Definition and clinical features

Kleptomania is defined in DSM-IV as follows:

• recurrent failure to resist impulses to steal objects that are not needed for personal use or for their monetary value (criterion A);

• increasing sense of tension immediately before committing the theft (criterion B);

• pleasure, gratification, or relief at the time of committing the theft (criterion C);

• the stealing is not committed to express anger or vengeance and is not in response to a delusion or a hallucination (criterion D);

• the stealing is not better accounted for by conduct disorder, a manic episode, or antisocial personality disorder (criterion E).

In ICD-10, kleptomania (or pathological stealing) is defined as the repeated failure to resist impulses to steal objects that are not acquired for personal use or monetary gain.

Two modern studies*1 ,15 and l6» have systematically examined the phenomenology of sizeable groups of people with DSM-defined kleptomania. In the first, (15 20 patients with DSM-IIIR kleptomania were referred for clinical evaluation. All 20 patients described irresistible impulses or urges to steal, and tension relief either during or shortly after the act of theft (as required by the DSM-IIIR criteria). Although most patients described the impulses as senseless, intrusive, and uncomfortable, and many tried to resist them, half reported pleasurable feelings during the act of theft, variously described as 'a rush' or 'a high'. All patients reported instances of impulsive stealing, but some also described premeditated stealing, the aim of which was often to relieve the impulses to steal. Several patients developed rules for their stealing behaviour—for instance, stealing only from work or from certain types of shops (e.g. drug stores but not department stores), or stealing certain items but not others (e.g. jewellery but not clothing). All patients stated that they considered their stealing to be wrong, and most, but not all, reported guilt or remorse after stealing.

In the second study/1. 16) 37 people fulfilling DSM-IV criteria for kleptomania recruited through newspaper advertisement were interviewed and compared with 50 shoplifters interviewed directly after apprehension. When asked to rate their last theft on a number of variables, persons with kleptomania reported more inner tension before the theft and greater relief and impulsivity during the theft than the shoplifters. However, the shoplifters also rated high on these variables. Also, both groups reported similar degrees of planning, thrill, vengeance, need, pleasure, and psychiatric imbalance on a visual analogue scale. The authors concluded that there were no 'absolute borders' between 'pure' DSM-IV kleptomania and other forms of shoplifting.

Breaking Bulimia

Breaking Bulimia

We have all been there: turning to the refrigerator if feeling lonely or bored or indulging in seconds or thirds if strained. But if you suffer from bulimia, the from time to time urge to overeat is more like an obsession.

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