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Kleptomania Presenting with Major Depressive Disorder : a Case Report

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Kleptomania Presenting with Major Depressive Disorder : a Case Report Indian J.Psychiat., 1996. 38 (3), 190-191 KLEPTOMANIA PRESENTING WITH MAJOR DEPRESSIVE DISORDER : A CASE REPORT. R.C. SHARMA ABSTRACT: A 35 year old, married, educated woman of well to do economic condition who was referred by court for psychiatric opinion was found to suffer from "Kleptomania" with "recurrent major depressive disorder." The patient had been stealing and hoarding (at times giving away when caught) defective and useless objects for the past 3 years .mostly during periods of depression and had been arrested twice for stealing. Her kleplomanic symptoms improved moderately when her depression lifted with antidepressants. KEY WORDS: Kleptomania, major depressive disorder, affective spectrum disorder. INTRODUCTION: steal the object made the patient severely de­ Kleptomania is defined as a disorder char­ pressed and suicidal at times. She described her acterised by recurrent failure to resist impulses to stealing as wrong and shameful but uncontrolla­ steal objects not needed for personal use or their ble. The patient's husband reported that she had monetary value. An increasing sense of tension is been suffering from recurrent episodes of de­ fek immediately before committing the theft and pression (with one suicidal attempt) along with pleasure or relieffelt at the time of committing the stealing behaviour for the last three years. The act. The stealing is neither an expression of anger stealing which used to be sudden, was described or vengeance nor it is due to conduct disorder or to be more pronounced during periods of depres­ antisoial personality disorder (DSM III-R, 1987). sion. The stolen items mostly used to be defec­ Classified as an impulse control disorder in DSM tive, old and useless and comprised of clothes, III-R, Kleptomania has been hepothesized as a polythene bags, cotton, shoes, socks, stationery, form of affective - spectrum disorder' (Mc Elroy tools, umbrellas, crockery, sand, bricks, elec­ etal, 1991). tronic items etc. as recovered by police from The author, to the best of his knowledge, patient's house. Apart from stealing, a few inci­ is not aware of any case report or study reported dents of shop lifting and a police arrest was also on kleptomania from India. The present case is reported in the past three years. described because of its rarity. The patient belonged to a joint family of middle socio-economic status and was second CASE REPORT: of seven sibs. She had good interpersonal rela­ N.D., 35 year old married woman, an arts tionships with her sibs and parents and there was post-graduate, working as a stenographer was no family history of any mental illness. She had brought to psychiatry O.P.D. of I.G.Medical Col­ uneventful childhood and was an average student lege Hospital,, Shimla for psychiatric opinion af­ in school and college. The patient had worked at ter being charged for theft. She presented with 3-4 different departments prior to the present complaints of uncontrollable desire to pick-up or one and used to get good salary every where. steal petty things, sadness, insomina, lack of in­ The patient had normal menstrual history terest in self and surroundings and suicidal idea­ and was living in a nuclear family with her tion for the last one month. A feeling of great husband ( a govt, servant) and two children. The tension was reported prior to stealing which used relations with the husband were strained eversince to subside after the theft and failure to pick-up or her illness. Pre-morbidly, whe was described to 190 R.C. SHARMA be reserved, intovoert, irritable and short temper­ sion after failing to steal and a moderate relief in ed without any antisocial or histrionic traits. No kleptomanic symptoms with antidpressant treat­ alcohol or drug dependence was reported. ment. Further research is warranted in the form On examination the patient was found to of systematic studies based on rigorously diag­ be retarded with depressed affect, depressive and nosed kleptomanic individuals to establish the suicidal ideation along with guilt feelings. In the etiopathological implications of kleptomania and ward, she attempted suicide twice but survived to evaluate the usefulness of pharmacological with multiple fractures. She was administered and psychsocial modes of treatment for this amitryptil Line-150 mg per day and 50 mg disorder. chlorpromazine at bed time. Her depression lifted REFERENCES: within a fortnight but hospitalisation had to be prolonged due to associated orthopaedic disabili­ American Psychiatric Association ty. During subsequent two year follow-up, the (1987) Diagnostic and statistical Manual of Men­ patient had two depressive episodes with the per­ tal Disorder, Third Edition, Revised. Wahsington. sisting stealing pattern but without any legal prob­ D C, APA. lems. Coid, J (1984) Relief of diazepam with drawal syndrome by shoplifting. British Journal COMMENTS: of Psychiatry. 145, 552-554. The patient satisfied DSMIII-R criteria for Fishbain, D.A. (1987) Kleptomania as the diagnosis of kleptomania and recurrent major risk taking behaviour in response to depression, depressive disorder. The striking feature of the American Journal of Psychotherapy, 41, 598- present case was her tendency for massive hoard­ 603. ing of a wide range of mostly defective stolen Goldman, M.J. (1992) Kleptomania: An items (though at times she used to give back the overview. Psychiatric Annals, 22, 68-71. stolen article on her own or on being caught). Mc Elroy, S.L., Hudson, J.I., Pope, A link between kleptomania and affective H.G. Jr. and Keck, P.E. (1991) Kleptomania : disorders (including major depression) has been Clinical characteristics and associated psycho- suggested by many authors (Ramelli and Mapelli, pathology. Psychological Medicine, 21,93-108. 1979; Mc Elroy et al. 1991; Goldman, 1992). Mc Elroy, S.L. Keck, P.E., Pope, H.G. Kleptomania has been found to respond to antide­ Jr. and Hudson, J.I. (1989) Pharmacological pressants (Ramelli and Mapelli, 1979; Fishbain, treatment of kleptomania and bulimia nervosa. 1987; Mc Elroy et al. 1989) and kleptomanic Journal of Clinical Psychopharmacology, 9,358- stealing has been reported to relieve major depres­ 360. sion (Coid, 1984; Fishbain, 1987). Kamelli,K and Mapelli, G (1979) Mel The present case also shows a strong as­ ancholia and Kleptomania. Acta psychiatrica sociation between kleptomania and major depres­ Belgica, 79, 57-74. sive disorder, most notably worsening of depres- R.C. Sharma, M.D, Assistant Professor, Dept. of Psychiatry, Indira Gandhi Medical College SH1MLA - 171 001. 191 .
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