You just tried on a silky soft $200 cashmere sweater in a department store and decide to buy it, so you head toward the checkout counter to pay. Passing by a display of $5 socks, you grab a pair and stuff them in your purse. Your heart pounds with excitement.
Later, standing on the sidewalk, you shake your head in bafflement. You could easily have paid for the socks along with the sweater, but something made you steal them. It was wrong, risky and made no sense, yet you couldn't help yourself.
Jon Grant has met scores of people like this in his clinical practice as a psychiatrist at the University of Minnesota. Their compulsive behavior fits the clinical definition of kleptomania.
"People suffer a lot from it," Grant says. "They don't want to do it. They fear the legal repercussions it might have. Morally, they feel this is the wrong thing to do, yet they get a rush from it, and it's very enticing."
As a leading expert on impulse-control disorders (including pathological gambling, pyromania, uncontrollable shopping and compulsive sexual behavior), Grant saw that they shared much in common with what are usually labeled addictions or chemical dependencies, and many had relatives with addictions.
That led him to theorize that they might be treated with the same medications used to provide some relief to addicts.
In a paper recently published in Biological Psychiatry, Grant and collaborators Suck Won Kim and Brian Odlaug reported that they had successfully used naltrexone, a drug that binds to the brain's opioid receptors, to alleviate the compulsion to steal in the majority of people they tested.
From 2006 to 2008, the team recruited kleptomaniacs through fliers and referrals from family practitioners. Potential subjects were told only that they were involved in the "investigational use of a medication."
A total of 25 men and women were enrolled in a randomized, double-blind drug trial in which about half received naltrexone and the other half a placebo. Before they began the drug trial, on average, the respondents reported having spent 47 minutes a week shoplifting, and an additional 114 minutes a week struggling with the urge to steal. Twenty-three of the 25 had been arrested at least once for stealing.
"People were told after the study was over we would refer them to counselors and therapists," Grant said. During the eight-week trial, everyone came in every two weeks for blood tests (administered in part to make sure there was no liver toxicity from the naltrexone). The subjects were interviewed about their behavior and also filled out a self-report form.
According to the paper, "A Double-Blind, Placebo-Controlled Study of the Opiate Antagonist, Naltrexone, in the Treatment of Kleptomania," eight people treated with naltrexone saw remission of their symptoms, compared with one on the placebo. Three of the 12 subjects who were given naltrexone failed to improve.
"It was a lessening of the urge," Grant said of the study subjects. "They were better able to control the behavior."
Naltrexone blocks the brain receptors that respond to naturally occurring endorphins — and to opiates — and has been used to treat alcoholism and heroin addiction. "It blocks some of the high that people get," Grant said. "Your desire is less if you get less of a high." Meanwhile, he said, there is also evidence that naltrexone has a dampening effect on the brain's dopamine reward-seeking system.
People suffering from behavioral compulsions have only a limited ability to control themselves. "I analogize it to having a full bladder," Grant said. "When you need to empty it, it's an intense feeling — you have to do something."
It turns out that the brains of kleptomaniacs show subtle structural abnormalities. In a 2006 study published in Psychiatry Research, Grant and collaborators Stephen Correia and Thea Brennan-Krohn conducted diffusion tensor imaging, a form of magnetic resonance imaging on the brains of 10 women who met the definition of kleptomania spelled out in the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition.
They discovered that, when compared with 10 female control subjects, the tissue in the white-matter tracts was significantly less dense in the inferior frontal brain region, which is associated with inhibiting behavior. "They didn't have enough neural pathways to keep sending an inhibitory message to the brain," Grant said.
Statistics on the prevalence of kleptomania and its societal impact are hard to come by. Some research has shown that as many as 11 percent of us engage in shoplifting at some time in our lives. Meanwhile, retailers lost an estimated $13 billion to shoplifting in 2006.
A 2004 paper by a team of psychiatric researchers at Stanford University looking at 40 kleptomania patients cited estimates that kleptomaniacs account for about 5 percent of shoplifting, suggesting a potential impact on the order of $650 million a year.
In "Overview of Kleptomania and Phenomenological Description of 40 Patients," published in The Primary Care Companion to the Journal of Clinical Psychiatry, Elias Aboujaoude, Nona Gamel and Lorrin Koran also noted that about 2 million Americans are charged with shoplifting each year. "If kleptomania accounts for 5 percent of these," they wrote, "this translates into 100,000 arrests."
Their study of 15 men and 25 women found that 35 percent had started stealing before the age of 11. Nearly three-quarters stole on a continuous basis, with a mean total of 7.2 stealing episodes reported in the previous two weeks.
Fully 85 percent of the group had been diagnosed with some sort of psychiatric disorder, with major depression being the most common problem, the study found.
In Grant's Naltrexone study, three-quarters of his subjects were taking medication to treat depression or anxiety. "The depression and anxiety was secondary to kleptomania," he says. "People would say, 'I hate myself because I'm stealing.'"
Meanwhile, 23 of his 25 subjects had been arrested at least once for stealing, yet they continued to shoplift. But they are not sociopaths who lack any remorse for their actions, Grant cautioned. "A lot of people with kleptomania attempt suicide because they want to stop themselves and can't."
Kleptomaniacs often find that when they are in a low mood, certain stimuli, like merchandise displays in stores, set off their stealing behavior. "Much like a drug-addicted person, people will sometimes try to reclaim a greater high that they experienced in the past," he said.
Grant, who has a juris doctor degree in addition to a medical degree, thinks the criminal justice system, which presumes people have voluntary control over their actions, is poorly prepared to recognize that kleptomaniacs have a psychiatric illness.
"I worry that there are people out there who are stealing who wish they could stop, and
it's out of control and they just get labeled criminals," he says. Grant would like to see more brain studies of kleptomaniacs, but there is little research funding available.
"There might be, if you look at enough of a sample, very significant differences," he says. "Not everybody in this study got better. What's the difference between those who got better and those who didn't?"
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