Child abduction

Abduction or stealing of a child is notified to police with increasing frequency; there were 390 reported incidents in 1997 but annual convictions or cautions are fewer than 30. The great majority are carried out by men in custody disputes with their partners. Although the abduction of a child by a stranger for sexual purposes is rare,(168) cases understandably receive wide publicity.

Baby stealing is almost invariably carried out by women. It is an extremely rare crime but occasional cases have led to the introduction of major security precautions at maternity hospitals/1.6^ Most stolen babies are found fairly quickly and have usually been well cared for by their abductors. The classification by d'Orban (!7°) based on 24 cases remains useful. He described three types of offences.

• Comforting offences by deprived women with backgrounds of immaturity, and often having had their own child taken into care.

• A manipulative offence by an older woman with personality difficulties but with a better social adjustment. Such women seek to manipulate a relationship by presenting the baby as their own.

• Mentally ill women who steal a baby impulsively with little or no planning during a psychotic illness.

The risk of repetition is a real issue, particularly in the third group in whom delusions concerning babies are often systematized. Shoplifting

Shoplifting is a form of theft which is perpetrated on a massive scale with huge losses to the retail trade. Most shoplifting has nothing to do with any mental disorder. Gibbens et al.,(1l1) in an early follow-up study of 532 women who had shoplifted 10 years earlier, found rates of subsequent psychiatric inpatient treatment three times greater than expected; depressive disorders were the most common. This type of study has not been repeated and its findings would not apply to the contemporary situation. A unitary causal model for the offence is rarely adequate(172) and few offenders fit neatly into any single diagnostic category.

The disorder of kleptomania has a place in ICD-10 and DSM-IV. The essential criteria from DSM-IV, where it is classified as a disorder of impulse control (see Qhapter_4_.13_._1), are:

• recurrent failure to resist impulses to steal objects that are not required for use or for their monetary value

• increasing tension before the act of theft

• pleasure, gratification, or relief at the time of the act

• the act is not an expression of anger or vengeance, or in response to psychotic phenomena

• stealing is not better accounted for by another diagnosis (e.g. antisocial personality disorder).

In clinical practice, it is rare to find a shoplifter who meets DSM-IV criteria for kleptomania but who does not have additional psychiatric disorders. A study of 20 patients who met diagnostic criteria for kleptomania were all found to have lifetime diagnoses of major mood disorders; 16 had additional diagnoses of anxiety disorders and 12 of eating disorders.(!l3) In a study from records, but without interviews, of nearly 400 repeat shoplifters in Stockholm (who might reasonably be expected to include some with kleptomania), 80 per cent were male and less than 10 per cent were in employment. Most offences were committed at some distance from the shoplifter's home address and food and confectionery were most frequently stolen. (!l4) The circumstances seemed to have little in common with descriptions of kleptomania. Shoplifting (non-kleptomanic in type) is often seen in association with substance misuse disorders, eating disorders, and schizophrenia. It may also occur in organic states or in states of absent-mindedness. Depressed, organically impaired, or absent-minded shoplifters commit absolutely unplanned offences with little or no effort to conceal their actions or to escape arrest.

The prevalence and clinical significance of kleptomania among those who shoplift is impossible to determine with accuracy. Only a tiny proportion of people who shoplift are assessed by psychiatrists and it is therefore unwise to make generalizations. A major problem is that apparently inexplicable acts of shoplifting may be perpetrated by people who have no DSM-IV features of kleptomania. However Goldman/175) in an extensive literature review, concluded that the disorder is more common than previously suggested. He emphasized that full disclosure by patients of the extent and nature of their shoplifting behaviour may require many hours of therapeutic exploration. Goldman described the 'typical' case as a 35-year-old woman who had been shoplifting for 15 years. Background features include sexual dysfunction or preoccupation, an emotionally unsupportive husband, and a history of dysphoria. Clearly these are features common to many neurotic disorders and their particular relevance for kleptomania is uncertain.

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