THESIS
Commonly found more in women than men, Kleptomania is characterized as an impulse control disorder in which people cannot fight the urge to steal and can be argued that it is positively correlated with theft. Given the parallels in symptom presentation and treatment response, kleptomania has been conceptualized both as a ‘‘obsessive compulsive spectrum disorder’’ and as an impulse control disorder (Grant & Potenza, 2006). Some symptoms include failure to resist impulses to steal items that are unrelated to personal use or financial gain, increased tension right before the theft occurs, and feeling pleasure, gratification, and relief during the theft.
Introduction
The criteria to meet a diagnosis of kleptomania includes; (a) recurrent failure to resist impulses to steal objects that are not needed for personal use or for their monetary value, (b) increasing sense of tension immediately before committing the theft, (c) pleasure, gratification, or relief at the time of committing the theft, (d) the stealing is not committed to express anger or vengeance and is not in response to a delusion or a hallucination and (e) the stealing is not better accounted for by conduct disorder, a manic episode, or antisocial personality disorder. Derived from the Greek words kleptein and mania, kleptomania translates to steal and insanity. Relatively rare, kleptomania affects 0.3-0.6 percent of the general population. Different from shoplifting, kleptomania is not planned out or done for personal gain and after being taken; the goods are given away, thrown out, or hoarded. According to the DSM-5 (The American Psychiatric Association), kleptomania typically follows one of three patterns of stealing, with either brief episodes of stealing with intermittent and long periods of remission, longer periods of stealing with brief periods of remission, or chronic and continuous episodes of stealing with only minor fluctuation in frequency (The American Psychiatric Association). Kleptomania is usually diagnosed based on a combination of patient reports, diagnostic scales, and legal records pertaining to instances of the kleptomaniac being caught during the crime. It is important that kleptomania be distinguished from ordinary acts of shoplifting, from other disorders, such as antisocial personality disorder, conduct disorder, manic, psychotic, or major neurocognitive disorders (The American Psychiatric Association; Maya, 2012). Evidence has linked kleptomania to neurotransmitters that are associated with behavioral addictions. It is often found kleptomania can be comorbid with depression and bipolar disorder, substance abuse disorders, anxiety disorders, and other impulse-control disorders. Jon E. Grant and Marc. N Potenza found that drug and alcohol abuse, along with depressive, bipolar spectrum, psychotic, anxiety disorder were all determined to be present in patients who suffered from kleptomania (Burns, 2013). They also found that females tend to steal items from public places such as grocery stores and clothing stores, and that both male and females stole from family, the homes of their friends and work which were places they spent most of their time and were comfortable being in. Kleptomania can begin in childhood, adolescence, adulthood, and late adulthood which is rare.
Affecting more women than men, the objects stolen are not needed. In a recent study of kleptomania cases where the subject was apprehended, three fourths of the group studied were females. The literature clearly suggests that the majority of those identified, as having kleptomania are women. Golson posits the vast difference of women suffering from kleptomania than men might be the fact that women seek psychiatric evaluation at a higher rate than men do (Burns, 2013). According to Talih (2011), in those arrested for shoplifting, the prevalence of kleptomania is 3.8 to 24 percent. The female to male ratio is estimated at 3:1. The onset is usually in adolescence, and the average age for presentation for treatment is 35 years for women and 50 years for men. Research conducted by Sarasalo et al., confirmed the presence of depression stemming from family issues as well as the subjects being addicted to shopping and also showed that patients with kleptomania presented a high level of monotony avoidance and a low degree of socialization. Kleptomania can also be a result of emotional stress or trauma during the childhood or youth, and theft is a way to make up for the loss in their life some patients reported a feeling of being deprived unfairly in some form or another. Impulse control disorders can be present as a neuropsychiatric sequel of head trauma and traumatic brain injury. New onset kleptomania has been reported in two cases of closed head trauma. Brain disorders, such as epilepsy and fronto-temporal dementia have been reported to cause kleptomania (Talih, 2011). If vengeance or psychosis were the result of the theft, the person would not be diagnosed with kleptomania. As a kleptomaniac begins to age, the desire to steal may decrease but if left untreated, room is left for kleptomania to ruin a person’s life due to severe legal consequences associated with theft.
