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8.80: Kleptomania (312.32)

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    23276
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    This is a short clip of Dr. Gary Solomon explaining what activities a person diagnosed with kleptomania might do.

    DSM-IV-TR criteria

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

    B. Increasing sense 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.

    E. The stealing is not better accounted for by a Conduct Disorder, a Manic Episode, or Antisocial Personality Disorder.

    Associated features

    Kleptomania is an irresistible impulse to steal, stemming from emotional disturbance rather than economic need. It is also said that it is a recurrent failure to resist stealing. It is most observed in patients who are “chemically dependent” or also have mood, anxiety, or eating disorders. It is possible that people with kleptomania could also be dealing with major depression, panic attacks, social phobia, anorexia nervosa, bulimia nervosa, substance abuse, and obsessive compulsive disorder. People with this disorder get a thrill from stealing and randomly have an overwhelming urge to do so. Strangely enough, they often feel guilty after committing theft and surreptitiously return the stolen items. If the items, usually of lesser importance, aren’t returned they are hoarded, discarded, or given away. In less severe instances of kleptomania, things are borrowed and not returned.
    Kleptomania is not to be confused with the regular act of stealing. Whether planned or impulsive, a normal thief steals for the objects value or usefulness. Many times they are teenagers or gang members that view theft as a rite of passage, form of rebellion, or commit them just for a dare.

    Child vs. adult presentation

    It is difficult to assess the differences in presentation of Kleptomania among children and adults. This is because Kleptomania typically presents itself during late adolescence or early adulthood. It is rare for Kleptomania to manifest itself during a person’s early childhood or late in their life. This is because it is hard to distinguish if children are stealing because of a disorder or if it is because they do not know any better.

    Gender and cultural differences in presentation

    In preliminary evidence, clinical samples suggest that approximately two-thirds of individuals with Kleptomania are female. Kleptomania in cultural differences are not stated.

    Epidemiology

    Kleptomania is a rare condition that appears to occur in fewer than 5% of identified shoplifters. Studies suggest that the prevalence in the general population may be around 0.6%. Studies also suggest that it is more prominent in females. Other studies, interestingly, have found an exceptionally high correlation of kleptomania in patients with bulimia of 65%. Also, approximately 7% of patients have a correlation with histories of OCD.

    Etiology

    • One theory suggests that receiving the thrill of stealing can aid in alleviating symptoms in people who are clinically depressed. They never seek aid in the act of theft and never plan to steal with others. There can be favored objects or environments where theft occurs, but detection of kleptomania, even by family, is difficult and the problem mostly goes undetected.
    • There is no known cause for kleptomania. It is possible that it is genetically related especially from first-degree relatives. There also tends to be a sharp inclination for kleptomania to coexist with OCD, bulimia nervosa, and clinical depression.

    Empirically supported treatments

    Actually finding a diagnosis is typically difficult given that patients do not seek medical help for this complaint. It is also difficult to detect in the initial psychological assessments. It is most commonly addressed when one comes in for other reasons like depression, bulimia, or are simply emotionally unstable. They may prefer certain objects and settings, but these may not be described by the patient. Initial psychological evaluations may reveal a past of inadequate parenting, conflicting relationships, or a point of severe stressors such as having to make a move from one home to another.

    There tends to be little or no system on the course of Kleptomania. There are, however, three typical courses that can be described as: “sporadic with brief episodes and long periods of remission; episodic with protracted periods of stealing and periods of remission; and chronic with some degree of fluctuation.” Though they are convicted numerous times for shoplifting, the disorder could go on for years.
    Treatments will vary concerning this disorder. It starts with an extensive psychological assessment. The patient will undergo therapy that targets impulse control and any and all coexisting mental disorders. They gain a comprehensible understanding of their specific triggers in order to prevent relapse. Psychotherapies, such as cognitive-behavioral therapy and rational emotive therapy, will be included in the treatment. Other psychotherapies include covert sensitization, aversion therapy, and systematic desensitization.

    Several medications have been shown to work, but the possibility of the patient having another mental disability should also be taken into account. Antidepressants are the most widely used medicine to treat kleptomania, which includes Prozac. These are serotonin reuptake inhibitors. Side effects often occur, so patients should consult doctor if any occur. Mood stabilizers can also be used to even out the patient’s mood. This will help the patient not have rapid or uneven mood changes that may trigger them to steal something. An example of this includes lithium which is shown to possibly be helpful. Benzodiazepines can also be used but the effectiveness often varies patient to patient and they may cause the patient to become dependent on the drug. These medications are central nervous system depressants, also known as tranquilizers. Examples of these include Xanax and Klonopin. Lastly, there are addiction medications. Revia falls into this category. Revia is known as an opioid antagonist and is most commonly prescribed for kleptomania. This particular drug blocks the part of the brain that feels pleasure with certain addictive behaviors, which in turn should reduce the patients urge to steal.

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