Introduction

How often have you been urged to steal the shiny dress displayed outside a shop and make a run for it? It might seem fun or thrilling, but that's the farthest you'll ever entertain this thought because you know it's a wrong act. Believe it or not, some people struggle with controlling the urge to steal and often find themselves shoplifting despite knowing what they're doing is wrong, but they can't seem to help it. This condition is called Kleptomania.

Kleptomania

Kleptomania is a lack of control over one's urge to steal. The person has absolutely no control over his desire to steal things. It is not because they can’t afford it or want to feel powerful and assert dominance, it is an impulse control disorder where the person knows what they are doing is wrong, but continues to steal anyway.¹

They may get a sudden rush of dopamine and euphoria, but once it calms down, they wallow in guilt and shame. It is a repetitive cycle of inability to resist stealing and feeling a rush, followed by guilt. They are the most misunderstood people, as they don’t mean any harm to anyone. It has been found that women are more likely to suffer from this disorder.²

Cause of kleptomania

The exact cause is not known, but this condition is more commonly found in people suffering from brain disorders such as depression, epilepsy, anxiety, and dementia.³ Sometimes it may also happen due to improper sleep patterns and serotonin imbalance.

It might also be due to addiction or obsessive disorder. The exact cause of this condition is unknown, as the human brain is very complex, but an imbalance of neurotransmitters such as dopamine and serotonin can lead to the progression of kleptomania.

Medications used to treat kleptomania

Kleptomania is a brain disorder that can be an underlying symptom of depression, addiction, anxiety, and in rare cases, epilepsy. Since a proper diagnosis of this condition is not understood, the physician identifies the signs and symptoms of depression, addiction, etc, and based on the evaluation, they prescribe the medications. These medicines do not cure the disorder but rather help in managing the condition. Below are medications prescribed to the kleptomaniacs. 

Antidepressants

Depression occurs because of the chemical imbalance of neurotransmitters, dopamine, norepinephrine, and serotonin in the brain. It may occur due to rapid reuptake of serotonin and epinephrine from the synaptic cleft, thus decreasing their quantity in the cleft, which may lead to depression. In simple words, an inadequate amount of neurotransmitters causes depression.

Antidepressants can increase their levels and improve mood, decrease depression, and anxiety. They are as follows:

Selective serotonin reuptake inhibitor (SSRIs)

They are the drug of choice and are relatively safe to use.⁴ These include

• Fluoxetine
• Citalopram
• Paroxetine
• Sertraline

How do they work?

SSRIs work by inhibiting serotonin reuptake and increasing its concentration in the synaptic cleft to increase the postsynaptic neuronal activity.⁴ This allows serotonin to stay in the cleft for a longer time, which results in elevating the mood and improving mental health. Kleptomaniacs are often prescribed antidepressants as they help in managing their condition.¹

Side-effects

• Sedation
• Constipation
• Urinary Retention
• Headache
• Insomnia
• Tachycardia
• Prolonged QT interval

Benefits to Kleptomania

It is not a guaranteed cure, but SSRIs can reduce the worsening of the condition because

• It increases the serotonin levels and reduces depression, which allows control over the impulse to steal
• It allows the person to avoid repeating stealing and suppresses the urge to steal

Mood stabilizers

As the name suggests, Mood stabilisers work by controlling extreme mood swings, such as bipolar disorder and impulse disorder, or kleptomania. 

Mood stabilisers elevate the mood by balancing the neurotransmitters and chemicals, managing extreme emotions such as high(mania) and low (depression). By controlling these emotions, you can have control over your impulse to steal.

The examples include:

Lithium

Lithium is used to manage bipolar disorder in those who show the symptoms of mania. Lithium has a narrow therapeutic index and is administered with caution in kleptomaniacs. It is generally given as the last option if all the other treatments have failed to show results.

How do they work?

