Kleptomania is pathological stealing. By “pathological” we mean something that goes against the person’s intentions, even though it consists of a voluntary behavior that is, in fact, consciously desired and carried out. The capacity to act voluntarily is not impaired; rather, it is the ability to want not to act that is impaired. In other words, the ability to control the urge to engage in certain actions is overwhelmed.
The fact that the stealing is unintentional can also be inferred from the disproportion between the number of thefts and the risk involved, as well as the value or choice of the objects stolen. The kleptomaniac is focused on the act of taking, on appropriating something without paying, on “getting one over on” whoever is in charge of security, while the usefulness of what is taken is incidental. The kleptomaniac may also adapt to stealing whatever is available, and may even throw away the stolen items afterward in order to avoid trouble once the act has been committed.
Kleptomania may emerge as one aspect of an otherwise definable psychiatric disorder; more rarely, it is the only type of psychiatric manifestation throughout the lifetime of the person affected.
As has happened, without sufficient basis, with many other psychiatric conditions, for a long time kleptomania was systematically addressed either through surveillance and educational interventions or through supposed psychological treatments and sessions aimed at interpreting a hypothetical underlying distress as the cause of the urge to steal.
Because the phenomenon involves a recurrent urge to perform an act, associated with a sense of satisfaction and pleasure during the act, it was thought appropriate to try a treatment that also works in other “addictions,” that is, situations involving recurrent loss of control over the urge to engage in behaviors experienced as rewarding.
To date, treatment with opioid antagonists (naltrexone) has demonstrated a certain degree of usefulness under controlled conditions. Specifically, data are available from a small group of patients followed for three years, of whom approximately half had “stopped” stealing, or at least reported doing so anonymously, while about three out of four nevertheless experienced a reduction, at least partial, in theft episodes, including the legal consequences of individual incidents. Data of this kind are important because they provide an indication of an effect that may be stable over time or may even increase progressively.
People who have experienced legal problems because of kleptomania-related thefts should therefore know that a therapeutic approach can be proposed as part of their defense, and that such an approach is not merely speculative but is supported by scientific evidence.
The mechanism through which the treatment works could be of two types. The drug may be able to inhibit the escalation of the initial impulse, the excitement associated with stealing. It may also maintain the mental balance between the urge to steal and the emotional perception of risk in favor of the latter, thereby keeping awareness of the anxiety associated with the consequences alive.
When committing the act, the kleptomaniac is often as though “taken over” by an impulse that also enables them to behave in a seemingly casual manner, as if absent or dissociated, without experiencing embarrassment, anxiety, or shame. Maintaining these emotions instead, without allowing them to be obscured, could underlie the pharmacological “brake” produced by naltrexone.
One possible side effect of treatment is a lack of gratification, which anyone accustomed to a particular outlet may experience. A person who overcomes the addiction is happy about it, but may initially also find themselves facing a certain “void” of pleasure.
Grant JE. Understanding and treating kleptomania: new models and new treatments. Isr J Psychiatry Relat Sci; 43, 2: 81–87.
Grant JE. Outcome study of kleptomania patients treated with naltrexone. A chart review. Clin Neuropharmacol 2005; 28: 11–14.