Kleptomania, a disorder in which one has an uncontrollable urge to steal, remains one of the most stigmatised mental health disorders and is consequently very poorly understood. Despite how it may look from the outside, kleptomania isn’t just about stealing; it is a complex neurobiological disorder involving specific brain regions and chemical imbalances that affect impulse control and reward processing. 

In this article, we will describe the key brain areas and neurotransmitters linked to kleptomania, analysing and breaking down key research to provide a possible answer to the question: what goes on in the brain of someone with kleptomania?

Introduction

Kleptomania is defined as a mental disorder in which a person compulsively steals. It affects approximately 0.5% of the population, making it a rare disorder, with a prevalence similar to those with bipolar disorder or schizophrenia.¹ Features of kleptomania include:

• Stealing that isn’t for personal gain 
• Sudden and unplanned episodes
• Stealing from public places, like stores, or from personal places, like friends and family 
• Stolen items often have no major monetary value or are not necessary 
• Stolen items are not usually used but instead stashed away, secretly put back or donated 
• The urge to steal may not be constant 

There is a great deal of stigma associated with kleptomania, but it is important to know that the disorder is less about the stealing in itself and more about a lack of impulse control. Current research about the disorder is limited; however, some researchers have put kleptomania on the impulsive-compulsive spectrum – a spectrum which includes, among others, obsessive-compulsive disorder and pathological gambling.^2,3 Kleptomania has also been described as an addictive disorder.¹

Understanding the neurobiology of kleptomania provides insight into the disorder, possibly paving the way to destigmatising it, as many patients avoid receiving professional help due to the shame associated with a diagnosis. The understanding of the mechanisms underlying kleptomania also aids professionals in developing treatment approaches. 

Key brain regions involved

Below, we will explore the possible brain regions associated with kleptomania. Research on this topic is still very limited; hence, all information should be taken with a pinch of salt. 

Prefrontal and orbitofrontal cortices 

The prefrontal cortex is an area at the front of the brain, which is responsible for functions such as decision making and other complex cognitive processes, including intentional behaviours.⁴ It is hypothesised that deficits in the prefrontal cortex nerve pathways can increase impulsive behaviours, both cognitive and behavioural.⁵ 

The orbitofrontal cortex is also located in the front of the brain. Its functions include the processing of both reward and non-reward (a scenario in which a reward is expected but not received).⁶ The orbitofrontal cortex is mainly associated with the reward we get from taste, smell and touch.⁶ However, there is evidence that this part of the brain can be involved in the development of kleptomania.⁷ 

Studies have shown that there are differences in the front parts of the brain between those with kleptomania and control (non-affected) individuals.⁸ 

Amygdala and anterior cingulate cortex

The amygdala sits right in the centre of the brain and is important in many cognitive processes like learning (in the context of reward and punishment), fear and certain learned behaviours (in the context of addiction). Because kleptomania is sometimes considered a “behavioural addiction”, the amygdala has been proposed to be involved in the disorder and the impulse or “urge” to steal; however, there is not enough evidence for this. 

The anterior cingulate cortex (ACC) receives input signals from the amygdala, among other structures. It is at the intersection of emotion and cognition, making it a possible brain region associated with kleptomania. A preliminary study has suggested that the ACC is overactive in those with kleptomania.⁹

Striatum and nucleus accumbens

The striatum and nucleus accumbens are two parts of the brain which also sit in the middle of the brain. The striatum is important in motor function, reward pathways and executive function.¹⁰ The nucleus accumbens is also associated with reward, as well as pleasure, motivation and addiction.¹¹ Both of these brain areas are rich in dopamine receptors, and their overexpression has been previously associated with the development of kleptomania in patients with Parkinson’s disease.¹²

Neurotransmitters implicated 

Neurotransmitters are chemicals that facilitate electrical signalling in the brain. Different neurotransmitters have different functions and can be present in different regions of the brain, although a lot of different neurotransmitters tend to overlap in location and function. 

Dopamine

Dopamine signalling is usually associated with reward, motivation and memory. Studies have linked increased dopaminergic signalling (for example, due to taking dopamine-enhancing drugs for Parkinson’s disease or dopamine receptor sensitisation with SSRI medications) to the development of kleptomania.^12,13 

Serotonin

Serotonin is associated with mood and sleep, among other things. Low serotonin levels have been linked to the development of kleptomania, with SSRI medications (drugs that increase serotonin levels) resolving kleptomania in some patients.¹⁴ Conversely, treatment with SSRIs has also been shown to induce kleptomania in some patients.¹⁵ This conflicting research goes to show just how complex the mechanisms underlying kleptomania are; serotonin may be important in kleptomania, but it is not the sole neurotransmitter responsible. 

Opioid system

The opioid system is typically associated with pain. However, it also plays a role in emotions, reward processing and behavioural addictions.¹⁶ There has been some evidence supporting the hypothesis that the opioid system is involved in kleptomania. Namely, the use of opioid antagonist drugs (drugs that limit opioid signalling) has been shown to be effective in the treatment of kleptomania.¹⁶ 

Implications for treatment

Kleptomania research has been limited for many years, possibly due to limited funding, which can be a direct consequence of the stigma surrounding the disorder. Knowledge of the neurobiology behind mental health conditions like kleptomania guides pharmacological treatment approaches, as well as decreasing the stigma that prevents people from seeking out treatment options. 

In this article, we have explored possible drug targets for treating kleptomania, which manage dopamine, serotonin and opioid levels. However, it is important to note that the most effective way to treat this disorder is a combination of medicines and talking therapies (like cognitive behavioural therapy). This ensures a holistic approach that tackles kleptomania from all possible angles, thus increasing the likelihood of the disorder being successfully treated. 

Summary

Kleptomania is a rare but serious mental health condition that causes people to steal compulsively, often without any personal gain from the theft. Research suggests that it is linked to differences in certain parts of the brain, especially those involved in decision-making, reward and impulse control. Areas like the prefrontal cortex, orbitofrontal cortex, amygdala and striatum may work differently in those with kleptomania compared to those without. Brain chemicals (neurotransmitters) such as dopamine, serotonin and those in the opioid system are present in these areas of the brain and affect how people integrate signals of reward, pleasure or control. While the exact neurobiology of kleptomania is yet to be fully established, this knowledge is key in helping to reduce the stigma surrounding kleptomania. This information can hopefully make it easier for those with kleptomania to seek the treatment they require, which includes drug interventions targeting the implicated neurotransmitters and talking therapies like cognitive behavioural therapy.