TRAIT 1: FAILURE TO RESIST IMPULSES AND THEFT
Kleptomania falls under the umbrella of impulse control disorders. Impulsive behavior is advantageous in situations where it is imperative to respond quickly when unexpected opportunities present themselves. Impulsive behavior is multifaceted starting from neural circuits and genes, which then affects motor inhibition, and decision making that leads to impulsive actions. Researchers in this tradition typically define impulses broadly as any thought, feeling, or behavior activated in response to a salient temptation that promotes securing and indulging in that temptation (Fujita, 2011). Difficulty dealing with emotional distress and alcohol consumption has shown to be linked to impulse control. Common features associated with impulse control disorders are repetitive or compulsive engagement in a behavior despite adverse consequences; diminished control over the problematic behavior; an appetitive urge or craving state prior to engagement in the problematic behavior; and a hedonic quality during the performance of the problematic behavior (Grant and Potenza, 2004; Schreiber et al., 2011). These features have led to a description of ICDs as behavioral addictions (Holden, 2010; Schreiber et al. 2011). Neurotransmitter pathways in the brain that are associated with behavioral addictions, serotonin, dopamine, and opioid systems have been linked to kleptomania. Being able to resist impulses and display self control goes beyond cognitive capacity and also requires a lot of energy. Some clinicians have described the impulse to steal as an alien, unwanted intrusion into their mental state (Christianini et al., 2015). The impulsivity associated with kleptomania is so strong that theft is repeated despite continuous efforts to stop.
People with kleptomania do not steal for personal gain or as an act of anger and vengeance. Most times the items they steal are hoarded, thrown away, or surprisingly returned. Although they know what they are doing is wrong, they cannot stop. Kleptomaniacs should not be confused with shoplifters because their end goals differ. A study that compared kleptomaniacs to shoplifters interviewed directly after apprehension found that 58% of the shoplifters were male compared to only 32.4% of kleptomania patients. This comparison solidifies the notion that kleptomania is a woman-dominated illness. The average age among shoplifters was 27 years old and among the kleptomaniacs, 41 years old. Although none of the shoplifters met DSM criteria for kleptomania, approximately one-fifth had not stolen for personal use and had eventually discarded the object. The study also found that both groups reported the same degree of impulsivity and “a feeling of not being one- self.” On the other hand, kleptomaniacs reported a relatively greater number of previous thefts compared to shoplifters, which supports the compulsive aspect of kleptomania.
Individuals suffering from impulse control disorders may want to gain control over their emotions and behaviors, but it is often difficult and almost impossible being that the urges to participate these behaviors can be overwhelming and very consuming. Dissociation and de-realization have also been found to accompany impulsive behavior in some people, which means they are more likely to have a hard time implementing self-control when needed. A study was conducted and 11 patients with kleptomania were compared who suffer from alcoholism and non-psychotic psychiatric patients. Results showed that those with kleptomania have significantly higher rates of impulsivity compared to both groups and they also showed higher rates of substance abuse as well as mood disorders (Talih, 2011).
Literature also shows that there is a positive correlation between major head trauma with those who suffer from impulse control disorders. Like most mental health disorders, genetics seems to have a positive correlation with impulse control disorders. Studies show that children and adolescents who have family members who suffer from mood disorders are more likely to develop symptoms of impulse control disorders. Environmental factors can also play a role in individuals displaying impulse control. Children that are exposed to verbal, emotional, and physical abuse, violence, and explosive emotional responses to certain situations in their families are at a higher risk of being diagnosed with an impulse control disorder. Although they know stealing is a crime, kleptomaniacs have a very hard time fighting the urge to steal. The thought of the act and satisfaction gained from stealing takes them over mentally as well as physically. There is an increase of arousal and tension right before the act, which I will now discuss.
