Is There a Relation Between Kleptomania and Female Periodicity in Neurotic Individuals?

IS THERE A RELATION BETWEEN KLEPTOMANIA AND FEMALE PERIODICITY IN NEUROTIC INDIVIDUALS? By Warren C. Middleton DePauw University There has recently come under my observation the rather un- usual case of a girl who exhibits kleptomaniac tendencies only during her menstruation periods. A diagnosis of kleptomania seems to be fully justified, although the author is not unmindful of the fact that genuine cases of this disorder are exceedingly rare, and that kleptomania is not only subject to wide variation in definition, but is, as well, amenable to unscientific diagnosis. The more pertinent facts involved in the case are as follows: Girl, nineteen years of age. A college freshman with a general intelligence level slightly below the average. Mother died when patient was six years of age; father married again about three years ago. Patient has an uncontrollable impulse to steal, without any real desire for the thing stolen. The stealing is of a motiveless kind and is sometimes done in a very childish manner. She has plenty of means. A very careful check-up has revealed that she frequently is guilty of theft during her menstrual periods, but apparently at no other time. Stealing was observed during several menstrual cycles in succession, but never during the inter- vening periods. Patient is inclined to be unstable and neurotic, but under ordi- nary circumstances adjusts herself in a fairly adequate manner. During menstruation she appears to be somewhat confused (says she is "dazed"). Sometimes she faints and appears to be slightly amnesic afterwards; but, she says, "I suddenly seem to come to '' myself.'' She complains that the menstrual pain is unbearable,'' so intense at times that she does not seem to know what she is doing. When she realizes that she has been guilty of theft, she cannot account for her misdeed and is usually very much ashamed of herself. At the time of the last report, made during menstruation, she regained consciousness from a fainting spell, inquiring '' repeatedly, doesn't think that I took her money, does she ?'' After each offense, she promises faithfully that she will not re- 232 KLEPTOMANIA AND FEMALE PERIODICITY 233 peat it, but, with her next menstrual period, her tendency to kleptomania reappears. In the light of the above case, in which kleptomania accom- panies menstruation, certain questions are to be raised. Do women with a slight psychoneurotic tendency have this tendency greatly exaggerated during the menstrual cycle? If kleptomania accom- panies menstruation in some (rare) cases, does it do so only in neurotic individuals? Could kleptomania be accounted for by the general nervous tension and instability which is likely to appear at this time? Is menstruation itself a causal factor, or does it merely exaggerate an already existing condition? Does female periodicity play a primary role, or is it merely an exciting (sec- ondary) factor, resulting from the general somatic and psychic disturbances incidental to the menstrual cycle? An extensive search for an answer to these questions did not bring wholly satisfactory results; the author was not able to discover any sub- stantial amount of published materials, either medical or psychological, upon the problem per se. Perhaps the most pertinent data of a specific nature are contributed by Burt, who finds in a small group of analyzed cases that theft is one of the common forms of delinquency among neurotic women during the menstrual cycle. He writes: "Theft?more often theft from impulse and opportunity than enterprises calmly planned?is the commonest offense occurring during these days; at such times, and at no other, many young women of a neurotic and unstable disposition take to shoplifting and to larceny of that seemingly motiveless kind which the popular journalist styles kleptomania. In some, however, a fuller study will disclose that the robberies are not exclusively confined to those occasions, but that they are then performed with greater careless- ness and so found out with greater ease.''1 i C. L. Burt, The Young Delinquent. New York, D. Appleton and Com- pany, 1925, p. 216. The author should not fail to mention that data of a less specific nature been contributed who have by Stekel, is of the opinion that "it is an open question whether any impulsive acts are other than sexual. I mean that in every instance a connection with sexuality is traceable. Many of the older writers, belonging to the preanalytic period, have pointed out that women yield to the kleptomaniac tendency mostly during the menstrual period, or while ... know pregnant. We that the female organism is sexualized during menstruation as well as during pregnancy" (W. Stekel, Peculiarities of Behavior. New York, Boni and Liveriglit, 1924, p. 259). Stekel offers a detailed account 234 THE PSYCHOLOGICAL CLINIC In a footnote, Burt adds: "In eighteen young girls, age fourteen to nineteen, kept under