Impulse Control Disorder of Kleptomania

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Table of Contents

Introduction
The Diagnostic Criteria as Contained in the DSM-IV-TR
Diagnostic Differentials of Kleptomania
Treatment Approaches and their Efficacies
Conclusion
Reference

Introduction

There is the recent story of a well-to-do actress Winona Rider stealing mere merchandise just worth $5,500 from Saks Fifth Avenue in Beverly Hills, California that puzzled many people (Plante, 2006). Many questions were asked why a well-groomed actress of means could steal some clothes that she was able to buy with a little pinch of her pocket at the expense of her glamorous career. Was this a case of Kleptomania?

Kleptomania is defined in the Diagnostic and Statistical Manual of Mental Disorders Fourth Edition (DSM-IV) as a persistent drive to steal objects that are neither useful in terms of personal use nor have any monetary value to the ‘thief’ (Marazziti, 2007). It’s normally classified under “impulse control disorders not elsewhere classified” (Marazziti, 2007). The description of Kleptomania has always been that it is an unknown disorder, which has led to little studies, misdiagnosed, underestimated as many assumed that it’s a non-existent disorder. The little attention it has received is associated with the stigma it comes with, i.e. the person being considered acting illegally should not be defended as suffering from a disorder (Marazziti, 2007).

Before the person commits the theft, he or she experiences an increased sense of tension immediately before the crime is committed, but gets relieved, gratified, and experiences some sort of pleasure at the time of accomplishing the act (Marazziti, 2007). Ordinarily, the stealing is never committed in an expression of anger or even with the intention of vengefulness, neither is it in response to any form of dissolution nor hallucination. However, attempts to link the habit to the conduct disorder, a manic episode or antisocial personality disorder have never yielded any substantial benefits to its diagnostic as well as treatment criteria (Durand & Barlow, 2005).

The Diagnostic Criteria as Contained in the DSM-IV-TR

Criterion A: as opposed to what motivates a professional thief, a person suffering from Kleptomania is to some extent indifferent to the items he or she has stolen after completing the act. The person may return the items or even discard them as he or she will feel disgusted when in possession of the stolen items. Again unlike the case of adolescent group delinquency, theft is a solitary behavior that the thief will strive to keep secret as much as he or she can.

Criteria B& C: These particular criteria describe certain specific features that separate what motivates a person suffering from kleptomania and those which motivate other types of thieves. The criteria also take care of kleptomania being included in the ‘Impulse-Control Disorder’ section;
Criteria D& E: It has been highlighted above that theft may occur as a result of many other reasons rather than kleptomania, i.e. from any other context associated with mental disorders. The criteria require that these other reasons should be eliminated or ruled out before linking the behavior to Kleptomania (First, Frances & Pincus, 2004, p. 336).

Diagnostic Differentials of Kleptomania

Kleptomania first got its designation as a psychiatric disorder in 1980 when it was included in the DSM-III and the DSM-III-R; categorized under Disorder of Impulse Control Not Elsewhere Classified (Dannon, 2003; Grant, 2004a). Currently, Kleptomania is in the class of DSM-IV-TR as an impulse control disorder. This puts it in the category of other disorders such as “pathological gambling, pyromania, intermittent explosive disorder, and trichotillomania” (Grant, 2004a).

What makes Kleptomania exclusive in terms of diagnostic difference is that it has certain diagnostic features that are unique under the DSM-IV-TR. The current diagnostic associations of Kleptomania patients are: a) they experience recurrent failures in an attempt to avoid an impulse leading to theft; b) they normally experience an immense sense of tension just before they commit the theft; c) they have a pleasurable feeling, get gratified, and relief at the particular time of theft; d) they do not feel any form of anger or any form of vengeful attitude to be considered as a motivation factor in the theft process; and strangely, they also lack any form of psychosis; and lastly, e) they lack any form of “conduct disorder, a maniac episode, or even an antisocial personality disorder that may account for stealing episode” (Grant, 2004a, p.4).

Ordinary stealing happens for many reasons that have completely nothing to do with Kleptomania. That is to say, under normal circumstances, people steal to have a monetary or material gain or value that an item or items may have. For instance, a professional thief or burglar is motivated by the monetary value of the items stolen. First, Frances & Pincus (2004) observe that “much less commonly, the act of stealing occurs as an act of anger or vengeance, on dare, or as a rite of passage” (p.336). It is, therefore, necessary to distinguish the above-highlighted reasons for stealing to separate the act from Kleptomania, which is normally a much less encountered as well as narrowly defined pattern of stealing purposefully for pleasurable gratification as well as a tension relief. Since some individuals have claimed that their act of theft was motivated by Kleptomania, which was later proved to be untrue, the need to separate the disorder from the actual theft cases is important in the maintenance of law and order.

Theories of Causation and Predicted Cause of the Disorder

The history of Kleptomania suggests that various hypotheses have been advanced to explain the causes of the disorder. However, there are quite clear indications that causal factors associated with this disorder have not been expressly found. For example, in the middle of the last century, there was an increased development of psychodynamic and psychoanalytic theories of Kleptomania, although they assumed that Kleptomania and stealing did have the same meaning and even cause. Kleptomania has been interpreted as a “reflection of an unconscious defense against anxiety, forbidden instincts or wishes, unresolved conflicts, prohibited sexual drives, fear of castration, and sexual arousal, sexual gratification, and orgasm during the act of thievery” (Plante, 2006, p.107). It is critical to note that the association of Kleptomania and sexuality or sexual drive has appeared in various literature, mostly described as ungratified sexual instinct (Plante, 2006).

