Introduction 

Kleptomania is an impulse control disorder. Individuals with kleptomania experience recurrent urges to steal items, not out of necessity or financial gain, but due to an uncontrollable compulsion.¹ In this article, you will learn about the diagnostic process and the criteria used by health professionals to accurately identify kleptomania.

Overview of kleptomania 

Kleptomania was first identified as a distinct disorder in the early 19th century, when clinicians noticed that certain individuals repeatedly stole items with no rational motive. Over time, kleptomania came to be classified under impulse control disorders, a group of psychiatric conditions. Kleptomania is classified under Impulse-Control Disorders in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) published by the American Psychiatric Association (APA, 2013). Individuals with kleptomania experience a persistent inability to resist impulses to steal, even though the items taken are often of little or no value to them. Unlike typical theft, which is driven by financial need or social influence, kleptomania involves a psychological compulsion. The person feels an increased sense of tension before the theft. After the theft, they get a sense of relief and satisfaction. However, the act is often followed by feelings of guilt and shame. It affects approximately 0.3% to 0.6% of the population. It is more commonly diagnosed in women.¹ 

Diagnosis

DSM-5 criteria

Kleptomania is classified under Impulse-Control Disorders in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) published by the American Psychiatric Association (APA, 2013). According to the DSM-5, five specific criteria must be met for a diagnosis of kleptomania.Diagnostic Criteria According to DSM-5 include:² 

• Criterion A: Repeated inability to resist the urge to steal items

The individual finds it difficult to resist the urge to steal. The behaviour is not occasional but repetitive and persistent over time. Items are not stolen for personal use or monetary gain. They often discard, hoard, or give away the items afterwards

• Criterion B: Person experiences an increased sense of tension immediately before the theft

A build-up of internal tension or anxiety usually precedes the act, reflecting the compulsive nature of the disorder

• Criterion C: Satisfaction and relief when committing the theft

The act of stealing temporarily relieves the emotional tension and brings satisfaction, which reinforces the behaviour

• Criterion D: Stealing is not driven by anger or revenge, nor in response to a delusion or hallucination

This distinguishes kleptomania from other conditions where stealing might also occur, but is motivated by different psychological or behavioural mechanisms

• Criterion E: Rule out other conditions  

Evaluate whether the theft is not linked to other conditions such as conduct disorder, a manic episode, or antisocial personality disorder

Application of these criteria in clinical practice

Diagnosing kleptomania involves more than simply observing a pattern of stealing. Since many people with kleptomania are reluctant to seek help due to embarrassment or legal concerns, the condition often goes unnoticed or is misdiagnosed. Diagnostic steps include:¹

• Clinical Interview: A comprehensive psychiatric interview is the foundation of diagnosis. The clinician asks questions to assess the patient’s history, behaviour patterns, emotional experiences, and motivation behind the stealing
• Rule Out Other Conditions: Kleptomania differs from ordinary theft or shoplifting, which are usually intentional acts driven by the item's utility or value, and sometimes occur as rebellious behaviour or social dares, especially among adolescents. Unlike these common forms of theft, kleptomania is rare and involves specific psychological characteristics. The diagnosis should only be made when these distinct features are present. In some cases, individuals may pretend to have kleptomania to avoid legal consequences, which is considered malingering. Additionally, kleptomania must be differentiated from antisocial personality disorder and conduct disorder, both of which involve a broader pattern of antisocial behaviour. It should also be distinguished from stealing that happens during manic episodes, where impulsivity is high, or in psychotic episodes involving hallucinations or delusions, such as in schizophrenia. Moreover, individuals with major neurocognitive disorders may steal due to cognitive impairments rather than a compulsive drive

Differential diagnosis

One of the challenges in diagnosing kleptomania is differentiating it from other disorders that might involve stealing behaviours. It is essential for clinicians to carefully consider the underlying reasons for theft and assess whether the behaviour fits the characteristics of kleptomania or if it is due to another condition. Differential diagnosis includes:¹

• Antisocial Personality Disorder
• Conduct Disorders 
• Maniac episodes in schizophrenia

Challenges in diagnosis 

Various challenges include:

• It can be difficult to distinguish kleptomania from intentional theft, therefore complicating diagnosis
• Social stigma surrounding both mental illness and theft leads to underreporting of symptoms
• Guilt and fear of legal consequences often prevent individuals from disclosing their stealing behaviour
• People with kleptomania are frequently treated as criminals rather than being referred for psychiatric assessment.
• Kleptomania is usually associated with co-morbidities such as bipolar disorders, anxiety disorders, eating disorders, personality disorders, substance use disorders and other disruptive, impulse-control, and conduct disorders, which can complicate diagnosis
• Concerns about legal or social consequences prevent individuals from seeking help or being honest during evaluations

Treatment and management

Once diagnosed, kleptomania is treated using a variety of therapeutic approaches. Treatment often includes cognitive-behavioural therapy (CBT), which helps individuals identify and manage their urges to steal. Medication, such as antidepressants and mood stabilisers, is used in some cases. Support groups and family therapy are beneficial. It helps individuals in building coping strategies and reduces the stigma associated with the disorder.¹

Frequently asked questions

Can people with kleptomania control their behaviour if they try hard enough?

No. While individuals may feel guilt or remorse after stealing, the compulsion is typically stronger than their ability to resist without help.

How long does kleptomania last?

Kleptomania can be a chronic condition, lasting for years if untreated. Some people experience intermittent episodes throughout life, while others have more frequent or worsening symptoms over time.

Do people with kleptomania plan their thefts?

No. Kleptomania-related thefts are typically spontaneous and impulsive. Unlike typical shoplifters, individuals with kleptomania do not usually strategise or prepare before stealing.

Can lifestyle changes help manage kleptomania?

Yes, they can complement the treatment. Stress management, mindfulness practices, and strong social support can help reduce urges.

What should someone do if they suspect they have kleptomania?

They should seek help from a health professional, such as a psychologist or psychiatrist. Early diagnosis leads to better outcomes. Treatment can help reduce the urges and improve self-control, even if the person has struggled for years.

Can kleptomania lead to legal issues or criminal charges?

Yes, kleptomania can lead to legal issues, as stealing is still considered a crime. However, individuals with kleptomania may be eligible for a legal defence based on their mental health condition, which might affect the outcome of a criminal case. This varies by jurisdiction, and the individual would need a proper diagnosis from a clinician.

Summary

Kleptomania is an impulse control disorder. It is an often-misunderstood mental health condition. It is characterised by recurrent, uncontrollable urges to steal items. These items are not taken for personal use or monetary gain. Unlike typical theft, it involves psychological compulsion, tension before stealing, and relief afterwards, followed by guilt. Diagnosis, based on DSM-5 criteria, requires ruling out other mental health conditions like conduct disorder or mania. Challenges in diagnosis include denial, stigma, and co-morbidities. Kleptomania is often underreported and misdiagnosed due to shame, fear of stigma, or legal repercussions. Social misunderstanding and lack of awareness often lead to individuals being treated as criminals rather than people with a mental health issue. This misperception contributes to delayed diagnosis and treatment, often worsening the condition. Co-morbidities such as depression, anxiety, eating disorders, bipolar disorder, or substance abuse can also complicate the diagnosis. Treatment involves the combination of cognitive-behavioural therapy, medications, and psychosocial support. Understanding kleptomania not only helps in diagnosing and treating the disorder but also reduces the stigma surrounding it, paving the way for more people to seek the help they need. Ongoing research continues to explore various aspects of these conditions, including their cause, diagnostic tools, and treatment.  Increasing public awareness is also crucial to reducing stigma and encouraging those affected to seek help.