June 24, 2022 • 16 mins
The compulsion to take things you don’t really want or need is three times more common in women than men. Dr. Saltz advises a listener who feels awful about her stealing habit, but doesn’t know how to halt it. The good news: there is a cure.
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Episode Transcript
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Speaker 1 (00:05):
Bees are challenging times, but you don't have to navigate
them alone. Welcome to How Can I Help? I'm doctor
Gale Salt. I'm a clinical Associate Professor of Psychiatry at
the New York Presbyterian Hospital, a psychoanalyst, and best selling author,
and I'm here every week to answer your most pressing questions,
(00:26):
hopefully with understanding, insight and advice. I podcast to you
from New York City, where there are many concerns that
crime is on the rise. Amongst other types of crime
is the rise of theft and robbery. But today I'm
answering a question from a young woman who herself has
(00:50):
been shop lifted and she doesn't really need the items
and is wondering how she keeps doing it. Stealing is stealing,
It's against the law, and if convicted, it comes with
legal punishments. For the most part, we assume if you
are stealing, you are a criminal, and that is that
(01:13):
it's true by definition you are a criminal. What sometimes
what is driving certain behaviors, even criminal behavior, is worth
figuring out because sometimes impulsive and reckless and risky behavior
is part of a psychiatric illness, and treatment rather than jail,
(01:36):
can help change that. Kleptomania is a condition in which
a person experiences a consistent impulse to steal items they
do not need. The things people with kleptomania steel typically
have little value to them, unlike those who steal for
(01:57):
monetary gain, genuine aid, or revenge. The focus of people
with kleptomania is generally not the item itself, but the
act of the theft. They steal for the sake of stealing.
Individuals with kleptomania typically take things they could otherwise have
(02:19):
afforded to buy. Occasionally, an individual will hoard the things
they take, although this is believed to be rare and
appears to be more common among women with the disorder.
Some people even attempt to surreptitiously return the things they take.
(02:41):
While the prevalence of kleptomania in the general population is rare,
occurring about point three to point six percent of all people,
the disorder is three times more common in women than
in then. People with kleptomania generally act alone without help.
(03:02):
Shoplifting is much more common than kleptomania, and it's not
a psychiatric disorder, but it has been estimated that anywhere
from four to twenty four percent of people arrested for
shoplifting do have kleptomania. Arrest does not generally stop people
(03:24):
with kleptomania from stealing. In many cases, the disorder continues
for years, despite multiple arrests and even convictions, leading to legal, family, career,
and personal difficulties. This disorder often starts in childhood or adolescence,
(03:46):
although it can begin in adulthood. The main issue is
impulse control, and so people with kleptomania often have other
impulse controlled disorders. While it does not run in families,
problems with impulse control, like antisocial personality disorder, substance abuse,
(04:10):
or even alternatively obsessive compulsive disorder, can run in the
families of those with kleptomania. According to the d s
M five, the Diagnostic and Statistical Manual of Psychiatry, the
symptoms of kleptomania include a persistent, recurrent impulse to steal
(04:31):
items that are not needed for personal use and do
not bring financial gain, Feelings of increased tension before a theft,
of pleasure, of gratification or relief at the moment of
a theft, and often of guilt, shame, and or remorse
(04:54):
after a theft, and sometimes even of depression. The individual's
thefts are not committed due to delusions or mania or hallucinations,
and are not motivated by revenge or anger, and a
person's thefts cannot be better explained by having antisocial personality disorder,
(05:17):
a conduct disorder, or a manic episode. Kleptomania appears to
be caused in part by disruptions of neurotransmitter pathways in
the brain that are associated with serotonin and dopamine to neurotransmitters,
which can influence aggression and the brain's reward system. Individuals
(05:41):
may also experience and imbalance in the brain's opioid system,
which influences the ability to resist urges. So people with
kleptomania often live with another psychiatric disorder, such as depression
or bipolar disorder, and anxiety to order, even eating disorders,
(06:02):
personality disorders, and substance abuse disorders, particularly alcohol use disorder.
