Mental health professionals' use of the ICD-11 classification of impulse control disorders and behavioral addictions: An international field study.

Background and aims: The ICD-11 chapter on mental, behavioral and neurodevelopmental disorders contains new controversial diagnoses including compulsive sexual behavior disorder (CSBD), intermittent explosive disorder (IED) and gaming disorder. Using a vignette-based methodology, this field study examined the ability of mental health professionals (MHPs) to apply the new ICD-11 diagnostic requirements for impulse control disorders, which include CSBD and IED, and disorders due to addictive behaviors, which include gaming disorder, compared to the previous ICD-10 guidelines. Methods: Across eleven comparisons, members of the WHO's Global Clinical Practice Network (N = 1,090) evaluated standardized case descriptions that were designed to test key differences between the diagnostic guidelines of ICD-11 and ICD-10. Results: The ICD-11 outperformed the ICD-10 in the accuracy of diagnosing impulse control disorders and behavioral addictions in most comparisons, while the ICD-10 was not superior in any. The superiority of the ICD-11 was particularly clear where new diagnoses had been added to the classification system or major revisions had been made. However, the ICD-11 outperformed the ICD-10 only in a minority of comparisons in which mental health professionals were asked to evaluate cases with non-pathological high involvement in rewarding behaviors. Discussion and Conclusions: Overall, the present study indicates that the ICD-11 diagnostic requirements represent an improvement over the ICD-10 guidelines. However, additional efforts, such as training programs for MHPs and possible refinements of diagnostic guidance, are needed to avoid over-diagnosis of people who are highly engaged in a repetitive and rewarding behavior but below the threshold for a disorder.

An adolescent boy with kleptomania and attention-deficit hyperactivity disorder treated with methylphenidate and guanfacine: A case report.

We present the case of a patient, a boy of 16 years of age at initial presentation, with kleptomania, an impulse disorder characterized by an impulse to steal unneeded items, and attention-deficit hyperactivity disorder (ADHD). The patient's parents reported that he would frequently impulsively steal items and money that he did not need. Cognitive and physical assessments revealed no abnormalities, and the patient had no history of substance abuse. The patient was diagnosed with kleptomania and ADHD. The patient was started on Osmotic Release Oral System Methylphenidate (OROS-MPH), a medication commonly used to treat ADHD, and experienced improvement in ADHD symptoms and stealing behavior. At 19 years of age, it was discovered that the patient's behavioral symptoms were uncontrolled during times of the day when the blood concentration of MPH was likely to have waned. After starting an additional dose of guanfacine at night, his symptoms during these times of day improved. While existing research is not definitive, there may be a connection between ADHD and kleptomania. Further, there are some reports that treatment of ADHD with MPH also reduced stealing behavior, aligning with our present findings. We discuss the potential mechanisms behind these improvements and further present the first evidence of the efficacy of guanfacine in the treatment of kleptomania.

Pharmacotherapy of impulse control disorders: A systematic review.

There are currently no evidence-based treatment recommendations for impulse control disorders, which include intermittent explosive disorder (IED), kleptomania and pyromania. Therefore, this systematic review sought to identify all randomized controlled trials (RCTs) that investigated pharmacological treatments for impulse control disorders, to evaluate their efficacy and tolerability. Searches were conducted within MEDLINE, PsychINFO, EMBASE, Web of Science, and Cochrane Central Register of Controlled Trials (CENTRAL) databases. Eight studies were included, six investigated pharmacotherapies for IED, while two investigated management for kleptomania. For the treatment of IED, oxcarbazepine and fluoxetine were the most efficacious. Importantly, divalproex was not superior to placebo in decreasing IED symptoms and was associated with significant adverse effects. In the treatment of kleptomania, only naltrexone was effective. The existing data suggest that the pharmacological treatment for impulse control disorders is an understudied area of psychiatry. Much of the current research on impulse control disorders focuses on management with anticonvulsants and antidepressants. Further studies conducted on these interventions in this population may yield promising results.

