Introduction

Many of us find ourselves compelled to act or eat certain foods after making a personal resolve not to do so. This is especially true if you started a new diet and then relapsed and indulged in junk foods. Self-discipline and determination play a significant role in curbing these setbacks, but this could be a challenge if you have an impulse control disorder. 

An impulse control disorder is defined as the inability to control emotions or behaviours. This group of disorders can be categorised into five different conditions: kleptomania, pyromania, gambling, trichotillomania, and intermittent explosive disorder.

Additionally, these disorders can be incorporated into other mental-health-associated conditions like bulimia, anorexia, among others. This article demystifies the startling connection between kleptomania and obsessive-compulsive disorder.

Understanding kleptomania 

According to the American Psychological Association (APA), in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), kleptomania is an impulse control disorder characterised by an uncontrollable urge to steal without logical need or financial gain.

An increase in emotional tension and anxiety before the theft, accompanied by a feeling of pleasure and satisfaction after the theft, are some of the criteria used to diagnose this disorder.¹ 

Nevertheless, there is often a feeling of guilt, remorse, or shame afterwards. 

Kleptomania is reported more in women than men, with a ratio of 3:1, and a link has been shown between kleptomania and menstrual disorders.² Kleptomania is a rare clinical presentation, which could be underdiagnosed due to the stigma associated with it.⁴

The clinical manifestations can occur from adolescence to adulthood, with a mean age of onset being 20 years, with one study reporting the late development of kleptomania in a 77-year-old woman.³ Prevalence in the general population is relatively low and varies between 0.3% and 2.6%, which increases to between 4% and 24% in cases of theft and shoplifting.⁴

Kleptomania and other impulse control disorders appear to be more prevalent among individuals with psychiatric disorders.⁵ These psychiatric conditions include anxiety and mood disorders, eating disorders, and alcohol and drug abuse.⁵ 

What is obsessive-compulsive disorder?

Obsessive-compulsive disorder (OCD) is a common anxiety disorder characterised by ritualised behaviours and repetitive and unwanted thoughts that an individual feels uncontrollably compelled to act upon. According to the National Institute of Mental Health, individuals with OCD experience symptoms that can be time-consuming, bordering on obsessive, and they feel the only way to curb the anxiety and intrusive thoughts is to carry out certain behaviours in a ritualistic manner. 

The symptoms of OCD, such as repeating certain words, arranging things in a particular order, excessive cleaning, and so on, could be accompanied by feelings of embarrassment.⁶

OCD generally affects about 1-3% of the population worldwide and doesn’t have a gender predilection.⁷ Contrarily, according to the American Academy of Family Physicians, pregnant women or those in the postpartum period are more likely to experience OCD in comparison to the general population. Also, women who had OCD before pregnancy may develop worsening OCD symptoms and are at increased risk of postpartum depression.¹⁴

OCD usually starts in childhood, teens or early adulthood. However, it is rare for people to develop OCD after age 30.⁶ Generally, the hallmark features of OCD are obsessive thoughts or compulsions, but usually both.⁷

Obsessions are repetitive actions or thoughts that are unwanted, uncontrollable and often persistent. For instance, someone who obsesses over something they did, or has an unquenchable urge to say something out of habit to the same person daily. These intrusive thoughts, followed by worries, cause intense anxiety and suffering in the person with OCD.⁷ 

Performing repetitive behaviours or rituals is referred to as compulsion. Some examples include confirming several times if a door was closed, arranging clothes in a particular way or carrying out certain rituals before performing an activity.⁶

Risk factors of kleptomania and OCD

Kleptomania is generally more prevalent in women than in men. However, the following factors predispose people to kleptomania: 

• Family history of kleptomania or other impulse control disorders⁸
• Imbalances in levels of serotonin and dopamine
• Stress or childhood trauma⁸
• Personality behaviours such as impulsiveness and lack of self-control
• Upbringing in an environment where stealing is not regarded or addressed seriously
• Constant justification of theft behaviour
• Gender
• Certain injuries affecting the brain 
• Substance abuse⁸
• Side effects of certain medications, such as SSRIs¹¹

On the other hand, the following key factors have been associated with an increased likelihood of developing OCD:

• Genetic predisposition to OCD⁹
• Physical or emotional abuse
• Solid focus and interest in certain activities 
• Over-expectation of academic excellence and pressure on children 
• Low self-esteem and lack of appreciation of efforts can lead to unrealistically striving for perfection⁹
• Using daily routines to alleviate distress could lead to an unhealthy need for order 
• People-pleasing personality and the need to maintain order and correctness in almost every aspect of your life⁹

What is the connection between kleptomania and OCD? 

