What is kleptomania? Understanding the compulsive urge to steal

Australia Broadcast Center

2 days ago

Lynn* can remember the very first time she stole something. A kid's toy from a friend when she was seven years old.
It was nothing out of the ordinary — young kids often steal and tend to grow out of it.
But as she got older, Lynn found herself stealing more often. She'd take hair ties from her teacher's desk, umbrellas from her university, a small doll from the shops.
And at 22, the urge to steal has taken over Lynn's life.
"Almost everywhere I go right now I have to steal something, which is really disabling for me," she says.
Two years ago, Lynn was officially diagnosed with kleptomania — a mental health condition characterised by a compulsive urge to steal.
Kleptomania is considered an "impulse control disorder" under the Diagnostic and Statistical Manual of Mental Disorders (DSM), a clinician's key handbook for mental health conditions.
Impulse control disorders are a relatively rare cluster of conditions that also includes pyromania (an intense fascination with fire and the repeated, deliberate setting of fires) and oppositional defiant disorder (a pattern of disobedient or hostile behaviour towards authority figures in childhood).
People with kleptomania repeatedly steal items, but they do it impulsively and they find it very difficult to stop," says Sam Chamberlain, a professor of psychiatry at the University of Southampton.
"Importantly, when they steal these items, it's not because they need them and it's not for personal or financial gain," he says.
According to Dr Chamberlain, the typical pattern of behaviour for someone with kleptomania is a sense of tension that builds up before the theft, followed by a feeling of gratification or release after they've done it.
Lynn says the urges feel like she is being pulled towards a particular object — that "it feels like there's no way of not taking it." She says it feels reflexive and difficult to suppress, like a sneeze or a yawn.
And once she's taken the object, there's a rush of euphoria, quickly followed by guilt.
"After a minute already I feel so very guilty about it. And I feel like a terrible human being," she says.
Despite being mentioned in medical manuscripts for hundreds of years, kleptomania is still not well understood.
"It's really stigmatised and hidden," Dr Chamberlain says.
"And this means, sadly, that the person with a condition will suffer more.
"It also makes this condition hard to study because people might be reluctant to come forward for research and admit that they've got this condition," he adds.
The evidence we do have suggests about three to six in every 1,000 people have kleptomania.
That makes it much rarer than conditions like anxiety and depression, which affect sizeable proportions of the population.
It typically emerges during someone's teenage years and is thought to be more common in women than men — though again, that finding is based on the limited number of people diagnosed with the disorder.
And while the numbers of people affected are small, kleptomania can be debilitating.
Lynn often avoids going to the shops or visiting friends because she's scared of stealing and being caught.
"And my parents will know and I will be arrested and convicted and the anxiety starts going up from there," she says.
Concealing the condition — and the associated anxiety that comes with it — is typical of people with kleptomania, Dr Chamberlain says.
"We often see that people, develop, anxiety and depressive disorders and other addictions such as alcohol use disorder. Sometimes these can be a direct consequence of the kleptomania and other times they can be happening in parallel."
Research into kleptomania is limited, and work that examines the drivers of the condition is less common still.
While no clear cause has been identified, we do know people with severe symptoms of kleptomania are more likely to also be diagnosed with other conditions such as obsessive-compulsive disorder or an eating disorder.
They also tend to have higher levels of impulsivity.
"This means that in terms of their personality, they have a tendency towards doing things on the spur of the moment. Maybe in response to reward, perhaps not planning things through to the extent that a less impulsive person would," Dr Chamberlain says.
When researchers look at the brains of people diagnosed with kleptomania against those who don't have the condition, there appear to be subtle differences in the white matter tracts (bundles of nerve fibres) that connect key parts of the brain together.
"We also see changes in the white matter tracts … in people with other conditions such as attention deficit hyperactivity disorder or obsessive-compulsive disorder," Dr Chamberlain says.
"So probably there's some kind of common brain processes contributing to these different conditions."
After receiving her diagnosis two years ago, Lynn trialled a number of different strategies to curb her impulses.
These included talking therapies, recordings of her friends' words of encouragement she plays through headphones while at the shops, and a card she carries listing the potential consequences of stealing.
She's also been prescribed the drug naltrexone, which is most often used to treat alcohol use disorder — and which has the best evidence of any medication for treating kleptomania, Dr Chamberlain says.
A small but high-quality study done in 2009 found the drug was better than a placebo pill in reducing both urges and actual stealing among people with kleptomania.
"So naltrexone is often a useful choice, but obviously as with any medication there are side effects for some people … it's not the easiest medication to prescribe," he says.
For Lynn, none of these treatments have been effective in reducing her stealing. She wants more work done in researching ways to address the urges.
In the meantime, she manages as best she can.
"I have never been caught, and I hope to let it stay that way. But I'm not sure how long I will be able to," she says.
*Lynn's name has been changed to protect her identity.
Listen to the full episode of All In The Mind about kleptomania and its impact , and follow the podcast for more.