TRAIT 2: INCREASED TENSION AND THEFT
The increased tension prior to the theft is a cause of anxiety. As I previously mentioned, a person with kleptomania usually suffers from other mental illnesses including anxiety, depression, bi-polar disorder, and etcetera so some of the symptoms associated with the disorder will be present. Tension is experienced before the act and in an attempt to resist the impulse. Both the urge and the behavior are experienced as ego-alien, non-comprehensible, wrong and in dissonance with the basic personality of the perpetrator (Fujita, 2011). The urge to steal is so strong that despite the known repercussions, in that instance the only way to feel better is to complete the act completely disregarding possible punishment. Kleptomania is impulsive and repetitive which is one of the reasons it can be considered a form of OCD. This struggle to ignore the drive is what creates tension. People pay little attention to hiding the theft because they are more focused on releasing the tension that has been built up right before stealing. Some authors contend that kleptomania and other impulse-control disorders may have something in common with fetishistic behaviors and that fetishism may be the basis of kleptomania (Öncü et al.; 2009 & Burn, 2013).
Psychoanalysts have interpreted kleptomania as an unconscious ego defense against anxiety, forbidden instincts or wishes, unresolved conflicts or prohibited sexual drives, and sexual gratification during the act. Symbolic meaning has been attributed to the act itself, the object stolen, and the victim of the theft. Kleptomania has also been linked to psychosexual issues such as sexual repression and suppression and some researchers posit that kleptomania is a delinquent expression of a neurotic nature with which stealing has been considered a symbol of sexual impulse or a substitution for masturbation. Öncü et al., (2009) state that many young patients with kleptomania have stolen women’s underwear, and stressed that they ecstasy and urge as felt while stealing a fetish object contribute to sexual arousal and orgasm; a condition which is also observed in individuals with other fetishistic behaviors (Burns, 2013). This may be in reference to male offenders, which can lead us to believe the theft is a result of fulfilling a form of sexual gratification. Most of the literature on kleptomania focuses on its relationship to anxiety, depression or sexual disturbances (Goldman, 1991; Burns, 2013). Individuals with kleptomania tend to be depressed and socially isolated (Goldman, 1991). This behavior is different, says Goldman (1991) from those individual who steal with the intention to make profit (Burns, 2013).
TRAIT 3: GRATIFICATION AND RELIEF AND THEFT
The feeling present after the theft is done is gratification. There is an irresistible urge that kleptomaniacs are confronted with which makes it an addiction. Completing the theft brings about feelings of satisfaction similar to someone who has a substance abuse problem. This feeling is what keeps the behavior going. When confronted with a stimulus, especially one that is visible, when the increase tension has reached its peak, fulfilling the theft is what brings about that satisfaction. Research done by Tice et al., (2000), showed that subjects describe sitting at home and suddenly experiencing the urge to steal, buy something or pull their hair. Once triggered, the impulse encourages immediate action, and it may be powerful and persistent. These impulses are hard to resist because of the pleasurable feeling that is brought about once the person has successfully stolen the desired item. Some patients reported that their experience (excitement, tension) during a theft alleviated their depressive symptoms or even suspended them temporarily, while others reported clear-cut relief or remission of their tension headaches or migraine attacks (Weidemann, 1999).
Impulsivity was originally viewed as a behavior learned from the familial environment in which a child learns to react immediately to fulfill their want. Due to the lack of self-control, delayed gratification brings on a sense of emotional distress, which is responsible for the theft being carried out despite the consequences. The capacity to delay gratification has long been one of the prototypes of self-control, insofar as it requires people to resist impulses and facilitates the enlightened pursuit of long-term self- interest (Mischel, 1996). Delayed gratification is very vulnerable when it comes to emotional distress therefore unhappy thoughts can lead to self-gratification and self-indulgence which is why we may see many patients who have kleptomania suffer from a mood disorder as well. More generally, when people face a choice between immediate small rewards and larger but delayed rewards, emotional distress causes people to shift toward the former (Mischel, Ebbesen, & Zeiss, 1973; Underwood, Moore, & Rosenhan, 1973; Wertheim & Schwartz, 1983 & Tice et al., 2000). Bandura and Schunk (1981) similarly said, the self-efficacy version would propose that feeling upset would make the person feel incapable of successfully guiding behavior toward the realization of distal goals, and so the person would give up on them and concentrate on immediate gratification.