Some clinicians see kleptomania as part of the obsessive compulsive
spectrum of disorders, because many people experience the impulse to
steal as an unwanted, intrusive thought into their mind. In
(06:23):
other words, they get a thought, you have to do this,
you have to take this, and it upsets them. They
don't want to do it, but they feel compelled. Other
evidence suggests kuptomania may be more closely related to, or
be a variant of, a mood disorder like depression. So
with that, right after the break, we'll get to my
(06:46):
listeners question. Welcome back. Let's get to my listeners question
and see how can I help, dear doctor Salts. I
(07:10):
have been carrying around a secret that deeply embarrasses me.
I steal things. I walk into stores and I take stuff,
and honestly, I don't know why. I have taken various
lipsticks that I don't even use. In fact, I've literally
taken the exact same lipstick more than once. I have
(07:34):
taken random stuff like candles, perfumes, even things I would
never use, like a toy, and multiple ones. I just
have these things thrown in a drawer or on a shelf,
and after I do it, I feel horrible. I know
it's stealing, and I know it's wrong, and I'm terrified
(07:58):
of getting caught. But beyond even my fear of getting
caught and in trouble, I feel like a terrible person.
People who know me would be horrified and think I'm
a terrible person if they knew I did this, so
I don't tell anyone, and I feel like I'm walking
around with this terrible secret that makes me a person
(08:21):
with a bad and criminal inside. I tell myself I'll
never do it again, and then at some point I
just feel compelled to do it again, like I just
need to, and I do feel really up when I'm
doing it, and I feel excited, kind of on top
(08:43):
of the world. And then I walk out with my
secret stash. But by the time I get home, the
thrill and satisfaction is gone and replaced with the wish
to crawl in a hole. I swear I won't do
it again, but then I do. It's such a dark
(09:04):
secret that I feel like I can't let anyone know
me too well or they will find out and not
like me. I really don't know what is going on
with me, and I have no idea how to stop this.
I feel like I'm ruining my life. Please help. That
(09:26):
you are not making any money from this, do not
need the objects you take and feel terrible afterwards. Really
does make this sound more like kleptomania. Then the antisocial
behavior of just stealing what you are doing is still
against the law, and even though it sounds like and
(09:48):
may very well be a psychiatric disorder, because you know
that it is wrong, you can still be charged with
and found guilty of theft. If you leave this an treated,
it is likely to continue and may even escalate, increasing
the odds you are arrested and increasing the likelihood that
(10:09):
you're continued. Shame and guilt will evolve into depression. If
you are quite sure that you are not doing this
to make money, nor to harm certain people who you
are taking from, then I urge you to see a
psychiatrist or psychologist who treats impulse control problems. The therapist
(10:33):
should discuss this problem in a non judgmental way. That's
very important, and professionals who work with impulse control problems
know how to do that. They may ask you if
you have had a head trauma of any kind, as
there have been cases of kleptomania brought on by head trauma.
(10:55):
They should also ask you about symptoms of depression, anxiety,
substance use and abuse, and eating disorders, because any of
these other disorders may come along with kleptomania, and they
need to be treated as well as they may be
driving the continued stealing. The issue with this disorder is
(11:17):
that when you steal something and get a rush, that
rush serves as positive reinforcement for the stealing, so it
makes you want to and need to do it again.
The bad feeling that you have later is actually not
inclose enough proximity to serve as a deterrent. So one
(11:42):
goal of treatment is to come up with things you
can do that actually feel lousy to you in the
moment and can be done when you get the urge
to steal, so that you can induce your own negative reinforcement,
which will in the long run decrease the urges you have.
(12:04):
There are other aspects of cognitive behavioral therapy which can help,
and in many cases medication is used. S s R.
Eyes may be used to help with mood and anxiety
that can bring on stealing in the first place, the
stealing being actually a bad coping mechanism to feel better
(12:25):
in the moment. But more commonly used are medications that
are called opioid antagonists that serve to block neurochemicals that
make you feel high or get a rush in the
moment and stop. Therefore, the positive reinforcement you are getting
for stealing this can really help control the illness. The
(12:49):
most important thing is to understand that a brain disorder
is just that, and rather than drowning in shame, seek treatment,
put your life back on path. I hope that was helpful.
Here are a few more thoughts on treating kleptomania. While
(13:11):
the exact path of physiology of kleptomania is unknown, psychoanalytic
theories link compulsive stealing to childhood trauma and neglectful or
abusive parents, and stealing may symbolize repossessing the losses of childhood.