Inositol is a chemical that sends signals to the brain and keeps the brain overactive, due to which the person shows manic behaviour. Lithium inhibits the enzymes that play an important role in the signalling of the inositol and decreases the inositol quantity, which relaxes the mood and makes the person less hyper. ⁵

Side effects

• Polyuria
• Polyphagia
• GI distress
• Dizziness
• Fatigue
• Sedation

Benefits to kleptomania

Lithium can help to stabilise your mood and keep your emotions well-balanced. They can also help in controlling the impulse to steal as it activates the part of the brain which forces you to think about the consequences of the action and allows you to practice self-restraint. Lastly, it calms the overactive mind, normally associated with kleptomania.

Other drugs

These drugs are only considered if the first-line medications have not been helpful in treatment, as they are more commonly used for other addictions and disorders.

Opioid antagonists

Kleptomania is an addiction to stealing that gives a rush of adrenaline, which acts as a “reward,” and to chase this reward, people often find themselves repeatedly stealing. Similarly, opioids and other substances also give the same rush, which leads to addiction and substance abuse.

Naltrexone is an opioid antagonist that binds to brain receptors, and when the person steals, it gives less pleasure or thrill, thus making the act less rewarding. This eventually leads to a reduction in stealing urges and control over impulses. Studies have shown that subjects taking naltrexone have reduced signs of kleptomania.⁶

Atypical antipsychotics

Antipsychotics are not the first line of treatment and are only used in Kleptomania if the person also shows signs of psychosis. Thus, it is only used in rare cases. 

The drugs include

• Risperidone
• Olanzapine

They play an important role in balancing chemicals such as dopamine and serotonin. They also boost the mood and allow control over impulses to steal and promote emotional well-being.

Some side effects include weight gain and sedation. Therefore, these medications must never be given during the day as the person needs to be alert and attentive to perform daily routine tasks.

Anti-anxiety medications

Some patients struggling with kleptomania were found to be diagnosed with anxiety disorder.³ It is important to address and manage the anxiety to resolve kleptomania. If left unaddressed, it can lead to worsening of the condition and overthinking, guilt, and obsessive behaviour. The  Medications used to manage anxiety are

• Benzodiazepenes

These medications provide calming and soothing effects. They slow down the activity of the brain and cause relaxation. They include diazepam and lorazepam.

• Buspirone

It is also an antidepressant that increases serotonin levels in the brain, which also reduces anxiety and boosts mood. It is relatively safe to use as it has fewer chances of addiction.

• Serotonin-norepinephrine reuptake inhibitors (SNRIs)

While SSRIs inhibit the reuptake of serotonin.SNRIs can inhibit the reuptake of serotonin and norepinephrine in the synaptic cleft. This allows high levels of norepinephrine as well, which plays an important role in regulating the mood, cognitive skills, and keeping the mind alert.

Combination with therapy

Cognitive behavioural therapy

Cognitive behavioural therapy is the first line of treatment before initiating the use of medications. Since Kleptomania is not an actual disease, it is better to understand and assess the patient. Expert Psychologists perform weekly or daily sessions with the patients and evaluate the cause of the problem to find a way to treat it through therapy. The patient can share their experience with therapists who try to help them overcome the urges to steal.⁷

Medications

Medications such as SSRIs, Mood stabilisers, and Opioid antagonists are prescribed once the diagnosis is made. If kleptomania is due to depression, then it is important to address it, as depression could be the leading factor for kleptomania. The medications help provide the calming effects, manage anxiety, and reduce the impulse to steal.

The best outcome is seen with a combination of Cognitive behavioural therapy and medications, as this provides psychological and medical care. Patients will have better and faster chances at recovery as they will have control over the impulses to steal and lead a peaceful life.

Summary

Kleptomania is a psychological condition where the person has an irresistible urge to steal things. These people are struggling as they are aware of their wrong deed, but they have no control over the impulses and continue to shoplift. It is a brain disorder that may be an underlying reason for depression, anxiety, or bipolar disorder. It is treated with antidepressants, mood stabilisers, and antipsychotics, respectively. These medications do not provide a cure but only help to manage the disorder.