For other uses, see. KleptomaniaOther namesKlopemaniaThe result of kleptomaniaKleptomania is the inability to resist the urge to items, usually for reasons other than personal use or financial gain. First described in 1816, kleptomania is classified in as an. Some of the main characteristics of the disorder suggest that kleptomania could be an disorder, but also share similarities with addictive and mood disorders.The disorder is frequently under-diagnosed and is regularly associated with other psychiatric disorders, particularly and,. Patients with kleptomania are typically treated with therapies in other areas due to the grievances rather than issues directly related to kleptomania.Over the last 100 years, a shift from to interventions for kleptomania has occurred.
Kleptomania is typically diagnosed by a physician or mental health professional. Because kleptomania commonly co-occurs with other conditions such as eating disorders, substance and alcohol abuse, and anxiety disorders, it is often diagnosed when people are referred to a doctor for their comorbid psychiatric symptoms. Disorders in this category can also include those with impulse and behavioral control and problems with authority (The American Psychiatric Association, 2013). Kleptomania is an impulse control disorder characterized by the inability to resist the impulse to steal.
Treatments using (SSRIs), and, and other along with, have yielded positive results. However, there have also been reports of kleptomania induced by selective serotonin reuptake inhibitors (SSRIs).
Nowadays, children are mostly seen to be affected by kleptomania. Contents.Signs and symptoms Some of the fundamental components of kleptomania include recurring intrusive thoughts, impotence to resist the compulsion to engage in stealing, and the release of internal pressure following the act. These symptoms suggest that kleptomania could be regarded as an obsessive-compulsive type of disorder.People diagnosed with kleptomania often have other types of disorders involving mood, anxiety, eating, impulse control, and drug use.
They also have great levels of, and, and privacy issues accompanying the act of stealing. These signs are considered to either cause or intensify general comorbid disorders.
The characteristics of the behaviors associated with stealing could result in other problems as well, which include social segregation and substance abuse. The many types of other disorders frequently occurring along with kleptomania usually make clinical diagnosis uncertain.There is a difference between ordinary theft and kleptomania: 'ordinary theft (whether planned or impulsive) is deliberate and is motivated by the usefulness of the object or its monetary worth,' whereas with kleptomania, there 'is the recurrent failure to resist impulses to steal items even though the items are not needed for personal use or for their monetary value.'
Cause Psychoanalytic models Many psychoanalytic theorists suggest that kleptomania is a person's attempt 'to obtain symbolic compensation for an actual or anticipated loss', and feel that the key to understanding its etiology lies in the symbolic meaning of the stolen items. Was used to propose that the act of stealing is a defense mechanism which serves as to modulate or keep undesirable feelings or emotions from being expressed. Some French psychiatrists suggest that kleptomaniacs may just want the item that they steal and the feeling they get from theft itself. Cognitive-behavioral models Cognitive-behavioral models have been replacing psychoanalytic models in describing the development of kleptomania.
Cognitive-behavioral practitioners often conceptualize the disorders as being the result of, distorted cognitions, and poor coping mechanisms. Cognitive-behavioral models suggest that the behavior is after the person steals some items.
If this individual experiences minimal or no negative consequences (punishment), then the likelihood that the behavior will reoccur is increased. As the behavior continues to occur, stronger antecedents or cues become contingently linked with it, in what ultimately becomes a powerful behavioral chain. According to cognitive-behavioral theory (CBT), both antecedents and consequences may either be in the environment or cognitions. For example, Kohn and Antonuccio (2002) describe a client’s antecedent cognitions, which include thoughts such as 'I’m smarter than others and can get away with it'; 'they deserve it'; 'I want to prove to myself that I can do it'; and 'my family deserves to have better things'.
These thoughts were strong cues to stealing behaviors. All of these thoughts were precipitated by additional antecedents which were thoughts about family, financial, and work stressors or feelings of depression. 'Maintaining' cognitions provided additional reinforcement for stealing behaviors and included feelings of vindication and pride, for example: 'score one for the 'little guy' against the big corporations'. Although those thoughts were often afterward accompanied by feelings of remorse, this came too late in the operant sequence to serve as a viable punisher. Eventually, individuals with kleptomania come to rely upon stealing as a way of coping with stressful situations and distressing feelings, which serve to further maintain the behavior and decrease the number of available alternative coping strategies. Biological models Biological models explaining the origins of kleptomania have been based mostly on pharmacotherapy treatment studies that used selective serotonin reuptake inhibitors (SSRIs), mood stabilizers, and opioid receptor antagonists.Some studies using SSRIs have observed that opioid antagonists appear to reduce the urge to steal and mute the 'rush' typically experienced immediately after stealing by some subjects suffering from kleptomania.
