IF SYMPTOMS PERSIST  Dr. Jose Pujalte, Jr. “Thou shalt not steal.” – Exodus 20:15, The Holy Bible Let’s make it clear that indubitable, text book kleptomania (Greek for “craze for stealing”) is rare. We seem to have this habit of calling everyone and anyone who steals a “klepto.” But this is irresponsible. Neither politicians/government officials who steal nor shoplifting teenagers are kleptomaniacs. And while the legal consequence of being caught stealing is the same for all thieves, the motive of a kleptomaniac is gratification in the act of stealing, not for economic benefit. Obsessive-Compulsive Disorder. Kleptomania is also known as “compulsive theft behavior disorder” or simply “pathological stealing.” It is a manifestation of a larger psychiatric entity called obsessive-compulsive disorder. We all have our little rituals, superstitions, and daily habits. These are normal “adjustments” to make our lives familiar and manageable, even pleasurable. But there’s a limit. Once these behaviors become uncontrollable and seem to take over one’s thoughts, feelings – one’s life in fact, there is reason to suspect a brain malfunction called obsessive-compulsive disorder (OCD). It is NOT a person’s fault OR the result of a weak, spineless, unstable personality. Investigators are proving that in OCD, information processing in the brain suffers as the communication between parts of the brain (cortex and basal ganglia) fails. Serotonin, a neurotransmitter or chemical messenger in the brain, is insufficient in OCD patients. Obsessions are “thoughts, images, impulses” that occur over and over to a point that the person feels out of control. What’s significant is that there is recognition that these obsessions are a nuisance and do not make sense. Consequently, the person is disturbed and overwhelmed. Compulsions are intimately connected to obsessions because these are the acts performed to make obsessions go away. Criteria. The Diagnostic and Statistical Manual of Mental Disorders, the bible of mental health professionals, states that the symptoms of kleptomania are

• Recurrent failure to resist impulses to steal objects that are not needed for personal use or for their monetary value.
• Increasing sense of tension immediately before committing the theft.
• Pleasure, gratification, or relief at the time of committing the theft.
• Stealing is not committed to express anger or vengeance and is not in response to a delusion or hallucination.

Obviously, most thieves don’t exhibit any of these. In fact, just after a handcuffed thief in the police precinct is lynched by his victims, he usually says, “I was hungry” or “My son is sick,” and so on. There is always a motive for stealing. Indeed, the alternative list for kleptomania starts with criminal behavior. Malingering is pretending to have kleptomania when arrested for theft but that’s very hard to prove when you’ve been caught stealing motorcyles and not underwear. Shoplifters, usually teenagers, will admit that peers had dared them. Professional shoplifters, the ones with passport pictures posted on store walls, do it for profit. None of them are kleptomaniacs. Treatment. While family members and loved ones can form a strong support group, it is necessary to see a psychologist or a psychiatrist. Two effective treatments have evolved: CBT or cognitive-behavioral psychotherapy and medication with SRIs or serotonin reuptake inhibitors. In the acute treatment phase, the therapist aims to end a current episode of OCD. In the maintenance phase, the goal is to prevent or minimize further OCD occurrences. These may be accomplished through education (of both patient and family members), psychotherapy, and medication. Some examples of these drugs are fluoxetine, sertraline, and paroxetine. OCD is a waxing and waning disorder and so response to treatment may be hard to gauge. However, patients are kept on medication for at least one year and if OCD episodes are noted to be few and far between, the medicine is tapered off. Now that we know the strict criteria for kleptomania, all others are just plain thieves. Dr. Pujalte is an orthopedic surgeon. E-mail: [email protected]