Kleptomania is considered a variant of OCD and has been linked to OCD-spectrum disorders such as pathological gambling, compulsive-buying disorder, hair-pulling disorder and others.¹⁰ This is based on the similarities between the impulse to steal and the obsessive and compulsive behaviours associated with OCD.¹⁰

Additionally, the impulse to steal comes with an almost overwhelming urge related to increased anxiety, while stealing itself is described as uncontrollable and an anxiety release activity. This implies that kleptomania, which is characterised by an irresistible need to steal, can be seen as a compulsion that often follows an obsession over a particular item.¹⁰

Thus, these two conditions consist of repetitive behaviours with a specific focus; kleptomania focuses on stealing, while OCD encompasses a wider range of habits and rituals such as excessive cleaning, arranging objects or checking things repeatedly.¹⁰ Quite simply, kleptomania resembles OCD due to repetitive engagement of certain behaviours, which can be specific (such as stealing) or non-specific acts.¹¹

On the other hand, some visible differences exist between these conditions. Kleptomania has been seen to respond to heterogeneous drugs. However, OCD, which is associated with a combination of compulsive and obsessive behaviours, has not been confirmed to be managed by SSRIs.¹²

Individuals who have kleptomania are generally sensation-seeking and impulsive, which is different from people with OCD, who typically avoid harm with a heightened sense of caution associated with their ritualistic behaviour.¹³

Treatment and management strategies

Since the aetiology of kleptomania is complicated and yet to be completely understood, various therapeutic strategies have been researched for its treatment, which include psychoanalytic-oriented psychotherapy, behavioural therapy and pharmacotherapy.²

However, antidepressants, mainly from the group of SSRIs, became the treatment of choice for kleptomania, and in other impulse control disorders such as pathological gambling and pyromania.² This therapeutic strategy is based on the hypothesis that the biological cause of these disorders stems from different levels of serotonin in brain synapses.

Notably, the results of using SSRIs vary in different individuals. Thus, the therapeutic effectiveness of this strategy for kleptomania might also apply to other co-morbid psychiatric disorders.²

Cognitive behavioural therapy (CBT), specifically exposure and prevention of response, is the most effective psychotherapy modality for treating OCD. Motivational interviewing can also be incorporated to increase engagement with therapy and might improve its effectiveness.¹⁵

Diagnosis of kleptomania and OCD

Many people with kleptomania seek treatment due to external motivations. This could be legal troubles due to kleptomania, pressure from family or seeking intervention due to other psychiatric disorders.¹² The following is the criteria for diagnosis of kleptomania and OCD according to the Diagnostic and Statistical Manual of Mental Disorders, 5th edition (DSM-5); 

FAQs

Can kleptomania be inherited?

If there is a family member with kleptomania, there is an increased chance of developing this disorder. This risk is particularly heightened if the affected family member is a sibling or a parent. Furthermore, having a family history of addiction can elevate the risk of developing kleptomania

Can OCD and kleptomania go away on their own?

People with kleptomania are often reluctant to seek treatment, usually due to a desire to keep their behaviour hidden or feelings of shame. Consequently, their condition can lead to legal troubles. Hence, these conditions do not usually disappear on their own without intervention from a medical expert. 

Can kleptomania be cured? 

Although there is no known cure for kleptomania, it can be effectively managed with therapy and certain medications. Some people can go for a long time without experiencing the symptoms, while others may struggle with the disorder persistently.

Summary

• Kleptomania and obsessive-compulsive disorder (OCD) are neuropsychiatric disorders characterised by an irresistible urge to steal and indulging in compulsive and or obsessive behaviours, respectively
• These conditions share similar features, such as repetitive behaviours and thoughts, which can interfere with other areas of functioning
• Visible differences exist in terms of diagnosis and sensation-seeking traits in people with kleptomania compared to people with OCD, who are generally risk-averse
• Although the exact cause of both conditions is not well defined, the risk factors of kleptomania include family history, stress, and gender, among others 
• The risk factors for OCD include genetics, physical or emotional abuse and others 
• Treatment using SSRIs is conflicting with cases of recurrence. Hence, different types of cognitive behavioural therapy are the mainstay and most effective treatment for kleptomania and OCD