Behavioral Addictions _ _______________________________________________________________________
increased rates of kleptomania in patients with depression (3.7%), alcohol use disorder (3.8%), and gambling disorder (2.1% to 5%) [340; 343]. Most kleptomania studies report female predominance. How- ever, women are more likely to seek professional help, and the legal system is more likely to send female shoplifters for psychiatric evaluation and male shoplifters to jail [340]. So, the true prevalences in men and women may be more similar than reported. Among 101 adults meeting DSM-IV kleptomania criteria (73.3% female), the mean age of shoplifting onset was 19.4 years, persisting an average 8.2 years before full diagnostic criteria were met [344]. CLINICAL CHARACTERISTICS AND ILLNESS COURSE The average age for stealing behavior onset is adolescence, with the first professional evaluation in the mid- to late-30s. Women tend to present for evaluation at a younger age than men. The extended length of time between onset and mental health evaluation reinforces the guilt, shame, and secrecy involved in this disorder [340]. Little data are available on the natural history of kleptomania, but three patterns have been described [11]: • Sporadic: Brief episodes of kleptomanic behavior punc- tuating long periods of remission • Episodic: Relatively equal, protracted periods of klepto- manic behavior alternating with remission • Chronic: Long-term kleptomania with some degree of fluctuation in the behavior Up to 68.2% of individuals report the value of stolen items increases over time, suggesting tolerance. Most persons with kleptomania unsuccessfully attempt to stop stealing; these failed efforts contribute to feelings of shame and guilt [340]. A study of persons interviewed after apprehension for theft found that shoplifters and kleptomaniacs differed by mean age (27 years vs. 41 years) and male proportion (58% vs. 32.4%). Approximately 20% had not stolen for personal use and had discarded the object. Both groups reported the same level of impulsivity and “a feeling of not being oneself,” but those with kleptomania reported a greater number of thefts than shoplift- ers, reflecting the compulsive aspect of the disorder [341; 345]. Consequences One study found 24% of persons with kleptomania had attempted suicide, of which 92% attributed the attempt to kleptomania itself [341]. Suicide attempts were associated with comorbid bipolar disorder, other impulse control dis- orders, and personality disorders (especially borderline and narcissistic). These syndromes share neurobiologic deficits in executive function that also typify kleptomania. Unlike earlier studies, anxiety, depression, and substance use disorders did not correlate with increased risk of suicide attempt. Data on suicides were not included, and this group may have been
A Cochrane Review found that insufficient evidence from meta-analysis to confirm or refute the efficacy of any agent or class of medication for the treatment of trichotillomania in adults, children, or adolescents. Preliminary evidence
suggests there may be beneficial treatment effects for N -acetylcysteine, clomipramine, and olanzapine in adults based on four trials, albeit with relatively small sample sizes. (https://www.cochranelibrary.com/cdsr/ doi/10.1002/14651858.CD007662.pub2/full. Last accessed April 19, 2024.) Level of Evidence : Meta-Analysis
KLEPTOMANIA (COMPULSIVE STEALING) Kleptomania is characterized by repetitive stealing behavior and is associated with severe adverse outcomes, including incarceration and increased rates of suicidal behavior [339]. Persons with kleptomania differ from ordinary shoplifters because their stealing is motivated by symptom relief and not personal gain [340]. Persons with kleptomania mostly steal from stores, usually items of little value, and then discard, hoard, secretly return, or give the items away. The urge to steal may be resisted when immediate arrest is likely, but the odds of apprehension are usually not fully considered. The exhilaration, gratification, or relief experienced during the theft is short-lived, followed by feelings of guilt, remorse, or depression [340].
EPIDEMIOLOGY, RISK FACTORS, AND COMORBIDITY
The commonly quoted kleptomania prevalence of 0.6% in the general population was extrapolated from study data of patients with eating disorders [341]. A 2010 college student survey found a lower kleptomania prevalence rate of 0.38% [342]. This latter figure is likely more accurate because it was not derived from a specific subpopulation [341]. Among those arrested for shoplifting, kleptomania rates have ranged from 0% to 8%. This may be falsely low due to incomplete psychiat- ric evaluation, lack of strict diagnostic criteria for kleptomania, and/or selection bias [340]. In contrast to community prevalence rates, studies of patients with psychiatric disorders suggest prevalence rates of kleptoma- nia sufficient to potentially represent a public health concern. Among 203 inpatients with diverse psychiatric disorders, 7.8% met current and 9.3% met lifetime criteria for a diagnosis for kleptomania. The similar current and lifetime prevalence sug- gests that untreated kleptomania is chronic. Other studies show
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