Kleptomania
| Kleptomania | |
|---|---|
| Specialty | Psychiatry, psychology  |
Kleptomania is the failure to refrain the urge to steal items, not for reasons of personal use or financial increase. Kleptomania is presently classified in the psychiatric glossary as an impulse control disorder, but was first described in 1816. [1] Conversely, some of the main characteristics of the disorder, which consist of recurring intrusion feelings, incapability to refuse to give in to the urge to carry out the act of stealing and the release of pressure following the theft, propose that kleptomania could compose an obsessive-compulsive spectrum disorder.[2]
The disorder is frequently under-diagnosed and is regularly associated with other psychiatric disorders, particularly anxiety and eating disorders, and alcohol and substance abuse. Patients with kleptomania are typically treated with therapies in other areas due to the comorbid grievances rather than issues directly related to kleptomania. [3]
Over the last 100 years a shift from psychotherapeutic to psychopharmacological interventions for kleptomania has occurred. Pharmacological treatments are using selective serotonin reuptake inhibitors (SSRIs), mood stabilizers and opioid receptor antagonists, and other antidepressants along with cognitive-behavioral therapy, has formed hopeful results.[4]
Signs and Symptoms
Some of the fundamental components of kleptomania, which contain recurring intrusion thoughts, impotence to abide the compulsion to engage in stealing and the ease of pressure subsequent the act. These symptoms propose that kleptomania could be regarded as an obsessive-compulsive type of disorder.[5]
Persons diagnosed with kleptomania oftentimes have other types of disorders involving mood, anxiety, eating, impulse control, and drug use. They also have great levels of stress, guilt, remorse, and privacy issues are accompanied with the act of stealing. These signs are considered to either cause or intensify general comorbid disorders. The characteristics of the behaviors associated with stealing could result in other problems as well, which include social segregation and substance abuse. The many types of other disorders frequently occurring along with kleptomania usually makes clinical diagnosis uncertian.[6]
Diagnosis
Disagreement surrounds the method in which kleptomania is considered and diagnosed.At one corner some researchers believe that kleptomania is merely theft and disprove the suggestion that there are psychological mechanism involved, whilst others observe kleptomania as part of a substance-related addiction. Yet others categorize kleptomania as a variation of an impulse control disorder, such as obsessive compulsive disorder or eating disorders.[7]
According to the Diagnostic and Statistical Manual of Mental Disorders fourth edition (DSM IV-TR ), a frequent and widely used guide for the diagnosis of mental disorders the following symptoms and characteristics are the diagnostic criteria for kleptomania:
- repeated inability to defend against urges to steal things that are not essential for private use or for their economic value;
- escalating sense of pressure immediately prior to performing the theft
- satisfaction, fulfillment, or relief at the point of performing the theft;
- the theft is not executed to convey antagonism or revenge and is not in reaction to a delusion or a fantasy; and
- the thieving is not better accounted for by behavior disorder, a manic episode, or antisocial personality disorder. [8]
Skeptics have decried kleptomania as an invalid psychiatric concept exploited in legal defenses of wealthy lady shoplifters.After the twentieth century, kleptomania was strongly linked with the increasingly blossoming department stores, and “department store kleptomaniacs” were a widely held social stereotype that had political implications.[9]
Commorbidity
Kleptomania seems to be linked with other psychiatric disorders, especially mood, anxiety and eating disorders, and alcohol and substance abuse. The occurrence of stealing as a behavior in conjunction with eating disorders, particularly bulimia nervosa, is frequently taken as a sign of the harshness of the eating disorder.[10]
A likely connection among depression and kleptomania was reported as early as 1911. It has since been extensively established in clinical observations and available case reports. The mood disorder could come first or co-occur with the beginning of kleptomania. In advanced cases, depression may result in self-inflicted injury and could even lead to suicide. Some people have reported relief from depression or manic symptoms after theft.[11]
It has been recommended that because kleptomania is linked to strong compulsive and impulsive qualities, it can be viewed as a variation of obsessive-compulsive spectrum disorders, together with pathological gambling, compulsive buying, pyromania, nail biting and trichotillomania. This point achieves support from the unusually higher cases of OCD in close relatives of patients with kleptomania.[12]
Kleptomania Vs. Substance Abuse Disorder