This is something that a therapist can help analyze and
(13:33):
help you uncover if this is at the root of kleptomania.
It's also been linked to psycho sexual issues such as
sexual repression and suppression, another issue that a therapist can
help you understand to relieve symptoms. Neuropsychiatric factors are also
(13:53):
thought to play a role. As I mentioned, the disorder
appears to be highly associated with mood disorders and anxiety
spectrum disorders, and reports kleptomania responding to a selective serotonin
reuptake inhibitors suggest a common path of physiology with mood
and anxiety disorders. In other words, some common wiring and
(14:15):
chemical issues. Kleptomania may also be regarded as a form
of addictive behavior and has been shown to be associated
with other substance use disorders, like particularly alcohol and nicotine. Naltrexone,
which is an opiate antagonist, is used to treat addictive
(14:37):
behaviors and has been shown to reduce cleptomania symptoms. A
double blind, placebo controlled study of twenty five patients who
were administered naltrac zone showed a significant improvement in kleptomania.
Another medication called topiramate, an anticonvulsant drug, has been shown
(15:00):
to be effective in impulse control disorders, and recently, topiramate
demonstrated efficacy in treating binge eating. Again, this has been
extrapolated to kleptomania with encouraging results in small case series.
There are case reports in the literature which document kleptomania
(15:21):
responding to lithium valproate and trazodone. So there are a
couple possibilities that your psychiatrists might try. Clinicians should routinely
inquire about urges to steal during a general psychiatric interview
with all patients. Really, patients with a history of trauma,
(15:42):
head injury, or substance abuse should also particularly be screened
for kleptomania. It's important to approach this disorder in a
non judgmental manner and to reinforce confidentiality due to patient's
fear of legal consequences. Increased awareness and screening by doctors
(16:04):
may increase the number of patients seeking help. People who
suffer from this condition can reasonably expect a reduction and
possibly a total remission of symptoms with a combination of
psychotherapy and psychopharmacology. Do you have a problem I can
help with? If so, email me yet? How can I help?
(16:27):
At Seneca women dot com. All centers remain anonymous and
listen every Friday too. How can I help with me?
Doctor Gale's Salts
Bees are challenging times, but you don't have to navigate
them alone. Welcome to How Can I Help? I'm doctor
Gale Salt. I'm a clinical Associate Professor of Psychiatry at
the New York Presbyterian Hospital, a psychoanalyst, and best selling author,
and I'm here every week to answer your most pressing questions,
(00:26):
hopefully with understanding, insight and advice. I podcast to you
from New York City, where there are many concerns that
crime is on the rise. Amongst other types of crime
is the rise of theft and robbery. But today I'm
answering a question from a young woman who herself has
(00:50):
been shop lifted and she doesn't really need the items
and is wondering how she keeps doing it. Stealing is stealing,
It's against the law, and if convicted, it comes with
legal punishments. For the most part, we assume if you
are stealing, you are a criminal, and that is that
(01:13):
it's true by definition you are a criminal. What sometimes
what is driving certain behaviors, even criminal behavior, is worth
figuring out because sometimes impulsive and reckless and risky behavior
is part of a psychiatric illness, and treatment rather than jail,
(01:36):
can help change that. Kleptomania is a condition in which
a person experiences a consistent impulse to steal items they
do not need. The things people with kleptomania steel typically
have little value to them, unlike those who steal for
(01:57):
monetary gain, genuine aid, or revenge. The focus of people
with kleptomania is generally not the item itself, but the
act of the theft. They steal for the sake of stealing.
Individuals with kleptomania typically take things they could otherwise have
(02:19):
afforded to buy. Occasionally, an individual will hoard the things
they take, although this is believed to be rare and
appears to be more common among women with the disorder.
Some people even attempt to surreptitiously return the things they take.
(02:41):
While the prevalence of kleptomania in the general population is rare,
occurring about point three to point six percent of all people,
the disorder is three times more common in women than
in then. People with kleptomania generally act alone without help.
