Introduction

 Kleptomania is a psychological condition where there is a lack of control to resist the impulse to steal. Mostly, the stolen objects are not needed or have no significant monetary benefit. The term kleptomania was introduced by the French psychiatrists Esquirol and Marc in the 19th century.¹ Kleptomania is a behaviour of addiction seen in all age groups. Kleptomaniacs often feel guilty during and after their actions, but at the same time, they feel pleasure and happiness. Mood disorders are a mental condition characterised by continuous disruption in the emotional state. Mood disorders are broadly classified into depressive disorders and bipolar disorders. Neurobiological factors, certain medical conditions, genetic factors, certain drugs, hormonal factors, and psychosocial factors contribute to the development of mood disorders.

Clinical features and diagnosis of kleptomania

A person with kleptomania will have a sense of fear or guilt when they are about to steal objects. The person will also have a sense of relief or pleasure after stealing. They will be fully aware of the legal consequences, but they might not be able to control the impulse to steal. The stealing is committed not because of anger, illusion, or hallucination. According to DSM-5 (The American Psychiatric Association), kleptomania typically follows one of three patterns of stealing, with either brief episodes of stealing with intermittent or long periods of remission, longer episodes of stealing with brief periods of remission, or chronic and continuous stealing with minor fluctuation in frequency. Kleptomania may often be accompanied by other psychological disorders, such as alcohol and substance use, eating disorders, or anxiety. One of the risk factors for depression includes chronic stress. The diagnosis of kleptomania depends on the above-mentioned signs and symptoms.

Causes of kleptomania

Some studies have suggested a link between kleptomania and other psychological disorders. People with kleptomania mostly have a first-degree relative with a psychiatric condition. In terms of the family history of people with kleptomania, the first-degree relatives might have obsessive-compulsive disorder (OCD), or mood disorders. People with kleptomania may exhibit traits of impulsive disorders such as bipolar disorder, substance use disorder, and attention deficit disorder. Some suggest that kleptomania is a consequence of consumerism and the abundance of commodities in modern society.² Kleptomania has been interpreted as a reflection of unconscious defence against anxiety, forbidden instincts or wishes, unresolved conflicts, forbidden sexual drives, fear of castration, sexual arousal, sexual gratification, and orgasm during the act of thievery.³ The act of stealing has been described as a risk-taking behaviour performed by people with depression, serving as a symptom of stress, a way of relief from stressful conditions, or having antidepressant significance.⁴ The dysregulation of neurotransmitters such as dopamine and serotonin can be a causative factor of kleptomania, as dysregulation or low levels of serotonin can cause depression.

Depression, anxiety, and kleptomania

Kleptomania has been described as an antidepressant behaviour because of its high comorbidity with depression.⁵ Kleptomania can be considered an individual’s maladaptation to a depressive state. The act of stealing can be done as a way to get relief from anxiety and stressful conditions. Cognitive behavioural therapy (CBT) is widely used now to treat kleptomania.

Bipolar disorder and kleptomania 

People with bipolar disorders exhibit high impulsivity. The bipolar mood variations may trigger kleptomania.

Management of kleptomania

The treatment options for kleptomania include psychotherapy and pharmacotherapy. More recently, cognitive behavioural therapy has replaced psychotherapy to a larger extent in the treatment of kleptomania. The approaches used in kleptomania include covert sensitisation (the patient is instructed to imagine stealing and to imagine a negative outcome, such as being caught, feeling short of breath or feeling sick), aversion therapy (unpleasant breath holding until mildly painful whenever an impulse to steal is experienced), and systematic desensitisation (helping the patient to achieve a relaxed state through muscle relaxation, and the patient to imagine the different stages of the stealing episode, meanwhile suggesting that they could better control the impulse to steal by controlling the anxiety).⁶ Studies reveal patients respond well to CBT combined with medications; however, no medications are currently approved by the FDA for the treatment of kleptomania. Current knowledge about the medication for kleptomania is based on case reports, research, causative factors, and neurobiological hypotheses.

The commonly used medications to treat depression and anxiety disorders, such as OCD and panic disorders, are selective serotonin reuptake inhibitors (SSRIs). The SSRIs used are fluvoxamine, escitalopram, paroxetine, and sertraline. Non-SSRI antidepressants that are used for the treatment of kleptomania include trazodone, imipramine, desipramine, and monoamine oxidase inhibitors. Mood stabilisers, like lithium, valproic acid, carbamazepine, topiramate, and lamotrigine, are used in the treatment of kleptomania. Studies have shown that lithium with fluoxetine achieved a substantial decrease in the urge to steal in a 40-year-old female.⁷ Opioid receptor antagonists such as Naltrexone are found useful in treating kleptomania. Some reports revealed the use of electroconvulsive therapy to treat kleptomania in depressive people. In recent research, a medication called memantine, which is used in Alzheimer’s disease, has been found useful in treating kleptomania. People with kleptomania should seek help and support to identify and treat the condition.

Summary

Kleptomania is a rare impulse control disorder. People with kleptomania lack the control to resist the urge to steal. The frequency is higher in females than in males. Out of the total population, 0.3-0.6% are found to have kleptomania. Kleptomania usually commences in adolescence, but can be found in all age groups. Kleptomania is different from theft or shoplifting - the stolen items are neither useful nor have any monetary benefit. The individual will be aware of the consequences of theft. People with kleptomania usually have other psychological illnesses like mood disorders, depression, anxiety, obsessive-compulsive disorder, or bipolar disorder.

The diagnosis of kleptomania is based on clinical presentation. Psychotherapy, pharmacotherapy, or combination therapy are the available treatment options for kleptomania. However, people with kleptomania are usually reluctant to seek medical help, and in most cases, it is diagnosed when people consult therapists for other psychological conditions. Currently, no medications have been approved by the FDA for the treatment of kleptomania. The medications used are based on case studies, research, causative factors and neurobiological hypotheses. Selective serotonin reuptake inhibitors (SSRIs) and non-SSRIs are found to be effective in treating kleptomania, along with other psychological illnesses like depression and anxiety. Mood stabilisers like lithium are used to treat kleptomania, and the opioid receptor antagonist Naltrexone is effective in controlling the impulse. It is important to diagnose the condition in the initial stage to manage it effectively.