Cleptomania: características clínicas e tratamento

Abstract

A b s t r a c t Objectives: Kleptomania, a disabling impulse control disorder, is characterized by the repetitive and uncontrollable theft of items that are of little use to the afflicted person. Despite its relatively long history, kleptomania remains poorly understood to the general public, clinicians, and sufferers. Method: This article reviews the literature for what is known about the clinical characteristics, family history, neurobiology, and treatment options for individuals with kleptomania. Results: Kleptomania generally has its onset in late adolescence or early adulthood and appears to be more common among women. Lifetime psychiatric comorbidity is frequent, mainly with other impulse control (20-46%), substance use (23-50%) and mood disorders (45-100%). Individuals with kleptomania suffer significant impairment in their ability to function socially and occupationally. Kleptomania may respond to cognitive behavioral therapy and various pharmacotherapies (lithium, anti-epileptics, and opioid antagonists). Conclusions: Kleptomania is a disabling disorder that results in intense shame, as well as legal, social, family, and occupational problems. Large scale treatment studies are needed.Descriptors: Impulse control disorders; Pharmacotherapy; Comorbidity; Theft; Study characteristics [Publication type] Resumo Objetivos: A cleptomania, um transtorno incapacitante do controle dos impulsos, caracteriza-se pelo furto repetitivo e incontrolável de itens que são de pequena utilidade para a pessoa acometida por esse transtorno. Apesar de seu histórico relativamente longo, a cleptomania continua sendo pouco entendida pelo público geral, pelos clínicos e pelos que dela sofrem. Método: Este artigo revisa a literatura sobre o que se sabe a respeito das características clínicas, histórico familiar, neurobiologia e opções de tratamento para indivíduos com cleptomania. Resultados: A cleptomania geralmente tem seu início no final da adolescência ou no início da vida adulta, e parece ser mais comum em mulheres. A comorbidade psiquiátrica ao longo da vida com outros transtornos de controle de impulsos (20-46%), de uso de substâncias (23-50%) e de humor (45-100%) é freqüente. Indivíduos com cleptomania sofrem de prejuízo significativo em sua capacidade de funcionamento social e ocupacional. A cleptomania pode responder ao tratamento com terapia cognitivo-comportamental e com várias farmacoterapias (lítio, antiepilépticos e antagonistas de opióides). Conclusões: A cleptomania é um transtorno incapacitante que resulta em uma vergonha intensa, bem como problemas legais, sociais, familiares e ocupacionais. São necessários estudos de tratamento em ampla escala.Descritores: Transtornos do controle de impulso; Farmacoterapia; Comorbidade; Roubo; Características de estudos [Tipo de publicação]

Treating kleptomania: cross-cultural adaptation of the Kleptomania Symptom Assessment Scale and assessment of an outpatient program

“…Patients often reject a diagnosis of kleptomania, perceiving their behavior more as an expression of a moral deviation than a treatable condition, complicating the process of seeking professional help. People affected by this disorder usually have an impaired quality of life, incurring significant losses in social, family and professional functioning, as well as serious legal problems [2], isolating themselves because of embarrassment and shame, which further complicates the treatment-seeking process [3,4]. There is evidence that the disorder is not as rare as has been believed [2,3,5,6].…”

“…People affected by this disorder usually have an impaired quality of life, incurring significant losses in social, family and professional functioning, as well as serious legal problems [2], isolating themselves because of embarrassment and shame, which further complicates the treatment-seeking process [3,4]. There is evidence that the disorder is not as rare as has been believed [2,3,5,6]. Probably underdiagnosed, the true prevalence of kleptomania in the general population remains unknown, but it has been estimated around 0.6-0.8% [5].…”

“…Most of the studies focusing on psychotherapeutic treatment of kleptomania have been based on case studies, with the use of behavioral therapy, psychotherapy, psychodynamic and cognitive-behavioral therapy [3,8]. The cognitive-behavioral therapy techniques most often cited as beneficial in the treatment of kleptomania are systematic desensitization, aversive therapy and covert sensitization [12][13][14][15][16].…”

Kleptomania: Clinical Characteristics and Relationship to Substance Use Disorders

“…In two studies of individuals with pathological gambling, rates of co-occurring kleptomania were 2.1% and 5% (10,11). A study of bulimic patients found that 24% met DSM-III-R criteria for kleptomania (12,13).…”

“…Reviews of the literature report lifetime rates of comorbid affective disorders ranging from 59% to 100%. Studies have also found high lifetime rates of comorbid anxiety (60% to 80%), impulse control (20% to 46%), and substance use disorders (23%-50%) (13,18).…”