Generality
Kleptomania is a psychiatric disorder characterized by the recurrent inability to resist the urge to steal .
Usually, the objects stolen from the kleptomaniac have no personal utility or commercial value, so much so that they are often sold, thrown away or returned in secret. Only in certain cases, those who suffer from kleptomania keep the stolen goods and can be pushed to steal specific objects.
The patient suffering from kleptomania does not plan the theft and puts it into practice without someone's complicity, paying attention not to be arrested. The act of stealing is preceded by a feeling of increasing tension, accompanied by pleasure; once the gesture is completed, they are followed by relief and gratification .
However, as happens in similar disorders, when the subject becomes aware of the senselessness of the act, they follow profound feelings of guilt, remorse, worry and disapproval for their own gestures.
However, despite the good intentions of not repeating this action, the cycle tends to repeat itself infinitely, without the kleptomaniac interrupting it.
The diagnosis of kleptomania is difficult and, often, the disorder proceeds unnoticed. Over time, however, the condition can cause legal, family, professional and personal difficulties.
Kleptomania may benefit from antidepressant-based drug therapies (SSRIs) and / or mood tone stabilizers, which promote control of impulsiveness. In any case, the treatment of choice is cognitive-behavioral psychotherapy, which usually manages to reduce symptoms effectively.
Impulse control disorders: what are they?
Kleptomania belongs to the category of impulse control disorders. This diagnostic framework has only recently been recognized and reported in the third edition of the Diagnostic and Statistical Manual of Mental Disorders, prepared by the American Psychiatric Association.
As the term itself indicates, impulse control disorders are characterized by the subject's inability to resist an impelling impulse or temptation. This unstoppable push induces the subject to carry out a dangerous action for themselves and / or for other people. This impulse is preceded by a feeling of increasing tension and excitement, followed by pleasure, gratification and relief.
Generally, the action is followed by a feeling of remorse or guilt.
The category of impulse control disorders also includes pathological gambling, intermittent explosive disorder and pyromania.
Causes
The causes that can lead to kleptomania are in some ways unknown.
Psychiatry defines kleptomania as an obsessive form of thought, as the idea of theft and its fulfillment pervades the mind, preventing any other type of activity. For this reason, the kleptomaniac is considered a person with the capacity to understand, but not to want, since, as a rule, he is not able to oppose the act he is going to perform.
The act of stealing would therefore produce an emotional effect, which far surpasses any rational attempt to stop, to the point of not even considering its consequences. The gratification that comes from theft becomes, therefore, indispensable for the kleptomaniac subject, who tends to repeat the gesture again.
According to a psychoanalytic interpretation, however, theft would serve to resolve depressive phenomena and states of anxiety due to an unconscious sense of guilt. The explanation of kleptomania should therefore be sought in the desire for punishment as a compensatory act for one's behavior. The goal of the kleptomaniac would therefore be the mortification, humiliation and expiation of a penalty, on which the attainment of a temporary serenity depends.
Kleptomania appears to be more frequent among women than men, as is the case with compulsive shopping.
Although there are some pathologies that are often present, kleptomania is not due to other psychiatric problems.
Possible associated disorders
Kleptomania can occur in conjunction with other disorders: major depression, bulimia nervosa and obsessive-compulsive disorder.
This pathological condition has also been observed frequently in patients with drug and alcohol abuse disorders. Other conditions associated with kleptomania include anxiety disorders and social phobia.
Furthermore, the disorder can manifest itself after having undergone brain trauma or carbon monoxide poisoning.
Signs and Symptoms
Kleptomania is a complex disease, characterized by an impulsive tendency to theft, which is independent of the value and usefulness of the object (ie the act is not necessary for survival).
Although the subject is aware of having a wrong behavior and shows a certain suffering (state of depression and a strong sense of guilt) for his actions, he experiences a marked difficulty in interrupting this behavior. Before committing theft, the subject experiences a feeling of tension; instead, after stealing, he feels a marked relief and feels gratified.
When the subject becomes aware of the senselessness of the act, a depressive state can occur.
The onset of symptoms typically occurs during adolescence, but can also occur during childhood and in adulthood.
Kleptomania may undergo changes: in some cases, the urge to steal represents sporadic behavior and is limited to a short period of time; other times, episodes of theft can alternate with periods of remission or the disease can become chronic.
As is natural that, over time, kleptomania can cause legal, family, work and personal difficulties.
Diagnosis
The diagnosis of kleptomania is not easy, as most people affected by this disorder tend not to seek help to solve the problem.
The condition is often diagnosed when patients go to the doctor for other reasons (such as depression, bulimia, etc.) or feel emotionally unstable.
The explanation that the kleptomaniacs adduce to justify their behavior is usually a lack of means of subsistence or personal dissatisfaction, but in reality the causes are much more profound and the reasons multiple.
Psychological assessment can encounter relationship conflicts or factors that cause excessive stress. The act of recurring stealing can be limited to specific objects and modalities, but the patient may or may not describe these particular preferences.
During the diagnostic journey, any other psychopathological or organic disorder must be excluded.
Kleptomania: DSM diagnostic criteria
The Diagnostic and Statistical Manual of Mental Disorders (DSM) has established five criteria to diagnose the behavior of a kleptomaniac individual:
- Recurrent inability to resist the impulses of stealing objects that are not needed for personal use or economic value.
- Increased feeling of tension immediately before committing theft.
- Pleasure, gratification or relief at the time the theft is committed.
- Theft is not carried out to express anger or revenge, nor in response to delirium or hallucination.
- Theft is not attributable to a behavioral disorder, manic episodes or personality disorders.
Treatment
If the subject is really motivated to get help, therapeutic interventions for kleptomania can be effective in a relatively short time.
In the management of the disorder, cognitive-behavioral therapy is strongly indicated. This approach allows the control of impulses through particular techniques, such as exposure with response prevention and cognitive restructuring.
In addition to trying to solve the problem from a psychotherapeutic point of view, it is possible to use some drugs, such as selective serotonin reuptake inhibitors (SSRIs, such as fluoxetine), mood stabilizers and opiate receptor antagonists (such as naltrexone). Supportive drug therapy can be useful for lowering the intensity of compulsion, encouraging the cessation of uncontrollable impulses and alleviating depressive symptoms.