Heightened Negative Affects Associated With Neurotic Personality in Behavioral Addiction.

Although studies have demonstrated that negative affects are critical attributes of drug addiction, this has remained less clear in behavioral addiction. In this preliminary study with a relatively small number of samples, we investigated negative affects in patients diagnosed with behavioral addiction, particularly paraphilia and kleptomania. Negative affects were examined using self-rating questionnaire and further evaluated by objective assessments in behavioral addicts and normal subjects. Explicit, self-referential negative affects, such as anxiety, stress, and depression, were higher in behavioral addicts than control subjects. Such self-referential negative affects were, although not entirely, consistent with objective evaluations by others and blood stress hormone concentrations. Further investigation of personality traits in behavioral addicts unveiled that heightened negative affects were associated with stronger neurotic personality in behavioral addicts than normal subjects. These results suggest that behavioral addiction, such as paraphilia and kleptomania, may be characterized by heightened negative affects attributable to stronger neurotic personality.

Kleptomania as a neglected disorder in psychiatry.

Kleptomania is an impulse control disorder characterized by the irresistible urge to steal not for monetary gain. Since its conceptualization, this categorical diagnosis has been conflated with common beliefs regarding the social class and gender such as the idea that women are intrinsically fragile and that people in the middle class were unlikely to commit theft. Also, its use has been controversial in the medical and forensic fields. This review of the literature will provide a historical excursus through the definitions of the syndrome and summarize the available pharmacological and psychotherapeutic options for its treatment. Currently, there is a lack of systematic studies regarding the clinical characteristics of kleptomania and its treatment options for practical standardized approaches.

Validity and reliability of the Japanese version of the kleptomania symptom assessment scale: A comparison between individuals with kleptomania and prisoners in Japan.

INTRODUCTION: In Japan, the rate of recidivism among thieves is high, some of which may be caused by kleptomania. The purpose of this study was to translate the Kleptomania Symptom Assessment Scale (K-SAS) into Japanese and validate its psychometric properties in a Japanese sample. A second purpose of the study was to evaluate the validity of K-SAS to discriminate between individuals with kleptomania and shoplifters not affected by the disorder. METHODS: The original K-SAS was translated by researchers. The back-translation of the scale into English was conducted by a professional translator who was fluent in both languages. The items on the Japanese version of K-SAS were deemed appropriate for the Japanese context after being reviewed by a forensic psychiatry specialist. The sample included 22 kleptomania patients, 26 shoplifters, and 47 healthy adults. We tested the scale properties and validity to discriminate between the three groups. RESULTS: The Japanese version of the K-SAS showed adequate reliability and validity. Individuals affected by kleptomania had significantly higher scores than shoplifters and healthy adults. Furthermore, the K-SAS score of kleptomania was not correlated with typical antisocial tendencies. Moreover, the K-SAS score for kleptomania was not correlated with psychometric scales related to obsessive-compulsive disorder and borderline personality disorder. CONCLUSIONS: The Japanese version of the K-SAS is a useful assessment tool for distinguishing between individuals with kleptomania and shoplifters not affected by the disorder in Japan.

Exposure and response prevention therapy augmented with naltrexone in kleptomania: a controlled case study using galvanic skin response for monitoring.

BACKGROUND: Kleptomania is a disease that shares features with obsessive compulsive spectrum disorders (OCD) and with substance abuse disorders (SAD). This is underlined by therapeutic approaches in kleptomania ranging from cognitive behavioural therapy and selective serotonin reuptake inhibitors that are effective in OCD, and opioid antagonists that are currently being used in SAD. However, almost no literature exists about exposure and response prevention (ERP) therapy in kleptomania. Furthermore, there is a clear lack of objective markers that would allow a therapeutic monitoring. AIM: To show the effectiveness of ERP therapy in kleptomania in a single case report. METHOD: An ERP therapy under real-world conditions and later augmentation with the opioid antagonist naltrexone is described. Continuous measurements of galvanic skin response (GSR) before, during and after therapy sessions are reported in association with changes of the Kleptomania Symptom Assessment Scale (KSAS) self-questionnaire. RESULTS: While KSAS scores showed a clear treatment response to ERP sessions, the GSR was significantly lower during ERP treatment in comparison with baseline measures. However, during augmentation with naltrexone, GSR measures increased again and clinical severity did not further improve. CONCLUSIONS: This case shows the possible usefulness of ERP-like approaches and therapy monitoring using electrophysiological markers of arousal for individualized treatment in kleptomania.