Conclusion
People who suffer from kleptomania have poor impulse control responses so when presented with stimuli, they cannot resist from stealing things they do not want or need. Contrary to popular belief, some researches feel that kleptomania is more prevalent than previously assumed. Kleptomania is rarely brought to medical attention voluntarily. Patients usually present for treatment by legal mandate due to repeated shoplifting. Men are more likely to be sent to prison instead of being referred to treatment (Talih, 2011). When presented with stimuli, the urge to steal becomes so overbearing that the person develops an increase of tension and in order to get over that feeling they have to steal which brings them a feeling of pleasure. Kleptomania may be a fairly common disorder that results in significant personal distress and legal consequences (Odlaug & Grant, 2012; Burns, 2013). There is more than enough evidence that proves the positive relationship between kleptomania and theft but more research is needed in order to determine the exact cause.
Treatment options of kleptomania include cognitive therapy where talk therapy is used to focus on replacing negative, distorted thoughts with positive, accurate ones and behavior therapy that focuses on modifying harmful behaviors associated with psychological distress. SSRI’s are also used in treating those who suffer from kleptomania because they target depression and mood disorders, which can trigger an episode where someone who suffers from kleptomania feels the need to compensate for those feelings by stealing. In one study that considered 101 individuals diagnosed with kleptomania, 68.3% had been arrested, 36.6% arrested but not convicted, 10.9% convicted but not incarcerated, and 20.8% had been arrested, convicted, and incarcerated following their crimes (Grant, Odlaug, Davis, & Kim, 2009). Historically, kleptomania has been considered a disorder mainly seen in white upper and middle-class women. It is possible that the current criteria for kleptomania only captures a limited piece of the population (e.g., upper middle class, white women) and ostensibly ignores others that may be suffering from kleptomania, but instead are labeled as criminals (e.g., lower SES, males) (Kohn, 2006). Researchers should continue to examine the characteristics of those diagnosed with kleptomania, keeping in mind not to neglect the commonly accepted criteria. Approximately ten years ago, researchers suggested that one way to understand an impulse control disorder, such as kleptomania, was as part of an obsessive-compulsive spectrum. Characterizing kleptomania as being apart of the obsessive-compulsive spectrum is valid being that the increased sense of tension does not go away until the theft is completed therefore the person brain becomes obsessed with stealing until it is done. This conceptualization of kleptomania was based on what was then known about the clinical characteristics of the disorder, familial transmission, and response to both pharmacological and psychosocial treatment interventions. Family structure and neurobiological factors seem to play a main role in being a cause of kleptomania. Demonstrating that OCD is common in relatives of subjects with kleptomania but on the other hand, family history studies of kleptomania subjects are, however, limited, may also show a relationship between kleptomania and OCD. Two uncontrolled studies found that 7% to 25% of family members of individuals with kleptomania may suffer from OCD. In the only study that used a control group, however, there were no significant differences that were found in rates of OCD among first-degree relatives of kleptomania subjects compared to controls (Grant, 2006). With that being said, the legal and social consequences of kleptomania are significant, and there is a great need for extensive research into treatment strategies to help prevent kleptomaniacs from continuing to relapse into thieving behaviors (Maya, 2012). Incarceration cannot and will not prevent kleptomaniacs from reoffending so it is imperative that we start taking a look into kleptomania amongst the male population so that they can be treated instead of incarcerated and so that we can have a better estimate of the number of men that do suffer from it.