Although kleptomania, the irresistible impulse to steal objects not needed for personal use or for their monetary value, is currently classified in psychiatric nomenclature as an impulse control disorder, research suggests it is, rather, a variant of obsessive-compulsive disorder. The principle effects of the theft are repetitive, unwanted intrusions of thoughts, and an inability to avoid the compulsion to perform the theft, and the relief of tension following the act. Comparison of both disorders, their comorbidity with other psychiatric disorders, and the treatment used to reduce and eliminate symptoms may have a baring on the “correct” classification.
Kleptomania, listed in the DSM-IV as an impulse control disorder not elsewhere classified, is a psychiatric condition still poorly understood and subject of only a few systematic studies. Kleptomania is characterized by the persistent impossibility to resist the drive to steal objects. Kleptomania should be distinguished from shoplifting, in which the action is usually well-planned and motivated by need or monetary gain. Often a kleptomaniac steals things he or she could have easily bought or things that are not expensive. The objects stolen are not stolen for their immediate utility or monetary value; on the contrary, the person will most likely discard them, give them away, or collect them. This behavior is usually associated with a sense of satisfaction during and immediately after its accomplished. Stealing is not done to express anger or vengeance nor is it a response to delirium or hallucination. Most patients with this disorder seem to be women; their mean age is about 36 and their mean duration of illness is roughly 16 years.
Some individuals report the onset of kleptomania as early as age five, but on average, it seems to appear around adolescence and early adulthood.
Since the thefts of the kleptomanic person cannot be explained by Antisocial Personality Disorder, Conduct Disorder, or a Manic Episode and involve the inability to control ones impulse to steal, it is classified as an impulse control disorder. The core feature of ICDs is the repeated expression of impulsive acts that lead to physical or financial damage to the individual or another person. Since kleptomania represents this quality and shares the three characteristics of impulse control disorders one would easily agree with this classification. This being a failure to resist an impulse or temptation to perform some act, although they know the act is considered wrong by society or is harmful to them, experiencing tension or arousal before the act, and after committing the act there is a sense of excitement, gratification, or release that is felt.
By definition, obsessive-compulsive disorder is closely linked to kleptomania. The two-part disorder contains obsessions, which are intrusive, repetitive thoughts or images that produce anxiety, and compulsions, which is the need to perform acts or to dwell on thoughts to reduce anxiety. Obsessions can be broken down into two distinct subtypes. One being, autogenous obsessions, which tend to come abruptly into consciousness without identifiable evoking stimuli, which are perceived as ego-dystonic (considering the thoughts and actions alien and not subject to his or her voluntary control) and aversive enough to be repelled, and include sexual, aggressive, and immoral thoughts or impulses. On the other hand, reactive obsessions are evoked by identifiable external stimuli, which are perceived as relatively realistic and rational enough to do something toward the stimuli, and include thoughts about contamination, mistake, accident, asymmetry, loss, etc. Some clinicians view kleptomania as part of the obsessive-compulsive spectrum of disorders, reasoning that many individuals experience the impulse to steal as ego-dystonic. For example, Dannon believed that pathological stealing resembled OCD in the experience of tension before the act and feature of a struggle to oppose the drive.
Taking a psychodynamic perspective of both obsessive-compulsive disorder and kleptomania, there is reason to derive a strong correlation between the two. For instance, the psychodynamic perspective suggests that obsessive-compulsive behaviors are attempts to fend off anal sadistic (antisocial), anal libidinous (pleasure soiling), and genital (masturbatory) impulses. A review of a case report of a woman, G.Z., who had kleptomania and only experienced orgasm when apprehended for stealing and the feelings of “shoplifting whenever levels of internal tension increased”, suggests that kleptomania may be more closely linked to OCD. Fenichel reported the case of a woman who obtained a sexual thrill from shoplifting, to the point of orgasm, and had fantasies of shoplifting while masturbating. Abraham also reports that the stealing of a kleptomaniac represented doing a “forbidden thing secretly” such as masturbation. Holding the psychoanalytic perspective that these behaviors are a reflection of unconscious ego defenses against anxiety, forbidden instincts or wishes, unresolved conflicts or prohibited sexual drives, fear of castration, sexual arousal, sexual gratification and orgasm during the act of stealing, kleptomania would be classified as an obsessive-compulsive disorder.
Another correlational aspect linking kleptomania to OCD is seen in the biological perspective on obsessive-compulsive disorders, which bases assumptions on data relating to brain structure, genetic studies and biological chemical abnormalities. Recent preliminary studies of the brain using magnetic resonance imaging showed that the subjects with OCD had significantly less white matter than did normal control subjects, suggesting a widely distributed brain abnormality associated with OCD. Researchers hypothesize that OCD is a result of serotonin deficiency. The use of selective serotonin reuptake inhibitors both with patients suffering from OCD and in patients with kleptomania is a key link to the relationship between the two. For example, fluoxetine has been used in both treatment for OCD and also for kleptomania. The use of fluoxetine (a medication that increases the activity level of serotonin) reported that the cerebral blood flow to the frontal lobes was decreased to values found in individuals without the disorder and patients with obsessive-compulsive disorder reported a reduction in symptoms. Dannon states that biological etiology stems from different levels of serotonin in the brain synapses, which leads to many psychiatric disorders.