Kleptomania: Recent Advances in Symptoms, Etiology and Treatment.

Kleptomania is a kind of uncontrollable impulse and behavior of stealing, and it is also a serious disease. At present, studies on pathological theft at home and abroad are not sufficient, and the understanding of the symptoms, etiology and treatment of this disease is very insufficient. This article focuses on the latest development of symptoms, etiology and treatment of kleptomania, providing a reference for people to further identify, treat and study the disease.

Imaging studies of kleptomania in a middle-aged woman with obsessive-compulsive disorder: a case report.

A 57-year-old woman who had been arrested for shoplifting visited our hospital. She was diagnosed with kleptomania. She had previously been diagnosed with CREST (calcinosis, Raynaud's phenomenon, esophageal dysmotility, sclerodactyly, and telangiectasia) syndrome and obsessive-compulsive disorder. Cranial magnetic resonance imaging showed mild atrophy of the bilateral dorsolateral prefrontal cortices, left hippocampus, and occipital cortex, as well as diffuse mild T2 hyperintensity in the deep and subcortical white matter, including the frontal region. During a single-photon emission computed tomography scan, significant hyperperfusion was observed in the right ventral striatum, including the nucleus accumbens, ventral thalamus, and right ventrolateral prefrontal areas. Patchy hypoperfusion was found in the bilateral posterior cingulate, parietal, and occipital regions. The patient's neurocognitive function was normal, except for slight impairment of her executive function. Her symptoms and neuroimaging findings were not suggestive of a specific neurocognitive disorder. Hyperactivity of the right ventral striatum may contribute to both obsessive-compulsive disorder and kleptomania. Although frontotemporal lobar degeneration is a major neurocognitive disorder related to illegal behaviours, CREST syndrome-induced white matter microstructural damage in the orbitofrontal lobe could have caused our patient's kleptomania.

Kleptomania or common theft - diagnostic and judicial difficulties. / Kleptomania czy kradziez pospolita ­ trudnosci diagnostyczno-orzecznicze.

First descriptions of kleptomania as a mental disorder date back to the nineteenth century. For the first time, kleptomania as an accompanying symptom rather than a formal diagnosis was included in the classification of psychiatric disorders of the American Psychiatric Association DSM-I in 1952. It was included in the International Classification of Diseases ICD-10 and classified under "habit and impulse disorders". Kleptomania is a serious disorder, as numerous thefts are impulsively carried out, carrying the risk of detection and consequently criminal liability. In Poland, we lack epidemiological data, however, it is estimated that 5% of those who commit theft are affected by kleptomania. People suffering from this disorder often do not seek a medical opinion so reviewing such cases is challenging for expert psychiatrists. The authors have proposed the term "kleptomania spectrum" for defining cases in which patients have an intense urge to steal, experienced a sense of tension from such an action, and relief following it, however, the criterion of theft of a superfluous object, without a profitable motive for themselves or others is not met.

Kleptomania and Co-morbid addictive disorders.

We examined the association between kleptomania and addictive disorders, including behavioral addictions. Fifty-three individuals with a diagnosis of kleptomania completed measures of kleptomania severity, semi-structured clinical interviews to assess co-morbid diagnosis of addictive disorders, and the Shorter PROMIS Questionnaire (SPQ) assessing an array of addictive behaviors. 20.75% of the sample met criteria for an addictive disorder; four for a substance use disorder and four for a behavioral addiction. Kleptomania severity was significantly associated with compulsive work and shopping measured by the SPQ. The results suggest the need to assess a wide array of addictive behaviors in individuals with kleptomania.