John Grant put forward the Reward- Reinforcement Pathway theory. This theory relies on the traditional belief that man will always do repeatedly that which gives him pleasure and avoid that which causes him pain (Grant, 2003b). It is linked to the underlying biological mechanism of disorder based on an urge. In this aspect, the urge to steal is processed with the help of incoming reward inputs by the ventral segmental area-nucleus accumbens-orbital frontal cortex (VTA-NA-OFC) circuit (Plante, 2006). This is the circuit that normally influences the behavioral habits of humans and animals, motivating urges and cravings for certain objects. Dopamine will play some critical role in the regulation of this particular region’s functioning (Plante, 2006). If this system is blocked, the chances of repeating the act are reduced. Grant point to note is that the victims know that what they are doing is an addiction yet they can’t stop doing it anyway. Reinforcement is therefore put to invoke negative feedback for actions that are deemed addictive and rewards the actions that seem positive to the treatment of the disorder.

Some psychologists have concentrated on the object relations theory, which associates kleptomaniac’s theft habit to an attempt of controlling a frightening as well as dangerous object by “reinstating a sense of omnipotence” (Aboujaoude, Game & Koran, 2004). Others on the other hand have associated the disorder to an attempt by the kleptomaniac to prevent fragmented self in response to narcissist’s injury.

The other common phenomenal association of kleptomania disorder is it’s the close link with anxiety and depression. In this case, the act of stealing by a kleptomaniac is viewed as a way of taking risks that is performed by a depressed person with antidepressant significance, just as a symptom of stress or just as away of relief from a stressful situation (Aboujaoude, Game & Koran, 2004). Some psychiatrists have used children who suffer from kleptomania to explain the psychological theories associated with the disorder. For example, Marazziti (2007) highlights that this phenomenon is common in children who have reported the feeling that they have been injured or neglected, where Kleptomania is viewed as a way of gratifying two major needs: the actions themselves may offer a sense of gratification, and the stolen objects is likely to dispel any feeling of deprivation they has harbored in their mind. Grant, cited in Denizet-Lewis (2009) remarks, “with all addictions, a person’s free will is greatly impaired, but the law does not want to entertain that….why shouldn’t someone’s addiction be considered as a mitigating factor, especially sentencing?” This statement highlights the extent to which the society stigmatizes the kleptomaniacs, with the full backing of the law (p.1).

Treatment Approaches and their Efficacies

Presently, the available treatments for kleptomania emanate from several aspects of psychotherapy and pharmacotherapy. However, it must be realized that studies meant to explore the efficacy of these treatments are limited in nature. Marazziti (2007) notes that many findings rely on a few case reports, series of cases, and just individuals with kleptomania who have shown willingness to participate in the few studies.

In the last decade, the most common treatment approached used was basically associated with psychoanalytic and psychodynamic theories. These theories therefore led to the popularity of psychoanalytic and psychodynamic psychotherapy as the treatment of choice for many individuals suffering from the disorder. However, the efficacy of this treatment approach is unknown largely due to limited controlled studies (Aboujaoude, Gamel & Koran, 2004; Marazziti, 2007). Some case reports suggest that some patients do respond positively to these treatments, particularly if combined with medications, while some patients have shown no improvements even after undergoing the treatments.

The Reward- Reinforcement theory is more promising as it takes care of the cognitive-behavioral therapy (CBT), which has been considered much more important and has generally replaced the older psychoanalytic and psychodynamic psychotherapies (APA, 2000). The CBT approaches to treating kleptomania are: covert sensitization, aversion therapy, and systematic desensitization (APA, 2000). CBT also lacks controlled studies to support its efficacy. However, individual cases have revealed that many patients do respond to the treatment very well, particularly when combined with pharmaceutical medications (APA, 2000).

Conclusion

This analysis suggests that causal theories of kleptomania have not received concrete studies to back them. However, it is critical to note that theories related to psychological perspective are more advanced, even though they lack medical backing. This is because treatment approaches that focus on psychotherapy are seen more positively than the medical approaches. If it was the biological aspect, more laboratory tests would have revealed the associated treatment that would best suit the biological treatment criteria. Furthermore, the pharmacotherapy has been known to only help in the treatment of symptoms associated with kleptomania, hence its application as a supporting treatment for psychotherapy.

Reference

Aboujaoude, E., Gamel, N. & Koran, L. (2004). Overview of Kleptomania and Phenomenological Description of 40 Patients. The Primary Care Companion. Web.

American Psychiatric Association (APA). (2000). Diagnostic and Statistical Manual of Mental Disorders IV, 4^th Edition. Washington, DC: American Psychiatric Association.

Dannon, P. N. (2003). Topiramate for the treatment of kleptomania: a case series and review of the literature. Clin Neuropharmacol, 26:1– 4.

Denizet-Lewis, B. (2009). American Anonymous. Biological Psychiatry. 2002.

Durand, M., & Barlow, D. (2005). Essentials of Abnormal Psychology. New York. Sage Publishers.

First, B., Frances, A., & Pincus, A. (2004). DSM-IV-TR Guidebook. New York. American Psychiatric Publications.

Grant, J.E. (2004a). Co-occurrence of Personality Disorders in Persons with Kleptomania: A Preliminary Investigation. J Am Acad Psychiatry Law, 32: 395-8. Web.

Grant, J.E. (2003b). Perceived stress in Kleptomania. Psychiatr Q, 74:251-8.

Marazziti, D. (2007). Kleptomania in Impulse Control Disorders, Obsessive-Compulsive.

Disorder, and Bipolar Spectrum Disorder: Clinical and Therapeutic Implications. Journal of Current Psychiatry Reports, Vol.5, No. 1, P. 36-40.

Plante, T.G. (2006). Mental Disorders of the New Millennium. California. Praeger Publishers.

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