Exist on Kleptomania. They May Include Treatment

¶ … exist on kleptomania. They may include treatment options, background on the disorders, or even how to identify a person suffering from kleptomania. New research however, has begun linking the disorder to others in hopes of better understanding what causes kleptomania and how to effectively treat it. Kleptomania has been linked to compulsive buying and binge-eating disorder. Women are known to suffer more from these disorders than men. This suggests these three disorders may have more in common than initially believed.

Prevalence

Kleptomania is a rare disorder found in both men and women with women producing higher occurrences than men. Shoplifting although similar to kleptomania, is not habitual nor does it produce the same effects that someone suffering from kleptomania would. The disorder is commonly characterized by a need to steal things, sometimes trivial things, in order to feel better or feel in control. Normally people who show symptoms of kleptomania have an inability to resist the urge to steal and do so impulsively and at times obsessively.

Because kleptomania is so rare, very few studies have been able to truly understand its neurological mechanism nor its origin. It is often simply lumped along with other, more common disorders like depression and ADHD. An article covering a case study of a sixteen-year-old girl with both kleptomania and ADHD reveals the kind of behavior typically associated with the disorder as well as the success of the treatment she received after diagnosis. The case study by Herguner & Tanidir not only provides important clues regarding diagnosis of the disorder, but also ways to manage it effectively.

Case Study

The sixteen-year-old girl developed symptoms of kleptomania early on. When she was around fourteen, she displayed negative habits that resulted in stealing from her neighbors continually for two years among other things. She would steal small things like food, candy, and money at first and then moved up to shoplifting. The girl was reported to have stolen clothes from stores on a daily basis. The kind of feelings she described fueled her behavior were to her, considered involuntary, and were mainly driven by anxiety. She felt relief when she stole the items, then shame and guilt shortly thereafter, which fueled higher levels of anxiety.

The anxiety not only drove the kleptomania, but it also caused her to become irritable, impulsive, have a poor attention span and thus perform poorly in school. She had issues with family and friends because of the altered state she was in and could not alleviate her symptoms anymore through stealing. With her diagnosis according to DSM-IV criteria, she was diagnosed with ADHD and kleptomania and was given supportive therapy along with 27mg/day of methylphenidate which was later increased to 36mg/day. The combination of medication and therapy alleviated her symptoms and by the fourth week her school work improved along with minimization of her urges to steal. (Herguner & Tanidir 383-384)

Mechanisms behind Kleptomania

Kleptomania poses increased risk for sufferers of the disorder to develop psychiatric disorders. Some of which are impulse control disorders, mood disorders, or even obsessive-compulsive disorder. "It is hypothesized that these 3 conditions might be viewed as impulse control disorders that belong to an extended family of compulsive-impulsive spectrum disorders (CISDs). The CISDs may, in turn, belong to the larger family of affective spectrum disorders." (Keck 14) With knowledge of the relationship between kleptomania and other psychiatric disorders, one can use treatments that they would use for the aforementioned conditions on people who suffer from kleptomania. As research suggests patients respond well to available psychological and psychopharmacologic treatments.

Binge eating disorder often mimics a lot of the mechanisms described in kleptomania. The need to quell the anxiety followed by the shame and guilt from the negative activity/habit can be seen in both disorders. With binge eating people will consume enormous amount of food in a short period of time to relieve the stress and anxiety they feel within their lives. Much like binge eating, stealing produces the same effect with the added risk of getting arrested as shoplifting or robbery is a misdemeanor punishable by jail time and fines. Both disorders also lack impulse control. People normally in this state are not self-aware and feel like they cannot control their behavior.

Most clinicians when dealing with possible kleptomania or attempting to run a diagnosis lack the knowledge of what kleptomania is and how to treat it. As Grant states: "Few health care professionals have education or training in kleptomania. In addition, clinicians may have many of the same biases about stealing as do patients." (Grant 335) These biases along with fear of patient confidentiality can sometimes lead to sufferers not reporting their disorder. They may not want to be judged or are paranoid of getting apprehended by law enforcement for their illegal activity. Additionally kleptomania is often associated with depression. People who report incidents of shoplifting also report feeling depressed. Depression could then become the main thing to treat if kleptomania is a symptom of it. Although some state kleptomania should also be treated if it is not mainly set off by depressive moods.

Some researchers explain the behavior brought on by kleptomania can transform into something entirely different. So what began as self-medication of mood can turn to a different focus maintained by another neurobiological mechanism as in the case with addicts. The behavior then turns from self-medication to addiction. The depression, although still existent, becomes separate from the kleptomania that consequently evolves into a main issue, instead of a supplementary one fueled by maintenance of the former (depression).

Treatment

New Treatments

Treatment options for kleptomania are numerous when connected to other more common disorders. Because kleptomania is so rare among people, it is often met with mixed ideas of treatment. An accepted form of treatment for kleptomania besides oral medication is cognitive behavioral therapy. Cognitive behavioral therapy attempts to reprogram the mind through increased self-awareness and restricting or old mindsets.

