Kleptomania

Primer

Kleptomania is characterized by the recurrent failure to resist impulses to steal items even though the items are not required for personal use or are of little value to the individual.

Epidemiology
  • The prevalence of kleptomania in the general population is very rare, and thought to be between 0.3 to 0.6%.[1]
  • Females outnumber males at (3:1).
  • Kleptomania is estimated to occur in about 4 to 24% of individuals who are arrested for shoplifting.[2]
Prognosis
  • The age at onset of kleptomania often begins in adolescence, but can develop at any stage.
  • Three typical courses of kleptomania have been described:
    • (1) Sporadic with brief episodes and long periods of remission
    • (2) Episodic with protracted periods of stealing and periods of remission; and
    • (3) Chronic with some degree of fluctuation.
  • The disorder may persist for years, despite multiple convictions for shoplifting.[3]
Comorbidity
  • Comorbid disorders include compulsive buying, depressive disorders (particularly major depressive disorder), bipolar disorders, anxiety disorders, eating disorders (particularly bulimia nervosa), personality disorders, substance use disorders (particularly alcohol use disorder), and other disruptive, impulse-control, and conduct disorders.[4]
Risk Factors
  • First-degree relatives of individuals with kleptomania may have higher rates of obsessive-compulsive disorder (OCD) than the general population.[5]
  • There are higher rates of substance use disorders and alcohol use disorder in relatives of individuals with kleptomania.[6]

DSM-5 Diagnostic Criteria

Criterion A

Recurrent failure to resist impulses to steal objects that are not needed for personal use or for their monetary value.

Criterion B

Increasing sense of tension immediately before committing the theft.

Criterion C

Pleasure, gratification, or relief at the time of committing the theft.

Criterion D

The stealing is not committed to express anger or vengeance and is not in response to a delusion or a hallucination.

Criterion E

The stealing is not better explained by conduct disorder, a manic episode, or antisocial personality disorder.

Signs and Symptoms

  • Individuals typically attempt to resist impulses to steal, and they are aware that their acts are wrong and senseless. They may often feel depressed or guilty about the thefts.
  • The individual may hoard the stolen objects or secretly return them.
  • Individuals usually do not preplan the thefts or fully take into account the chances of apprehension (e.g. - being arrested), and the stealing is done without assistance from, or collaboration with, others.

Screening Tools and Scales

Kleptomania Scales

Name Rater Description Download
Kleptomania Symptom Assessment Scale (K-SAS) Patient The K-SAS is a self-report scale consisting of 11 items designed to measure symptoms of kleptomania experienced in the last 7 days. Link to original study trial

Pathophysiology

Neurotransmitter pathways involving serotonin, dopamine, and the opioid system (the same ones associated with substance and behavioural addictions), are thought to play a role in kleptomania.[7]

Differential Diagnosis

  • Ordinary theft
    • Kleptomania should be distinguished from ordinary theft or shoplifting. Ordinary theft (whether planned or impulsive) is deliberate and is motivated by the usefulness of the object or its monetary worth. Some individuals, especially adolescents, as an act of rebellion, may also steal on a dare, or as a rite of passage. The diagnosis is not made unless other characteristic features of kleptomania are also present. It is important to remember that kleptomania is exceedingly rare, whereas shoplifting is relatively common.
  • Malingering
    • Malingers may simulate the symptoms of kleptomania to avoid criminal prosecution.
  • Antisocial personality disorder and conduct disorder
    • Antisocial personality disorder and conduct disorder are distinguished from kleptomania by a general pattern of antisocial behavior.
  • Manic episodes, psychotic episodes, and major neurocognitive disorder
    • Kleptomania should be distinguished from intentional or inadvertent stealing that may occur during a manic episode (e.g. - bipolar disorder), in response to delusions or hallucinations (e.g. - schizophrenia), or as a result of a major neurocognitive disorder (e.g. - frontotemporal dementia).

Investigations

  • As clinically indicated.

Treatment

Resources

For Patients

For Providers

Articles
Research

References

1) American Psychiatric Association. (2013). Diagnostic and Statistical Manual of Mental Disorders (5th ed.). Arlington, VA.
2) American Psychiatric Association. (2013). Diagnostic and Statistical Manual of Mental Disorders (5th ed.). Arlington, VA.
3) American Psychiatric Association. (2013). Diagnostic and Statistical Manual of Mental Disorders (5th ed.). Arlington, VA.
4) American Psychiatric Association. (2013). Diagnostic and Statistical Manual of Mental Disorders (5th ed.). Arlington, VA.
5) American Psychiatric Association. (2013). Diagnostic and Statistical Manual of Mental Disorders (5th ed.). Arlington, VA.
6) American Psychiatric Association. (2013). Diagnostic and Statistical Manual of Mental Disorders (5th ed.). Arlington, VA.
7) American Psychiatric Association. (2013). Diagnostic and Statistical Manual of Mental Disorders (5th ed.). Arlington, VA.
8) Grant, J. E., Kim, S. W., & Odlaug, B. L. (2009). A double-blind, placebo-controlled study of the opiate antagonist, naltrexone, in the treatment of kleptomania. Biological psychiatry, 65(7), 600-606.
9) Olbrich, S., Jahn, I., & Stengler, K. (2019). Exposure and response prevention therapy augmented with naltrexone in kleptomania: a controlled case study using galvanic skin response for monitoring. Behavioural and cognitive psychotherapy, 47(5), 622-627.