Cleptomania – “Pathological stealing”
Kleptomania and pathological stealing. By pathological we mean what goes against the intentions of the person, even if it consists in a voluntary behavior, and indeed desired and carried out with lucidity. The ability to want is not compromised, but the ability to want-than-not. In other words, the control over the desire to commit certain actions, which takes over.
The fact that it is an unintentional stealing is also derived from the unbalanced relationship between the number of thefts and the risk and value or choice of the objects to be stolen. The kleptomaniac is concentrated on the act of subtraction, on appropriating without paying, on “cheating” whoever controls, while the utility of what he subtracts is incidental. The kleptomaniache also adapts to stealing what he finds, and it can happen that he throws away the stolen stuff to avoid problems, once the deed is done.
Kleptomania may be an emerging aspect of an otherwise definable psychiatric disorder, more rarely it is the only type of psychiatric manifestation in the life course of the sufferer.
Unfoundedly, as for many other psychiatric pictures, for a long time it was systematically treated either with surveillance and education interventions, or with alleged psychological treatments or sessions of interpretation of a hypothetical discomfort underlying the desire to steal.
Since the phenomenon is that of a recurrent urge to perform an act, associated with a sense of satisfaction and pleasure during the act, it was decided to try a treatment that also works in other “addictions”, or situations of recurrent loss of control over the desire to perform acts that are experienced as gratifying.
To date, treatment with opioid antagonists (naltrexone) has shown some degree of usefulness in a controlled manner. In detail, there are data on a small group of patients followed for three years, of which about half have “stopped” stealing, or at least so they report anonymously, and about 3 out of 4 have in any case had a reduction, at least partially , of the theft incidents, including the legal consequences of the individual incidents. Data of this type are important, because they give the idea of a stable or progressive effect over time.
People who have had legal problems due to kleptomanic theft should know that for their own defense a therapeutic solution is therefore possible, which is not only blindly, but based on scientific data.
The mechanism by which the cure works could be of two kinds. The drug is able to block the growth of the starting impulse, the excitement towards theft. Furthermore, it can maintain the mental balance between the urge to steal and the emotional perception of risk in favor of the latter, and thus keep the anxiety of the consequences alive.
The kleptomaniac often when he performs the act and as “taken” by a push that also makes him able to behave casually, as if he were absent, dissociated, did not feel embarrassment, anxiety and shame. On the other hand, maintaining this type of emotion without allowing it to be obscured could be the basis of the pharmacological “brake” created with naltrexone.
A collateral aspect of the treatment is that of the lack of gratification that anyone, accustomed to an outburst, can perceive. Those who resolve the addiction are happy with it, but may at first also find themselves with a “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.
