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Kleptomania

Introduction
Signs and symptoms
Causes
Risk Factors
Screening and diagnosis
Treatment
Prevention

Kleptomania is the irresistible urge to steal items that you don't need and that usually have little value. Although kleptomania is often the butt of jokes, it's a very real and serious mental health disorder that can tear your life apart if not treated.

Kleptomania is a type of impulse control disorder - a disorder in which you can't resist the temptation or drive to perform an act that's harmful to you or someone else. People with kleptomania know that their actions are harmful. Yet the urge to steal is so powerful that they can't resist it. This urge makes them feel uncomfortably anxious, tense or aroused. To soothe these feelings, they steal. During the theft, they feel relief and gratification. Afterward, though, they feel enormous guilt, remorse, self-loathing and fear of arrest. But the urge comes back, and the kleptomania cycle repeats itself.

Many people with kleptomania live lives of secret shame because they're afraid to seek mental health treatment. Although there's no cure for kleptomania, treatment with medication or psychotherapy may be able to help end the cycle of compulsive stealing.

Symptoms of kleptomania may include:

• Powerful urges to steal items that you don't need
• Feeling increased tension leading up to the theft
• Feeling pleasure or gratification while stealing
• Feeling terrible guilt or shame after the theft

Unlike typical shoplifters, people with kleptomania don't compulsively steal for personal gain. Nor do they steal as a way to exact revenge. They steal simply because of an inexplicable urge. Episodes of kleptomania seem to occur spontaneously, without planning. However, stressful events, such as an argument, may trigger an episode of kleptomania.

Most people with kleptomania steal from public places, such as stores and supermarkets. Some may steal from friends or acquaintances, such as at a party. Often, the stolen items have no value to the person with kleptomania. The stolen items are usually stashed away, never to be used. Items may also be donated, given away to family or friends, or even secretly returned to the place from which they were stolen. In rarer cases, people with kleptomania may repeatedly pilfer the same kinds of items, such as undergarments. In these cases, the kleptomania may include an element of fetishism.

Kleptomania is thought to be uncommon. 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. It's thought that fewer than 5 percent of shoplifters have kleptomania. Kleptomania often begins in adolescence or in the 20s, but in rare cases it begins in very early childhood or late in life.

Although the cause of kleptomania isn't known, researchers continue to learn more about the factors that may increase the risk of developing kleptomania. These risk factors may include:

• Excessive life stressors, such as a major loss
• Head trauma or brain injuries
• Having blood relatives with kleptomania, mood disorders, addictions or obsessive-compulsive disorder
• Being preoccupied with financial success or material gains

When you decide to seek treatment for symptoms of possible kleptomania, you may have both a physical and psychological evaluation. The physical exam can determine if there may be any physical causes triggering your symptoms.

There's no laboratory test to diagnose kleptomania. Instead, kleptomania is diagnosed based on your signs and symptoms. Kleptomania is a type of impulse control disorder. Your doctor or mental health provider will ask many questions about any impulses, compulsions or obsessions you have, how often and when they occur, and how they make you feel. He or she may review a list of situations to see if they trigger kleptomania episodes. You may also fill out psychological questionnaires or self-assessments to help pinpoint a diagnosis. Because it's not uncommon for people with kleptomania to have other mental health problems, such as depression, anxiety or substance abuse, you and your mental health provider may explore these issues, too.

To be diagnosed with kleptomania, someone must meet criteria spelled out in the Diagnostic and Statistical Manual of Mental Disorders (DSM). This manual is published by the American Psychiatric Association and is used by mental health professionals to diagnose mental conditions and by insurance companies to reimburse for treatment.

Criteria for kleptomania to be diagnosed include:

• Inability to resist urges to steal objects that aren't needed for personal use or monetary value
• Increasing tension leading up to the theft
• Pleasure, relief or gratification during the act of stealing
• The theft isn't committed as a way to exact revenge or to express anger, and isn't done while hallucinating or delusional
• The stealing isn't related to manic episodes of bipolar disorder or other mental health disorders, such as antisocial personality disorder

Although fear, humiliation or embarrassment may make it difficult for you to seek treatment for kleptomania, it's important to get help. Kleptomania is very difficult to overcome on your own. Treatment of kleptomania typically involves medications and psychotherapy, perhaps along with self-help groups. However, there is no standard kleptomania treatment and researchers are still trying to understand what may work best. You may have to try several types of kleptomania treatment to find something that works well for your situation.

Medications
There's little solid scientific research about using psychiatric medications to treat kleptomania. However, some studies have suggested that certain medications may be helpful. Which medication is best for you depends on your overall situation and other conditions you may have, such as depression or obsessive-compulsive disorder. You may benefit from taking a combination of medications. Medications to consider include:

• Antidepressants. Those most commonly used to treat kleptomania are selective serotonin reuptake inhibitors (SSRIs). These include fluoxetine (Prozac, Prozac Weekly), paroxetine (Paxil, Paxil CR), fluvoxamine and others. However, there have been a few case reports of SSRIs actually triggering kleptomania symptoms. Talk to your doctor about your concerns and coping with side effects of antidepressants.
• Mood stabilizers. 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. Some evidence suggests that lithium (Eskalith, Lithobid) may be helpful.
• Benzodiazepines. These medications are central nervous system depressants, also called tranquilizers. They include clonazepam (Klonopin) and alprazolam (Xanax). The effectiveness of benzodiazepines often varies, and they may be habit-forming - causing mental or physical dependence, especially when taken for a long time or in high doses.
• Anti-seizure medications. Although originally intended for seizure disorders, these medications have shown benefits in certain mental health disorders, possibly including kleptomania. Some studies have shown benefits from topiramate (Topamax) and valproic acid (Depakene).
• Addiction medications. Naltrexone (Revia), known technically as an opioid antagonist, is most commonly prescribed for kleptomania. Naltrexone blocks the part of your brain that feels pleasure with certain addictive behaviors. It may reduce the urges and pleasure associated with stealing.

You may have to try several different medications or combinations of medications to see what works best for you with the fewest side effects. Keep in mind that it may take several weeks to notice full benefits. Talk to your doctor or mental health provider if you're bothered by side effects. Under his or her guidance, you may be able to switch medications or change your dosage. Many side effects go away on their own with time.

Psychotherapy
Cognitive behavioral therapy has become the psychotherapy of choice for kleptomania. In general, cognitive behavioral therapy helps you identify unhealthy, negative beliefs and behaviors and replace them with healthy, positive ones. Cognitive behavioral therapy may include these techniques to help you overcome kleptomania urges:

• Covert sensitization, in which you picture yourself stealing and then facing negative consequences, such as being caught.
• Aversion therapy, in which you practice mildly painful techniques, such as holding your breath until you become uncomfortable, when you get an urge to steal.
• Systematic desensitization, in which you practice relaxation techniques and picture yourself controlling urges to steal.

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

Self-help groups
Some people with kleptomania have benefited from participating in self-help groups based on 12-step programs. Even if you can't find a group specifically for kleptomania, some research indicates benefits of attending A.A. or other addiction meetings. Such groups don't suit everyone's tastes, so ask your mental health provider about alternatives.

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. If you're on probation, you may also consider touching base with a trusted and compassionate probation officer.