Kleptomania and drug addictions seem to have central qualities in common, including: 1) recurring or compulsive participation in a behavior in spite of undesirable penalties; 2) weakened control over the disturbing behavior; 3) an need or desire condition before taking part in the problematic behavior; and 4) a positive pleasure-seeking condition throughout the act of the disturbing behavior. Data from epidemiological studies additionally propose there is a affiliation between kleptomania and substance use disorders along with high rates in a unidirectional manner. Phenomenological data maintain that there is a relationship between kleptomania and drug addictions. Higher percentage in cases of kleptomania have been noted in adolescent and young adults and lesser number of cases among older adults, which imply a analogous natural history to that seen in substance use disorders. Family history data also propose a probable common genetic input to alcohol use and kleptomania. Substance use disorders are more common in kin of persons with kleptomania than in the general population. Furthermore, pharmacological data (e.g., the probable efficacy of the opioid antagonist, naltrexone, in the treatment of both kleptomania and substance use disorders) could present additional support for a joint relationship between kleptomania and substance use disorders. Based on the idea that kleptomania and substance use disorders may share some etiological features, it could be concluded that kleptomania would react optimistically to the same treatments. As a matter of fact, certain nonmedical treatment methods that are successful in treating substance abuse are also accommodating in treating kleptomania.[13]
OCD vs. Kleptomania
Kleptomania is frequently thought of as being a part of obsessive-compulsive disorder, since the irresistible and uncontrollable actions are similar to the frequently excessive, unnecessary and unwanted rituals of OCD. Some individuals with kleptomania demonstrate hoarding symptoms that resemble those with OCD.[7] Prevalence rates between the two disorders do not demonstrate a strong relationship. Studies examining the comorbidity of OCD in subjects with kleptomania have inconsistent results, with some showing a relatively high co-occurrence (45%-60%)[8][9] while others demonstrate low rates (0%-6.5%).[10][11] Similarly, when rates of kleptomania have been examined in subjects with OCD, a relatively low co-occurrence was found (2.2%-5.9%).[12][13]
Treatment
Although this disorder has been known to psychologists for a long time, the cause of kleptomania is still ambiguous. Therefore, a diverse range of therapeutic approaches have been introduced for its treatment. These treatments include: psychoanalytic oriented psychotherapy, behavioral therapy, and pharmacotherapy.[14]
Psychoanalytic and Dynamic Approach
Several explanations of the mechanics of kleptomania have been presented. A contemporary social approach proposes that kleptomania is a outcome of consumerism and the large quantity of commodities in society. Psychodynamic theories depend on a variety of points of view in defining the disorder. Psychoanalysts defined the condition as a indication of defence mechanism deriving in the unconscious ego against anxiety, prohibited intuition or desires, unsettled struggle or forbidden sexual drives, dread of castration, sexual excitement, and sexual fulfilment and orgasm throughout the act of stealing.[15] The psychoanalytic and dynamic approach to kleptomania granted the basis for prolonged psychoanalytic or psychodynamic psychotherapy as the core treatment method for numerous years. Like most psychiatric conditions, kleptomania, was observed within the psychodynamic lens instead of being viewed as a biomedical disorder. However, the prevalence of psychoanalytic approach contributed to the growth of other approaches, particularly in the biological domain.[16]
Behavioral and Cognitive Intervention
Cognitive-behavioural therapy (CBT) has primarily substituted the psychoanalytic and dynamic approach in the treatment of kleptomania. Numerous behavioural approaches have been recommended as helpful according to several cases stated in the literature, they include: hidden sensitisation by unpleasant images of nausea and vomiting, aversion therapy (for example: aversive holding of breath to achieve a slightly painful feeling every time a desire to steal or the act is imagined), and systematic desensitisation.[17] In certain instances, the use of combining several methods such as hidden sensitisation along with exposure and response prevention were applied. Even though, the approaches used in CBT need more research and investigation in kleptomania, success in combining these methods with medication was illustrated over the use of drug treatment as the single method of treatment.[18]
Drug Treatment
The phenomenological similarity and the suggested common basic biological dynamics of kleptomania and OCD, pathological gambling and trichotillomania gave way to the theory that the similar groups of medications could be used in all these conditions, Consequently, the primary use of selective serotonin reuptake inhibitor (SSRI) group, which is a form of antidepressant, have been used in kleptomania and other impulse control disorders such as binge eating and OCD. Electroconvulsive therapy (ECT), lithium and valproic acid (sodium valproate) have been used as well.[19]