Phenomenology and treatment of behavioural addictions.

Behavioural addictions are characterized by an inability to resist an urge or drive resulting in actions that are harmful to oneself or others. Behavioural addictions share characteristics with substance and alcohol abuse, and in areas such as natural history, phenomenology, and adverse consequences. Behavioural addictions include pathological gambling, kleptomania, pyromania, compulsive buying, compulsive sexual behaviour, Internet addiction, and binge eating disorder. Few studies have examined the efficacy of pharmacological and psychological treatment for the various behavioural addictions, and therefore, currently, no treatment recommendations can be made.

Les dépendances comportementales se caractérisent par une incapacité à résister à une motivation ou une pulsion entraînant des actions qui sont nuisibles pour soi ou les autres. Les dépendances comportementales ont des caractéristiques en commun avec l'abus de substances et d'alcool, et avec des domaines comme l'évolution naturelle, la phénoménologie, et les conséquences indésirables. Les dépendances comportementales sont notamment le jeu pathologique, la cleptomanie, la pyromanie, les achats compulsifs, le comportement sexuel compulsif, la dépendance à Internet, et la suralimentation compulsive. Peu d'études ont examiné l'efficacité du traitement pharmacologique et psychologique des diverses dépendances comportementales et par conséquent, aucune recommandation de traitement ne peut être faite à l'heure actuelle.

A targeted review of the neurobiology and genetics of behavioural addictions: an emerging area of research.

This review summarizes neurobiological and genetic findings in behavioural addictions, draws parallels with findings pertaining to substance use disorders, and offers suggestions for future research. Articles concerning brain function, neurotransmitter activity, and family history and (or) genetic findings for behavioural addictions involving gambling, Internet use, video game playing, shopping, kleptomania, and sexual activity were reviewed. Behavioural addictions involve dysfunction in several brain regions, particularly the frontal cortex and striatum. Findings from imaging studies incorporating cognitive tasks have arguably been more consistent than cue-induction studies. Early results suggest white and grey matter differences. Neurochemical findings suggest roles for dopaminergic and serotonergic systems, but results from clinical trials seem more equivocal. While limited, family history and genetic data support heritability for pathological gambling and that people with behavioural addictions are more likely to have a close family member with some form of psychopathology. Parallels exist between neurobiological and genetic and family history findings in substance and nonsubstance addictions, suggesting that compulsive engagement in these behaviours may constitute addictions. To date, findings are limited, particularly for shopping, kleptomania, and sexual behaviour. Genetic understandings are at an early stage. Future research directions are offered.

Cette revue résume les résultats neurobiologiques et génétiques des dépendances comportementales, établit des parallèles avec les résultats relatifs aux troubles d'utilisation d'une substance, et offre des suggestions à la future recherche. Les articles concernant la fonction cérébrale, l'activité des neurotransmetteurs, et les antécédents familiaux et (ou) les résultats génétiques pour les dépendances comportementales que sont le jeu de hasard, l'utilisation d'Internet, les jeux vidéo, le magasinage, la cleptomanie, et l'activité sexuelle ont été examinés. Les dépendances comportementales présentent une dysfonction de plusieurs régions du cerveau, en particulier le cortex frontal et le striatum. Il est permis de croire que les résultats des études d'imagerie comportant des tâches cognitives étaient plus cohérents que ceux des études par induction de signaux. Les résultats préliminaires suggèrent des différences de matière blanche et grise. Les résultats neurochimiques suggèrent des rôles pour les systèmes dopaminergique et sérotoninergique, mais les résultats des essais cliniques semblent plus équivoques. Bien que limités, les antécédents familiaux et les données génétiques soutiennent l'héritabilité du jeu pathologique et le fait que les personnes ayant des dépendances comportementales sont plus susceptibles d'avoir un membre de la famille proche qui souffre d'une forme quelconque de psychopathologie. Il existe des parallèles entre les résultats neurobiologiques, génétiques et d'antécédents familiaux dans les dépendances à une substance et à une non-substance, ce qui suggère que l'exercice compulsif de ces comportements peut constituer des dépendances. Jusqu'ici, les résultats sont limités, particulièrement en ce qui concerne le magasinage, la cleptomanie, et le comportement sexuel. Les explications génétiques sont encore au premier stade. Des orientations sont offertes pour la future recherche.