This would suggest that poor regulation of, and/or natural opioids within the brain are to blame for kleptomania, linking it with impulse control and affective disorders.An alternative explanation too based on opioid antagonist studies states that kleptomania is similar to the 'self-medication' model, in which stealing stimulates the person’s natural opioid system. 'The opioid release 'soothes' the patients, treats their sadness, or reduces their anxiety. Thus, stealing is a mechanism to relieve oneself from a chronic state of hyperarousal, perhaps produced by prior stressful or traumatic events, and thereby modulate affective states.'
: 354 Diagnosis Disagreement surrounds the method by which kleptomania is considered and diagnosed. On one hand, some researchers believe that kleptomania is merely theft and dispute the suggestion that there are psychological mechanisms involved, while others observe kleptomania as part of a substance-related addiction.
Sir,Kleptomania has been described as an inability to refrain from the urge to steal things for reasons other than personal use or financial gain. Decades of research show that both dopamine and serotonin are the primary neurotransmitters involved in the pathogenesis and management of kleptomania, respectively. Selective serotonin reuptake inhibitors (SSRIs) have been used as first-line agents for treating kleptomania.
On the contrary, cases of kleptomania had been paradoxically induced in three adults who were started on SSRIs for depression. A recent Indian paper also reports a similar manifestation while on fluvoxamine treatment for obsessive compulsive disorder. Restlessness and impulsivity have been recognized as symptoms of behavioral activation during initiation of treatment with SSRIs. Emergence of kleptomania post SSRI treatment may be partly explained by the same phenomenon in which there could be effective depletion of synaptic serotonin post acute administration of SSRIs through serotonin-mediated action on its auto-receptor. While the role of serotonin is murky, the role of dopamine is increasingly getting clearer especially in neurological disorders. Kleptomania is seen as an emergent side effect of the use of dopamine agonists in Parkinson's disease (PD).
Other impulse control disorders (ICDs) like pathological gambling, compulsive shopping, compulsive eating and hypersexuality have also been reported with the use of dopamine agonists. This phenomenon is explained by the overdose theory. In PD, ventral striatal dopamine is preserved relative to dorsal striatal activity; thus, dopaminergic treatment titrated to alleviate motor dorsal striatal deficiencies may result in an “over-dosing” in ventral cortico-striatal cognitive and limbic pathways. And as such there is preliminary evidence for the benefit of atypical antipsychotics for treating impulse regulation disorders.At the same time, serotonergic and dopaminergic systems are not mutually exclusive. Could an alteration in dopamine levels post SSRI initiation explain the emergence of kleptomania in rare cases? SSRIs are known to sensitize dopamine (D2) receptors. On the other hand, could the apparent effectiveness of SSRIs in kleptomania be because of their dopaminergic modulation rather than their primary effect on the serotonergic system?Kleptomania shares certain distinct features with substance use disorders, unlike other impulse control disorders like intermittent explosive disorder.
This possible association between the two has resulted in naltrexone being tried as a treatment strategy for kleptomania with favorable results. Further supportive evidence can be obtained from the rare finding of new onset alcohol dependence linked to treatment with SSRI.
This intriguing phenomenon can be considered similar to the earlier mentioned reports of emergence of kleptomania after taking SSRIs. Probably the mechanism, although still speculative, may be similar in both phenomena. So along with the erstwhile serotonin and dopamine, treatment of kleptomania is further complicated with the involvement of opioid and glutamatergic system.Kleptomania is often been found comorbid with other psychiatric disorders including depression, addiction and personality disorders. Various structural brain lesions have been associated with kleptomania including head trauma. Decreased white matter microstructural integrity in the inferior frontal brain region has also been identified in patients with kleptomania. Functional anatomy of impulse control disorders including kleptomania has recently been reviewed.While medications that affect the serotonergic system have been most widely studied for the treatment of kleptomania, their clinical effects have been modest or inconsistent or even paradoxical. Medications that affect dopaminergic neurotransmission have received less research attention.
Kleptomania is the final common manifestation of various underlying pathogenic mechanisms which calls for rationalization of treatment based on co-morbid symptoms and personality traits rather than blanket use of one agent. Extension of this suggestion to other impulse control disorders requires renewed research interest and further elaboration. Developments in neurobiology and pharmaco-genetics, coupled with newer pharmacological models involving the opioid and glutamate systems will surely further our understanding of the pathophysiology and pharmacotherapy of kleptomania.