Kleptomania

Snapshot

• A 15-year-old girl is brought to pediatrician by her parents for a routine physical before starting a new school year. The patient describes feeling extremely worried about classes and having to deal with the “drama” of being social back at school. Her parents ask whether her feelings of anxiety may have any relation to the fact that she has been acting “out of character” and committing various acts of petty theft in the past months. The patient was caught stealing several containers of toothpicks at the grocery store earlier in the week, and had an incident where she was almost arrested for tucking away several pairs of stockings into her bag at the mall last month.

Introduction

• Overview 
  • kleptomania is the inability to resist the urge to steal items that may not be necessary nor valuable to the person 
• Epidemiology
  • incidence
    • ~6 per 1000 people
    • estimated to account for ~5% of shoplifting
      
      
  • demographics
    • female:male ratio is ~3:1
      
      
    • age of onset is usually in adolesence
• Pathophysiology
  • unknown cause
• Associated conditions
  • family history
    • higher rates of obsessive-compulsive disorder and substance use disorders in relatives of people with kleptomania have
• psychiatric comorbidity (i.e. major depressive disorder, anxiety disorder, eating disorder, or alcohol use disorder)

Presentation

• Symptoms
  • inability to resist powerful urges to steal items that one does not need
  • rising sense of tension leading up to theft
  • pleasure, relief, or gratification while stealing
• guilt, remorse, shame, or fear after theft

Differential diagnosis

• Shoplifting
  • key distinguishing factor
• typical shoplifters steal for personal gain or out of rebellion, unlike patients with kleptomania who steal because they cannot resist the strong temptation

Treatment

• Lifestyle
  • cognitive behavioral therapy
    • involves techniques to help control kleptomania urges
• Medical
  • naltrexone
    • opioid antagonist
    • may ↓ urges and pleasure associated with stealing
  • selective serotonin reuptake inhibitors
• may be indicated if patient also has depression

Complications

• Severe emotional, family, work, and financial problems
  • may result in depression, eating disorders, and anxiety