Kleptomania

What Causes Kleptomania?

Doctors and researchers have not yet determined the precise cause of kleptomania, but they have identified several risk factors that increase an individual’s likelihood of developing the disorder.

• Genetic Predisposition. Having a parent, sibling, or child who has been diagnosed with kleptomania or a substance use disorder increases the chance that you will also be diagnosed with the condition.
• Neurological Causes. People with impulse control disorders often have low levels of the neurotransmitter chemical serotonin. Kleptomania may also be related to the release of dopamine, a brain chemical that causes feelings of pleasure. Dopamine is often associated with addictive behaviors, and it may play a role in kleptomania as well.
• Age. Kleptomania usually develops in late adolescence or early adulthood.
• Sex. Women account for about two-thirds of diagnosed kleptomania cases.
• Mental illness. People with kleptomania often have at least one other co-existing mental illness.

Is Kleptomania Hereditary?

Studies of people with kleptomania suggest that those with a close relative who also has the disorder are at increased risk. However, no definite association between the disorder and a gene (or genes) has been established by scientists to date.

How Is Kleptomania Detected?

Kleptomania usually emerges in adolescence, but the behaviors can first appear either earlier in childhood or at any time during adulthood. Early detection is essential to avoid the social and legal consequences of continued problematic behavior.

Warning signs of kleptomania include:

• Strong urges to steal items you don’t need or that have little value
• Intrusive thoughts about stealing
• Intense pleasurable feeling while stealing
• Remorse, stress, shame, or fear after stealing

How Is Kleptomania Diagnosed?

To diagnose kleptomania, a doctor will first rule out other potential medical causes of the symptoms. If the symptoms seem to meet the diagnostic criteria for kleptomania, the patient will likely be referred to a mental health professional for further assessment.

Diagnostic steps may include:

• A physical exam. This exam will rule out physical conditions that could be causing the symptoms.
• Blood tests. These tests will look at the patient’s blood chemistry for issues such as thyroid function. Screenings for drugs and alcohol may also be conducted to rule out symptoms caused by substance abuse.
• Psychological assessments. These assessments may take the form of questionnaires or talk sessions with a mental health professional to assess the patient’s mood, mental state, and mental health history. Family members or caregivers may also be asked to participate in these assessments.

The results of the psychological assessments will be compared to the diagnostic criteria for kleptomania in the Diagnostic and Statistical Manual of Mental Disorders. Comparing these criteria will help a mental health professional decide whether the symptoms indicate kleptomania or another psychiatric problem (obsessive-compulsive personality disorder, anxiety disorders, or depression).

The diagnostic criteria for kleptomania include:

• Recurrent urges to steal items that have no value (financial or otherwise) to the patient
• Feelings of tension before stealing, pleasure while stealing, and remorse, guilt, or shame after stealing
• Stealing is not motivated by anger, revenge, or hallucinations
• Stealing behavior isn’t better explained by antisocial personality disorder, conduct disorder, or mania

How Is Kleptomania Treated?

Kleptomania currently has no cure, but a combination of medications and psychotherapy may effectively reduce the severity of symptoms in many patients.

Medication

Several different medications may be used to treat and manage the symptoms of kleptomania, and individual medication plans depend on the patient’s responsiveness to treatments and the severity of their symptoms.

• Antidepressants. Serotonin reuptake inhibitors (SSRIs) may be used to treat kleptomania.
• Opioid receptor antagonists. Naltrexone, a medication used to treat substance use disorders, has effectively treated some cases of kleptomania.
• Other Medications. Mood stabilizing drugs such as lithium, an Alzheimer’s drug called memantine, and anti-convulsant medications have all been proposed to treat kleptomania.

Psychotherapy

The most commonly used therapeutic approach is cognitive-behavioral therapy (CBT). This process focuses on helping the patient identify a pattern of harmful thoughts and construct strategies and solutions for dealing with them that don’t interfere with functionality.

Other types of therapy sometimes used to treat kleptomania include covert sensitization, aversion therapy, and systematic desensitization.

How Does Kleptomania Progress?

When untreated, kleptomania can produce severe, potentially life-threatening complications. Aside from the possible social, legal, and financial consequences of stealing, the disorder often leads to other serious mental illnesses.

Possible long-term complications of kleptomania include:

• Arrest and/or incarceration
• Disruption of relationships
• Loss of employment or financial consequences
• Exposure to violence caused by stealing behavior
• Depression
• Substance abuse
• Suicidal thoughts or suicide attempts

How Is Kleptomania Prevented?

Kleptomania cannot be prevented, but early diagnosis and a consistent treatment plan can help manage symptoms and prevent them from becoming as disruptive as they would be if they were left untreated. Therefore, it’s essential for those diagnosed with kleptomania to seek regular evaluation from their mental health providers and stick to any prescribed medication plan.

Kleptomania Caregiver Tips

Many people with kleptomania also suffer from other brain and mental health-related issues, a situation called co-morbidity. Here are a few of the disorders commonly associated with kleptomania:

• Many people with kleptomania also suffer from mood disorders such as depression.
• Kleptomania is sometimes associated with bipolar disorder.
• Many people with kleptomania also have other impulse control disorders, such as gambling disorder, intermittent explosive disorder, or trichotillomania.
• People with kleptomania are at increased risk of suicide, tobacco addiction, and substance use disorders.
• Personality disorders such as antisocial personality disorder are more common in people with kleptomania.