The SSRIs usage is due to the assumption that the biological dynamics of these conditions derives from low levels of serotonin in brain synapses, and that the efficacy of this type of therapy will be relevant to kleptomania and to other comorbid conditions.[20]
Opioid receptor antagonists are regarded as practical in lessening urge-related symptoms, which is a central part of impulse control disorders; for this reason, their used in treatment of substance abuse. This quality makes them helpful in treating kleptomania and impulse control disorders in general. The most frequently used drug is naltrexone, a long-acting competitive antagonist. Naltrexone acts mainly at µ-receptors, but as well antagonises kappa and lambda receptors.[21]
Currently there have been no controlled studies of the psycho-pharmacological treatment of kleptomania. This could be as a consequence of kleptomania being a rare phenomenon and the difficulty in achieving a large enough sample. To date facts in this region has largely come from case reports or from bits and pieces gathered from a pretty small number of cases enclosed in a group series.[22]
History
In the nineteenth century, based on observation, French psychiatry explain abnormal behaviour, however, was constrainted by its approach. By 1990, lots of case material on kleptomania had been developed. Hysteria, imbecility, cerebral defectm menopause might explain the nonsensical behaviour of stealing. The French and Germans had made observtions later became central to psychanalytic explanations of kleptomania. Some information showing that infants have a natural tendency to grab whatever and whenever they want. [23]
First Generation of Psychoanalysis
In the early twentieth century kleptomania was more a legal excuse for self-indulgent haut bourgeois ladies than a valid psychiatric aliment by French psychiatrists. [24] [25]
- Sigmund Freud The founder and guiding genius of psychoanalysis, he explianed the underlying dynamics of human behaviours assoicated with uncivilized savages-- impulses were curbed by inhibitions for social life. He reckoned human behaviour was seldom rational. He created large theoretical corpus which his disciples applied to such psychological problems such as kleptomania.
- Wilhelm Stekel He followed the suggestion of Freud and read the case of a female kleptomaniac who was driven by suppressed sexual urges to take hold of " something forbidden , secretly." Stekel concluded that kleptomania was " suppressed and superceded sexual desire carried out through medium of a symbol or symbolic action. Every compulsion in psychic life is brought about by suppression" [26]
Second Generation of Psycholanalysis
- Fritz Wittels He argued that kleptomaniacs were sexually underdeveloped people who felt deprived of love and had little experience with human sexual relationships; stealing was their sex lives, giving the, thrills so powerful that they did not want to be cured. Male kleptomaniacs were homosexual or invariably effeminate. [27] [28]
Psychoanalysis had brought to understanding of kleptomania. A famous large-scale analysis of shoplifters in UKridiculed Stekel's notion of sexual symbolism adn claimed that, 1 out of 5 apprehended shoplifters was a "psychiatric". [29]
New perspectives
Empirically-based conceptual articles have argued that kleptomania is getting more common than previously thought, more prone to women than men. These ideas are new in recent history but echo those current in the mid to late ninteenth century. [30]
Etiology
PSYCHOANALYTIC MODELS
Many psychoanalytic theorists reckon kleptomania is an attempt by the person “to obtain symbolic compensation for an actual or anticipated loss,” and feel that the key to understanding the etiology lies in the symbolic meaning of the stolen items [31] Drive theory was used to propose that the act of steal- ing is a defense mechanism which serves as to modulate or keep undesirable feelings or emotions from being expressed [32]
COGNITIVE-BEHAVIORAL MODELS
Cognitive-behavioral models are replacing psychoanalytic models recently for the development of kleptomania. Cognitive- behavioral practitioners often conceptualize the disorders as being the result of operant conditioning, behavioral chaining, distorted cognitions, and poor coping mechanisms (e.g., Gauthier & Pellerin, 1982; Kohn & Antonuccio, 2002). Cognitive- behavioral models provokes that the behavior is positively reinforced after the person steals some items. If this individual experiences minimal or no nega- tive consequences (punishment), then the likelihood that the behavior will reoccur is increased. As the behavior continues to occur, stronger antecedents or cues become contingently linked with it, in what ultimately becomes a powerful behavioral chain. According to cognitive-behavioral theory(CBT) both antecedents and consequences may either be in the environment or cognitions. For example, Kohn and Antonuccio (2002) describe a client’s antecedent cognitions, which include thoughts such as “I’m smarter than others and can get away with it”; “they deserve it”; “I want to prove to myself that I can do it”; and “my family deserves to have better things.”