observation for six to seventeen months and selected because of the frequency of their misdeeds, I found that, of the total number of demonstrable thefts (amounting in the aggregate to eighty-seven), as many as 34 per cent occurred during what may be termed the menstrual week; and, on the average, only 22 per cent during each of the other three weeks. In three of these cases more than half the thefts were committed during the seven days in question; in five other cases, taken from a longer list of 200 girl delinquents, more than three-quarters; in two, there seemed an approach to a fortnightly rhythm, with an interposed disturbance perhaps con- nected with the so-called Mittel-Schmerz. I can find but two in- stances in which stealing never occurred except during these short spells of stress.''2 From the foregoing data it would appear that menstruation is a factor of some importance in cases of kleptomania among neurotic females. Burt is, however, inclined to attach less significance to the actual period of indisposition than to what may be called the premenstrual phase.2 "In the premonitory stages," he points out, "the dominating mood is one of excitement rather than depression. Among unstable persons instability is then often at its high- 4 est; . ." Not being completely satisfied with what the literature con- tained relative to a possible relation between kleptomania and female periodicity, the author prepared a questionnaire-letter to be sent to a representative number of specialists in nervous and mental of one patient, who, at the time of committing a larceny, was menstruating "and shortly thereafter she fell into a severe depression" (Itidp. 272). Wagner-Jauregg also stresses the point that kleptomania occurs among women more frequently during the menstrual period. Laqueur believes that kleptomania has an organic background; he concludes that among store klep- tomaniacs the tendency to steal is an actual sexual toxicosis. He finds that relatively healthy-minded women may pass through occasional periods of giddiness during menstruation, at which time they may commit acts of theft which must be considered morbid. 2 Loc. cit. 3 In some menstruating women the "premenstrual tension" (a term originally coined by Frank) is characterized by a syndrome of marked nervous, vascular instability. Mazer and Goldstein (Clinical Endocrinology of the Female, p. 167) give a brief, but accurate, description of this premenstrual condition. 4 Op. cit., p. 216. KLEPTOMANIA AND FEMALE PERIODICITY 235 diseases in the cities of Chicago, Cleveland, St. Louis, Cincinnati, and Indianapolis.5 This form-letter was mailed to one hundred specialists (practitioners and medical school professors) in neuro- psychiatry and psychiatry, their names being carefully selected from the Twelfth Edition (1931) of the American Medical Direc- tory. In response to the one hundred questionnaire-letters which were sent out, forty-three answers were received and eight letters were returned unclaimed because of "insufficient address." The distribution, by cities, of the number of questionnaires sent and the number of answers received appears below: No. of A's City No. of Q'b Sent Received Chicago 42 18 Cleveland 15 8 St. Louis 22 8 Cincinnati 11 4 Indianapolis 10 5 The letter, to which these neuro-psychiatrists and psychiatrists were invited to respond, need not be reproduced here. It merely made a brief allusion to the case of the patient cited previously6 and asked the specialists to express their opinions, based either on clinical observation or on mere theoretical judgment, with reference to the relation, if any, between kleptomania and female periodicity. No attempt will be made here to classify the questionnaire answers, because most of them lack the specificity that is required for classificatory treatment. In general, however, the first twelve replies, appearing below, lean toward, or are somewhat in sympathy with, an affirmative answer to the question, "Do you believe that menstruation is causal in any way?" while the last twelve replies lean toward, or are rather in sympathy with, a negative answer. Only a few of the most pertinent extracts concerning the major interest of this present inquiry will be quoted. Chicago (NP):7 We have as yet insufficient fundamental in- 5 These cities were selected because of their proximity to the author. Nothing, of course, could be gained in a study of this kind by selecting specialists on a geographical basis. e It is to be regretted that a more detailed account of the case could not be given. Experience has repeatedly demonstrated, however, that questionnaires must be very much to the point, if answers are to be elicited. This is the chief weakness of the indeed, questionnaire as a method of securing scientific data. 7 the letters NP are Whenever used, this is to indicate that the physician or is limits his practice to, especially interested in, Neurology and Psychiatry.

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