Although infrequently diagnosed and, at times, a subject of contention, kleptomania is one of the impulse control disorder diagnoses included in the DSM-5 that is part of the common lexicon. While the impulse to steal or appropriate objects that are not ours is a common enough human tendency, the distinguishing feature of the disorder as a clinical syndrome is the persistence and pervasiveness of the impulse to steal in those affected and the associated emotional and other life consequences that may occur. Following is a review of the syndrome and some guidance for management for those working within the primary care setting.
The core positive features included in the DSM-5 criteria are:
1) Recurrent failure to resist thoughts and impulses to steal objects not needed for use or of monetary value
2) Experience of increased psychological tension immediately prior to committing the theft
3) Pleasure, gratification or relief at the time of the theft.
The absence of an interpersonal motivation for the theft and the absence of another mental health disorder that might explain the behaviors (e.g., psychosis, mania, conduct disorder) are other criteria. As with all psychiatric diagnoses, a significant degree of emotional distress and/or functional impairment would be associated with the patient’s presentation.
The clinical disorder is rare (+/- 0.4 %) and is most frequently seen beginning in adolescence but symptoms may persist into adulthood. Females are more commonly reported than males with a 3:1 rate differential.
Individuals with kleptomaniac profiles often have other types of disorders involving mood, anxiety, eating, impulse control, and drug use — attention to these issues should be included in the differential diagnosis process. Likewise, screening for kleptomania symptoms in individuals with these other disorders should be considered.
Treatment interventions that have been demonstrated to be of benefit include cognitive behavioral and exposure therapies and there is some indication that medication interventions can be helpful though to date there are no FDA approved medications for the condition. Of some note, one double blind placebo controlled study with Naltrexone has demonstrated efficacy in reducing both urges and behaviors. When co-occurring mental health and substance abuse conditions are present, coordinating medication and other treatment interventions to address all concerns is clearly warranted.
References:
K. Simon, MD, T. York, MD, Y. Anglero Diaz, MD Kleptomania: 4 Tips for better diagnosis and treatment, Current Psychiatry. 2020 August;19(8):44-45 | DOI 10.12788/cp.0031