Kleptomania

ICD-10F63.2	Pathological stealing [kleptomania]
DSM-5-TRF63.2	Kleptomania

1. Definition and nosology

Kleptomania (ICD-11: 6C71; DSM-5-TR: F63.2) — a recurrent impulse to steal objects that are not needed for personal use or monetary value; tension before the act, relief or pleasure after the act.

2. History

• Esquirol (1838) — “kleptomanie”.
• DSM-III — Impulse control disorders.
• ICD-11 — impulse control disorders.

3. Epidemiology

• Only ~5% of shoplifting incidents meet criteria for kleptomania (most theft is motivation-based).
• Sex: higher in females (in clinical populations).
• Comorbidity: mood disorders 45–100% across series, MDD up to ~65%; anxiety, OCD, eating disorders, substance use.

4. Etiology and pathogenesis

• Hypothesis of serotonin and opioid system dysregulation (Grant J.E.).
• Comorbid affective and impulsivity disorders.

5. Clinical features

• Failure to resist the impulse to steal items that are not needed for personal use or monetary value.
• Pre-act increase in tension.
• Post-act relief, pleasure.
• Stealing is not motivated by anger, revenge, or psychotic motivation.
• Objects are typically discarded, given away, or hoarded; sometimes surreptitiously returned.

6. Diagnosis

6.1 Unified diagnostic criteria

A. Repeated failure to resist the impulse to steal items that are not needed for personal use or monetary value.

B. Pre-act tension.

C. Post-act relief, pleasure.

D. Stealing is not motivated by anger, revenge, delusion, or hallucination.

E. Not better explained by conduct disorder, a manic episode, or ASPD.

6.2 Differences between sources

DSM-5-TR / ICD-11 — same criteria.

6.3 Diagnostic algorithm

1. Clinical interview.
2. K-SAS (Kleptomania Symptom Assessment Scale) — Grant J.E.
3. Comorbid MDD, anxiety, OCD, eating disorders.

6.4 Differential diagnosis

7. Examination and assessment

• K-SAS.
• Comorbidity scales.

8. Treatment

1. Naltrexone — Grant J.E. et al. Biol Psychiatry 2009 RCT — efficacy in kleptomania (50–150 mg/day).
2. CBT — cognitive restructuring, covert sensitization, imaginal desensitization.
3. SSRI — for comorbid MDD.
4. Multidisciplinary approach — legal context.

8.1 Treatment methods

1. Naltrexone — Opioid antagonist; reduces kleptomania cravings.
2. CBT for impulse control — Trigger management.
3. Kleptomania Symptom Assessment Scale (K-SAS) — Severity scale.

8.2 Differences between sources

• Grant J.E. — naltrexone evidence base.

9. Prognosis

• Significant improvement with naltrexone and CBT.
• Comorbid MDD predicts a poor prognosis.

10. Myths and misconceptions

Myth 1: “All repeated stealing is kleptomania”

Evidence: Most theft is motivation-based; kleptomania rare.

Myth 2: “The patient can stop ‘voluntarily’”

Evidence: impulse control disorder — failure to resist is clinical diagnostic feature.

Myth 3: “Legal punishment alone is sufficient”

Evidence: Clinical intervention and comorbidity treatment reduce relapse risk.

Myth 4: “There is no specific treatment”

Evidence: Naltrexone evidence base (Grant 2009 RCT); CBT is effective.

11. Sources

1. WHO. ICD-11. 6C71 Kleptomania. 2024.
2. APA. DSM-5-TR. 2022.
3. Grant J.E. et al. A double-blind, placebo-controlled study of the opiate antagonist naltrexone in the treatment of kleptomania. Biol Psychiatry 2009;65(7):600–606.