What is kleptomania? An independent illness, a symptom of other psychiatric disorders, or merely criminal behavior? Kleptomania—a disorder defined by an inability to resist the impulse to steal—is one of psychiatry’s most poorly understood diagnoses, even though it has been recognized in the literature for almost 200 years.
Kleptomania causes notable distress and impaired functioning.1 People with kleptomania often suffer from comorbid mood, anxiety, substance use, and other impulse-control disorders.14 They experience the humiliation of repeated arrests, which leads to guilt, depression, and even suicide.1,5 Yet kleptomania usually goes undiagnosed and untreated, despite a lifetime prevalence as high as 0.6%.6
Case report: ‘I’m a thief’
“I’m a thief,” began Susan, age 39. “I steal something four or five times every week. I steal from grocery stores and clothing stores. Sometimes I might steal something like vanilla extract; other times an expensive men’s tie. I probably steal $200 worth of items every week.
“You probably won’t believe this, but I don’t want or need the stuff I take. I have plenty of money. I have no idea why I take the things I do. That’s why I’m so depressed. What kind of person does something like this?
The urge to steal “I was probably 14 when I started stealing. I would go to stores with my mother. When I saw certain objects, I would get urges to steal them. The odd thing was that the items I stole were so ridiculous. I remember stealing key chains for several months, maybe three or four times a week. When I got older, things got worse. I was having urges more often, and so I needed to steal more often.
|Only little old ladies are kleptomaniacs.||Men and women of all ages suffer from kleptomania. Most patients report that the disorder began in adolescence.|
|It’s just a phase kids go through.||Parents of adolescents might see stealing as a phase. In many cases this might be true, but stealing may also suggest an underlying psychopathology.|
|People who steal are “bad.”||People with kleptomania steal because of urges to steal, not because of moral weakness. Treatment, not judgment, is the appropriate response.|
“My entire life has been torment. Each day I worry about having the urges, and then I worry about being caught stealing. I can’t relax. I’ve been married for 17 years, and I haven’t told my husband. My secrecy is tearing our marriage apart. My husband thinks I’m having an affair because I’ve distanced myself emotionally from him.”
SCREENING TEST FOR KLEPTOMANIA
|1. Do you steal or have urges to steal?||○||○|
|2. Do thoughts of stealing or urges to steal preoccupy you? That is, do you often think about stealing or have urges to steal and wish the thoughts or urges occurred less often?||○||○|
|3. Do you feel tense or anxious before you steal or when you have urges to steal?||○||○|
|4. Do you feel pleasure or a sense of calm when you steal something?||○||○|
|5. Has the stealing or urges to steal caused you much distress?||○||○|
|6. Has the stealing or urges to steal significantly interfered with your life in some way?||○||○|
|A patient who answers “yes” to questions 1 through 4 and to question 5 or 6 is likely to have kleptomania.|
|Adapted from DSM-IV criteria, American Psychiatric Association, 2000|
Susan described urges to steal almost every day. When the urges were mild, she could resist them. Other days they were severe, and Susan felt unable to control her behavior. At work, her urges distracted her from completing projects, and her performance suffered. The urge to steal would often compel Susan to leave work early so she could get to a store.
Calm, then guilt “Every time I steal something I feel both a thrill and a great sense of calm,” she said. “It feels good. The problem is that almost immediately after each theft, I feel guilty and ashamed. After I steal, I usually donate the items to the Salvation Army, throw them away, or give them away as gifts.”
Drug trials We started treating Susan with the selective serotonin reuptake inhibitor (SSRI), citalopram. She reported notable improvement in her mood after 3 weeks on a dosage of 60 mg/d and she had been attending weekly psychotherapy, although her stealing continued unchanged. The addition of naltrexone, 200 mg/d for 2 weeks, decreased the frequency of Susan’s stealing and reduced her urges to steal, but her symptoms continued to interfere significantly with her overall functioning.
We then added the atypical antipsychotic quetiapine, 100 mg bid, and Susan’s urges to steal and stealing behavior went into remission within 3 weeks. She has refrained from stealing for the last 9 months.