Kleptomania Brain Science

Researchers have searched for the brain chemicals that may be responsible for stealing behaviors in people with kleptomania. The two prime suspects are serotonin, a brain chemical essential for regulating mood, and dopamine, which produces feelings of pleasure when released in the brain. Scientists have not yet determined precisely how either of these chemicals might work to create the behaviors, but some suspect that a complex interaction of both might be responsible.

Some studies have suggested that low serotonin levels might cause restlessness and impulsivity, both of which are key components of stealing behaviors in kleptomania.

Impulse-control behaviors, such as compulsive gambling, shopping, or eating, have also been observed in Parkinson’s disease patients who are taking drugs that increase their dopamine levels. 

In some ways, kleptomania resembles substance abuse disorders, which are driven by the dopamine response. Over time, some addictive substances decrease the user’s response to dopamine, motivating them to use the substance more often to achieve the same effect. Some scientists believe that a similar process might be at play in kleptomania.

Kleptomania Research

Title: Serotonin in Impulse Control Disorders in Parkinson’s Disease (Park-IMPULSE)

Stage: Recruiting

Principal investigator: Stéphane Thosbois, PhD

Hospices Civils de Lyon

Bron, France

Impulse control disorders are frequent and troublesome in patients with Parkinson’s disease. However, the cerebral functional alterations related to impulse control disorders in Parkinson’s disease are poorly understood and may involve the serotoninergic system besides alterations in the dopaminergic system.

The primary objective of this study is to investigate the cerebral functional alterations in the serotoninergic system in patients with Parkinson’s disease and impulse control disorders using Positron Emission Tomography with highly specific radiotracers of serotonin transporter (SERT) using [11 Carbon]-3-amino-4-(2-dimethylaminomethylphenylsulfanyl)-benzonitrile ([11C]-DASB) and of serotonin 5-Hydroxytryptamine 2A (5-HT2A) receptor using [18 Fluorine]-altanserin ([18F]-altanserin), in comparison to patients with Parkinson’s disease without impulse control disorders and healthy volunteers.

Title: Randomized Placebo-Controlled Trial Evaluating the Efficacy of Pimavanserin, a Selective Serotonin 5-HydroxyTryptamine-2A (5HT2A) Inverse Agonist, to Treat Impulse Control Disorders in Parkinson’s Disease. (PIMPARK)

Stage: Recruiting

Contact: Mathieu Anheim, MD

CHU de Strasbourg

Strasbourg, France

There is no consensus on the treatment of Impulse Control Disorder (ICD) in Parkinson’s Disease (PD) though it is recommended to reduce the dosage of dopamine agonists (DA).

Reduction of DA frequently leads to a worsening of motor signs (parkinsonism or dyskinesias due to the concomitant increase of levodopa doses) and non-motor signs with the appearance of a DA withdrawal syndrome (DAWS).

Chronic stimulation of the sub-thalamic nuclei may reduce ICD but is restricted to a minority of patients, and cases of new-onset ICD symptoms post-stimulation have been reported. The benefit of amantadine in pathological gambling is controversial, and the efficacy of clozapine has been reported in a few cases but with serious safety limitations. Very recently, naltrexone did not significantly improve ICD.

Thus, an efficacious and safe treatment of ICD in PD remains an unmet need for clinical practice.

Recently, it has been reported that pimavanserin, a selective serotonin 5-HT2A inverse agonist with a satisfactory safety profile without motor side effects, was efficient in improving psychosis, insomnia, and day-time sleep in PD.

Pimavanserin, marketed under the tradename NUPLAZID®, was approved in 2016 by the U.S. Food and Drug Administration (FDA) for the treatment of hallucinations and delusions associated with Parkinson’s disease psychosis.

The link between serotonin and ICD has been well established, since the enhancement of 5HT2A receptors stimulation is associated with ICD, since serotonin modulates mesolimbic dopaminergic reward system transmission, and given that serotonin neurotransmission is increased during chronic intake of dopamine agonist such as pramipexole which is well-known to induce ICD in PD patients. Thus, a large body of evidence suggests that the decrease of the 5HT2A activity could be efficient in reducing ICD in PD. This further supports the concept of testing the efficacy of pimavanserin (a selective 5HT2A inverse agonist) for treating ICD in PD. The researchers aim to conduct a study evaluating the efficacy and safety of pimavanserin on ICD in PD.

Title: Clinical Response of Impulsivity After Brain Stimulation in Parkinson’s Disease (CRIPS)

Stage: Not Yet Recruiting

King’s College London

London, UK

The study will record outcomes related to ICBs for PD patients who have already been selected for DBS therapy as a routine clinical treatment in participating in DBS operating center.

It is routine practice to assess ICBs before DBS decisions are made, but the manner varies across DBS operating centers. The only additional factor to the routine DBS clinical pathway in this study is that the centers involved will perform assessments in a uniform manner to allow data to be combined. A unified set of clinical assessment scales for Impulsive Control Disorders ICDs and ICBs, as well as other relevant neuropsychiatric symptom assessments, will be added to routine pre- and post-operational clinical assessments for participants.

The study’s primary endpoint is the change in the severity of ICBs. If subjects score above 1 in any of the given questions on QUIP-RS, or if subjects had a disagreement with carers regarding scores, The Parkinson’s Impulse-Control Scale, PICs will be triggered. Our trained research fellow (AA) will then administer PICs over the phone or in the clinic.