(03:02):
Shoplifting is much more common than kleptomania, and it's not
a psychiatric disorder, but it has been estimated that anywhere
from four to twenty four percent of people arrested for
shoplifting do have kleptomania. Arrest does not generally stop people
(03:24):
with kleptomania from stealing. In many cases, the disorder continues
for years, despite multiple arrests and even convictions, leading to legal, family, career,
and personal difficulties. This disorder often starts in childhood or adolescence,
(03:46):
although it can begin in adulthood. The main issue is
impulse control, and so people with kleptomania often have other
impulse controlled disorders. While it does not run in families,
problems with impulse control, like antisocial personality disorder, substance abuse,
(04:10):
or even alternatively obsessive compulsive disorder, can run in the
families of those with kleptomania. According to the d s
M five, the Diagnostic and Statistical Manual of Psychiatry, the
symptoms of kleptomania include a persistent, recurrent impulse to steal
(04:31):
items that are not needed for personal use and do
not bring financial gain, Feelings of increased tension before a theft,
of pleasure, of gratification or relief at the moment of
a theft, and often of guilt, shame, and or remorse
(04:54):
after a theft, and sometimes even of depression. The individual's
thefts are not committed due to delusions or mania or hallucinations,
and are not motivated by revenge or anger, and a
person's thefts cannot be better explained by having antisocial personality disorder,
(05:17):
a conduct disorder, or a manic episode. Kleptomania appears to
be caused in part by disruptions of neurotransmitter pathways in
the brain that are associated with serotonin and dopamine to neurotransmitters,
which can influence aggression and the brain's reward system. Individuals
(05:41):
may also experience and imbalance in the brain's opioid system,
which influences the ability to resist urges. So people with
kleptomania often live with another psychiatric disorder, such as depression
or bipolar disorder, and anxiety to order, even eating disorders,
(06:02):
personality disorders, and substance abuse disorders, particularly alcohol use disorder.
Some clinicians see kleptomania as part of the obsessive compulsive
spectrum of disorders, because many people experience the impulse to
steal as an unwanted, intrusive thought into their mind. In
(06:23):
other words, they get a thought, you have to do this,
you have to take this, and it upsets them. They
don't want to do it, but they feel compelled. Other
evidence suggests kuptomania may be more closely related to, or
be a variant of, a mood disorder like depression. So
with that, right after the break, we'll get to my
(06:46):
listeners question. Welcome back. Let's get to my listeners question
and see how can I help, dear doctor Salts. I
(07:10):
have been carrying around a secret that deeply embarrasses me.
I steal things. I walk into stores and I take stuff,
and honestly, I don't know why. I have taken various
lipsticks that I don't even use. In fact, I've literally
taken the exact same lipstick more than once. I have
(07:34):
taken random stuff like candles, perfumes, even things I would
never use, like a toy, and multiple ones. I just
have these things thrown in a drawer or on a shelf,
and after I do it, I feel horrible. I know
it's stealing, and I know it's wrong, and I'm terrified
(07:58):
of getting caught. But beyond even my fear of getting
caught and in trouble, I feel like a terrible person.
People who know me would be horrified and think I'm
a terrible person if they knew I did this, so
I don't tell anyone, and I feel like I'm walking
around with this terrible secret that makes me a person
(08:21):
with a bad and criminal inside. I tell myself I'll
never do it again, and then at some point I
just feel compelled to do it again, like I just
need to, and I do feel really up when I'm
doing it, and I feel excited, kind of on top
(08:43):
of the world. And then I walk out with my
secret stash. But by the time I get home, the
thrill and satisfaction is gone and replaced with the wish
to crawl in a hole. I swear I won't do
it again, but then I do. It's such a dark
(09:04):
secret that I feel like I can't let anyone know
me too well or they will find out and not
like me. I really don't know what is going on
with me, and I have no idea how to stop this.
I feel like I'm ruining my life. Please help. That
(09:26):
you are not making any money from this, do not
need the objects you take and feel terrible afterwards. Really
does make this sound more like kleptomania. Then the antisocial
behavior of just stealing what you are doing is still
against the law, and even though it sounds like and
(09:48):
may very well be a psychiatric disorder, because you know
that it is wrong, you can still be charged with
and found guilty of theft. If you leave this an treated,
it is likely to continue and may even escalate, increasing
the odds you are arrested and increasing the likelihood that
(10:09):
you're continued. Shame and guilt will evolve into depression. If
you are quite sure that you are not doing this
to make money, nor to harm certain people who you
are taking from, then I urge you to see a
psychiatrist or psychologist who treats impulse control problems. The therapist
(10:33):
should discuss this problem in a non judgmental way. That's
very important, and professionals who work with impulse control problems
know how to do that. They may ask you if
you have had a head trauma of any kind, as
there have been cases of kleptomania brought on by head trauma.