Cognitive behavioral therapy has been used to treat many disorders, especially depression, making it a suitable option for those seeking help with their kleptomania but refusing to take prescribed medication like Prozac and so forth which will be mentioned later on. An article by Kohn (2002), focuses on using cognitive behavioral therapy on a male patient who suffers from kleptomania along with depression and other mental disorders. The various stages of treatment not only proved effective for the patient in relation to his depression and negative habits, but also helped greatly reduce his kleptomania. "Strategies included covert sensitization, behavioral chaining, problem solving, cognitive restructuring, and use of homework. On completion of treatment, symptoms of depression and kleptomania had decreased significantly." (Kohn 25)

The types of medication often used to treat kleptomania are the same as they use to treat depression. However, a study by Grant et al. reveals memantine, which is an NMDA-receptor antagonist, may be an effective treatment for kleptomania symptoms. The results are promising and reveal an alternative to other medications as it helps treat substance and behavioral addictions. Twelve participants who exhibited kleptomania received memantine daily at a dose of 10mg. The dose increased up to 30mg for participants who showed limited clinical response or tolerability.

Over the course of two months participants were observed and test in an open-label trial with positive results. Kleptomania disease severity scores diminished across all methods measured, and eleven of the twelve participants met the responder standards meaning there were major improvements detected in relation to anxiety (a major catalyst for the disorder), mood, and disability scores along with a major improvement in stop-signal response inhibition. (Grant et al. 106) Along with the positive results, the authors found memantine was usually well accepted as participants had few complications and exhibited little to no side effects. This study demonstrates the efficiency of memantine in decreasing impulses to shoplift along with minimizing shoplifting behavior. The medication also improves impulsivity, anxiety, mood, and psychosocial functioning.

Conventional Treatments

Treatment of kleptomania with fluvoxamine and other serotonin reuptake inhibitors was common practice ten years ago. Older articles show that kleptomania and depression were often lumped together producing treatment for kleptomania that was mainly derived from treatment of depression. Treatment of depression typically means use of Mao inhibitors. These kinds of medication although somewhat effective in relation to depression, were not as effective with kleptomania. Although patients given medications like fluvoxamine noticed some improvement with their anxiety, they impulsive urges to steal were not greatly minimized.

Some articles like that of Lepkifker et al. noticed improvement when administering SSRIs to patients with kleptomania, however, the data from another article by Gupta states these kinds of drugs could cause kleptomania instead of alleviate it. The study by Lepkifker et al. reported five cases of kleptomania patients "who were successfully treated with fluoxetine or paroxetine in combination with a psychotherapeutic intervention. In one case, the discontinuation of the medication repeatedly led to the resurgence of the kleptomanic behavior." (Lepkifker et al. 40) Some even needed to continue medication as symptoms re-emerged after stopping medication. Subjects noticed a change in anxiety levels and improved cognitive function with the addition of regular therapy visits. It is not certain if it was a combination of medication and therapy that helped the patients with kleptomania or if was just the medication alone, but most demonstrated improved function with the SSRIs.

The study continues with the possible connection the syndrome involves a dysfunctional serotoninergic mechanism. Since SSRIs worked so effectively in treating kleptomania, the authors believe the disorder itself could be caused by something either inhibiting or causing an imbalance in serotonin. More research in recent time's reveal that kleptomania, although linked to depression and other disorders, is not necessarily caused by a dysfunctional serotoninergic mechanism and that these medications may exacerbate or develop kleptomania in people.

The study by Gupta showed patients with obsessive compulsive disorder developing kleptomania with an introduction of fluvoxamine 100 mg/day. The girl, twelve years old, after discontinuing the medication stopped stealing and exhibiting other kleptomania symptoms within a week after said discontinuation of medication. Perhaps the dosing may contribute to the side effects of kleptomania as the previous study had much lower doses of 25-50mg/day, whereas in this study, the girl was given more than twice the max dosage.

A study by Kindler reported three cases of depressed patients who unexpectedly experienced kleptomaniac comportment during treatment with SSRIs. (Kindler 126-129) In each of the cases reported, fluvoxamine was the only drug administered and was the only logical cause of the sudden kleptomaniac symptoms which, when medication was ceased disappeared soon thereafter. Moreover no re-emergence of kleptomania symptoms followed as the author followed up one year later and found no evidence of symptoms. Though kleptomania is an infrequent adverse effect with SSRIs, it should be taken into consideration especially when SSRIs are used to treat kleptomaniac symptoms.

Treatment Alternatives

Conventional and recent treatments have been examined through recent and dated literature. In article from 2002 by Grant & Suck reveal yet another alternative to kleptomania treatment. Naltrexone is a medication that can be used for the treatment of kleptomania. In the study by Grant & Suck, ten participants, 70% female were given naltrexone for twelve weeks. Each person was screened to ensure they fulfilled criteria for kleptomania. The difference with this study in comparison to the others was the participants were also screened to make sure they did not suffer from other mental disorders. They were measured and monitored to see if any side effects presented weekly. Every two weeks they were given liver function tests.

Results from the study concluded naltrexone minimized the urge to steal including stealing behavior. "Men responded to naltrexone as well as women. The present findings provide evidence that naltrexone may be effective in the treatment of kleptomania." (Grant & Suck 349) Naltrexone much like SSRIs had positive effects on kleptomania without causing any serious adverse effects unlike the SSRIs. There is limited evidence on using naltrexone for kleptomania as kleptomania is not diagnosed often on its own, more or less it is coupled with other more common disorders. However the article's findings reveal a promising alternative to traditional SSRIs.

Discussion

Treatment options for kleptomania exist and range from medication to cognitive behavioral therapy or both. This paper discussed the use of memantine, SSRIs, and naltrexone to help with kleptomania symptoms such as the urge to steal and stealing behavior. All three were shown to be effective against treating kleptomania with SSRI's revealing adverse effects of causing kleptomania. Some articles pointed to kleptomania resulting from a dysfunction in the brain involving serotonin while others discussed other processes more linked to the mechanisms seen in addiction and substance abuse.