharmacology, 2004
3. [Case report: kleptomania and other psychiatric symptoms after carbon monoxide intoxication], Gürlek Yüksel E, Taşkin EO, Yilmaz Ovali G, Karaçam M, Esen Danaci A, , , Türk psikiyatri dergisi = Turkish journal of psychiatry, 2007 Full text available.
4. Understanding and treating kleptomania: new models and new treatments, Grant JE, , , The Israel journal of psychiatry and related sciences, 2006 Full text PDF
5. Impulsive disorders in Japanese adult patients with obsessive-compulsive disorder, Matsunaga H, Kiriike N, Matsui T, Oya K, Okino K, Stein DJ, , , Comprehensive psychiatry, 2005
6. Outcome study of kleptomania patients treated with naltrexone: a chart review, Grant JE, , , Clinical neuropharmacology, 2005
7. Clinical characteristics and associated psychopathology of 22 patients with kleptomania, Grant JE, Kim SW, , , Comprehensive psychiatry, 2002
8. Kleptomania: clinical features and comorbidity in an Italian sample, Presta S, Marazziti D, Dell'Osso L, Pfanner C, Pallanti S, Cassano GB, , , Comprehensive psychiatry, 2002
9. Kleptomania: a report of 20 cases, McElroy SL, Pope HG, Hudson JI, Keck PE, White KL, , , The American journal of psychiatry, 1991
10. Psychopathology and comorbidity of psychiatric disorders in patients with kleptomania, Baylé FJ, Caci H, Millet B, Richa S, Olié JP, , , The American journal of psychiatry, 2003 Full text available
11. Family history and psychiatric comorbidity in persons with kleptomania, Grant JE, , , Comprehensive psychiatry, 2003
12. Fontenelle LF, Mendlowicz MV, Versiani M, (2005) Impulse control disorders in patients with obsessive-compulsive disorder. ''Psychiatr Clin Neurosci''. 59:30-37.
13. Impulsive disorders in Japanese adult patients with obsessive-compulsive disorder, Matsunaga H, Kiriike N, Matsui T, Oya K, Okino K, Stein DJ, , , Comprehensive psychiatry, 2005