. These thoughts were strong cues to stealing behaviors. All of these thoughts were precipitated by additional antecedents which were thoughts about family, financial, and work stressors or feelings of depression. “Maintaining” cognitions provided additional reinforcement for stealing behaviors and included feelings of vindication and pride, for example: “score one for the ‘little guy’ against the big corporations”. Although those thoughts were often afterward accompanied by feelings of remorse, this came too late in the operant sequence to serve as a viable punisher. Eventually, individuals with kleptomania come to rely upon stealing as a way of coping with stressful situations and distressing feelings, which serve to further maintain the behavior and decrease the number of available alternative coping strategies. [33]
BIOLOGICAL MODELS
Biological models explain the origins of kleptomania have been based mostly on pharmacotherapy treatment studies that used selective serotonin reuptake inhibitors (SSRIs), mood stabilizers, and opioid receptor antagonists (see Dannon, 2002 for a review of the literature; Grant & Kim 2002b) Poor regulation of serotonin, dopamine, and/or natural opioids within the brain cause kleptomania was suggested by some studies. Based on SSRI studies suggest that kleptomania is akin to impulse control or affective disorders,it is mediated by poor regulation of serotonin levels in the brain. This is because opioid antagonists appear to reduce some people’s urges to steal and mute the “rush” typically experienced immediately after stealing [34] [35] [36] . An alternative explanation also based on opioid antagonist studies states that kleptomania is similar to the “self-medication” model, stealing can stimulate the person’s natural opioid system. “The opioid release ‘soothes’ the patients, treats their sadness, or reduces their anxiety. Thus, stealing is a mechanism to relieve oneself from a chronic state of hyperarousal, perhaps produced by prior stressful or traumatic events, and thereby modulate affective states” [37]
Society and Culture
Stealing becomes an obsession frequently, this obsession is called kleptomania. Although people know they could get caught and marked for life, they find it hard to give up the habit. Major symptoms include a person’s decreased resistance to steal objects unnecessarily feeling entitled to own it at any cost. “If a person does get away with stealing like this, the heart beat rate is known to increase, close to an adrenaline rush after committing and getting away with it,” says Dr Paralikar. [38] [39]
Megan Fox
“The ratio of women to men suffering from kleptomania is 4:1. The main reason is that women are right brained which means they’re more connected to their emotional centre. This also gives way to impulses and inability to control shoplifting or petty theft,” says eminent psychologist Dr. Nandu. She was banned from all Walmart forever. Megan has come clean about her kleptomaniac activities during her teenage years. During her rebellious teenage years, she stole a $7 tube of lip gloss from a Florida branch.
Winona Ryder
She who was a famous actress, found the feeling of relieve her stress by stealing. She was arrested in 2001 and was sentenced to three years probation and 480 hours of community service for shoplifting of clothings. She even lied that she stole because she was having preparation as a character for an upcoming movie.[40]
Kristin Cavalar
A person may seem out of the scope of kleptomania and it is precisely that shoplifters can sense when they decide to steal out of impulse. Due to psychological reasons , teenager girls may resort to steal as they feel the need to fill in the lack of emotional depth in their lives with materialistic petty thefts. Psychiatrist Vasudeo Paralikar believes young women who take things from shops are actually manifesting their depressive illness. During her "Laguna Beach" days, Kristin was caught stealing merchandise with three other girls from Tawny K. She was sentenced five years ago.
Britney Spears
She is a famous pop star, she forgot to pay for stuff for already a couple times even though she made a lot of money. She's been rushed out of a store without paying for a $200 top, lighter and a wig. According to statistics, psychiatrists remark that most kleptomaniacs are women between the ages of 20 and 35 and large percentage of them come from affluent backgrounds! Some reports claim it can be found as early as the age of five and late adolescence opens the key to illicit acquisitions.
Tila Tequilla
She was the worst shoplifters, on her blog saying that she was so hungry that she decided to "just steal some bubble gum and chips and not get caught." When a person with such a disorder is compelled to steal things like paper clips, small toys, stationary, and cosmetics which are worthless. Some cases of kleptomania have been so acute that shoplifters don’t realize their mistake until the cops come knocking at the door!
References
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