(10:55):
They should also ask you about symptoms of depression, anxiety,
substance use and abuse, and eating disorders, because any of
these other disorders may come along with kleptomania, and they
need to be treated as well as they may be
driving the continued stealing. The issue with this disorder is
(11:17):
that when you steal something and get a rush, that
rush serves as positive reinforcement for the stealing, so it
makes you want to and need to do it again.
The bad feeling that you have later is actually not
inclose enough proximity to serve as a deterrent. So one
(11:42):
goal of treatment is to come up with things you
can do that actually feel lousy to you in the
moment and can be done when you get the urge
to steal, so that you can induce your own negative reinforcement,
which will in the long run decrease the urges you have.
(12:04):
There are other aspects of cognitive behavioral therapy which can help,
and in many cases medication is used. S s R.
Eyes may be used to help with mood and anxiety
that can bring on stealing in the first place, the
stealing being actually a bad coping mechanism to feel better
(12:25):
in the moment. But more commonly used are medications that
are called opioid antagonists that serve to block neurochemicals that
make you feel high or get a rush in the
moment and stop. Therefore, the positive reinforcement you are getting
for stealing this can really help control the illness. The
(12:49):
most important thing is to understand that a brain disorder
is just that, and rather than drowning in shame, seek treatment,
put your life back on path. I hope that was helpful.
Here are a few more thoughts on treating kleptomania. While
(13:11):
the exact path of physiology of kleptomania is unknown, psychoanalytic
theories link compulsive stealing to childhood trauma and neglectful or
abusive parents, and stealing may symbolize repossessing the losses of childhood.
This is something that a therapist can help analyze and
(13:33):
help you uncover if this is at the root of kleptomania.
It's also been linked to psycho sexual issues such as
sexual repression and suppression, another issue that a therapist can
help you understand to relieve symptoms. Neuropsychiatric factors are also
(13:53):
thought to play a role. As I mentioned, the disorder
appears to be highly associated with mood disorders and anxiety
spectrum disorders, and reports kleptomania responding to a selective serotonin
reuptake inhibitors suggest a common path of physiology with mood
and anxiety disorders. In other words, some common wiring and
(14:15):
chemical issues. Kleptomania may also be regarded as a form
of addictive behavior and has been shown to be associated
with other substance use disorders, like particularly alcohol and nicotine. Naltrexone,
which is an opiate antagonist, is used to treat addictive
(14:37):
behaviors and has been shown to reduce cleptomania symptoms. A
double blind, placebo controlled study of twenty five patients who
were administered naltrac zone showed a significant improvement in kleptomania.
Another medication called topiramate, an anticonvulsant drug, has been shown
(15:00):
to be effective in impulse control disorders, and recently, topiramate
demonstrated efficacy in treating binge eating. Again, this has been
extrapolated to kleptomania with encouraging results in small case series.
There are case reports in the literature which document kleptomania
(15:21):
responding to lithium valproate and trazodone. So there are a
couple possibilities that your psychiatrists might try. Clinicians should routinely
inquire about urges to steal during a general psychiatric interview
with all patients. Really, patients with a history of trauma,
(15:42):
head injury, or substance abuse should also particularly be screened
for kleptomania. It's important to approach this disorder in a
non judgmental manner and to reinforce confidentiality due to patient's
fear of legal consequences. Increased awareness and screening by doctors
(16:04):
may increase the number of patients seeking help. People who
suffer from this condition can reasonably expect a reduction and
possibly a total remission of symptoms with a combination of
psychotherapy and psychopharmacology. Do you have a problem I can
help with? If so, email me yet? How can I help?
(16:27):
At Seneca women dot com. All centers remain anonymous and
listen every Friday too. How can I help with me?
Doctor Gale's Salts
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