Kleptomania and potential exacerbating factors: a review and case report.

Kleptomania is an impulse control disorder that can cause significant impairment and serious consequences. Often, the condition is kept secret by the patient, and usually help is sought only when confronted by the legal consequences of the impulsive behaviors. Historically, kleptomania has been viewed from a psychodynamic perspective, and the mainstay of treatment has been psychotherapy. Recently, attempts to explain kleptomania within a neuropsychiatric paradigm have highlighted the possible links between mood disorders, addictive behaviors, and brain injury with kleptomania. These associations with kleptomania can be extrapolated to pharmacological strategies that can potentially help in treating kleptomania. A case of kleptomania, which was potentially exacerbated by multiple factors, will be reviewed. Treatment modalities used in this case, including the use of the Yale-Brown Obsessive Compulsive Scale as a surrogate marker to gauge response to treatment, will be discussed.

La pasión erótica por las telas y lo femenino: aportes a la noción de compulsión / Erotic passion for cloth and the feminine: contributions to the compulsion notion

El presente trabajo se inscribe en el marco del Proyecto de Investigación UBACyT P805: "Alcances y actualidad del concepto de compulsión. Su relación con las adicciones". Es el propósito del mismo abordar el tema de la compulsión en la cleptomanía, específicamente, en el robo de telas por mujeres, tratando de realizar un aporte a las nociones de compulsión y responsabilidad subjetiva. Otro de los objetivos propuestos que enriquecerá este abordaje es el poder establecer una distinción entre la pasión erótica por las telas, típicamente femenina, y el fetichismo masculino. Para llevar a cabo ambos objetivos nos valdremos de la película "El placer de la seda" de Yvon Marciano y de aportes de la literatura psicoanalítica freudiana winicottiana y lacaniana.

The following paper is framed in the P805 UBACyT Investigation Project called " Scope and current state of the concept of compulsion. Its relationship with addictions". Its aim is to make an approach of the topic of compulsion in kleptomania, specifically, in the cloth theft by women, trying to contribute to the notions of compulsion and subjective responsibility. Another proposed aim which will enrich this approach is to distinguish between erotic passion for cloth, typically feminine, and male fetichism. To fulfill both objectives we will work on the movie called " The peasure of the silk" by Yvon Marciano and the freudian, winicottian and lacanian psychoanalytical contributions will be our theoretical tools.

Tratamento cognitivo e comportamental para transtornos do controle de impulsos / Cognitive-behavioral treatment for impulse control disorders

OBJECTIVES: This paper reviews the cognitive-behavioral treatment of kleptomania, compulsive buying, and pathological gambling. METHOD: A review of the published literature was conducted. RESULTS: Treatment research in all of these areas is limited. The cognitive-behavioral techniques used in the treatment of kleptomania encompass covert sensitization, imaginal desensitization, systematic desensitization, aversion therapy, relaxation training, and alternative sources of satisfaction. Regarding compulsive buying, no empirical support for treatment exists but common techniques examined were covert sensitization, exposure and response prevention, stimulus control, cognitive restructuring, and relapse prevention. Treatment of pathological gambling has been successful in both group and individual format using techniques such as aversive therapy, systematic desensitization, imaginal desensitization and multimodal behavior therapy (which have included in vivo exposure, stimulus control, and covert sensitization) along with cognitive techniques such as psychoeducation, cognitive-restructuring, and relapse prevention. CONCLUSIONS: There is a general consensus in the literature that cognitive-behavioral therapies offer an effective model for intervention for all these disorders. An individualized case formulation is presented with a case study example. Clinical practice guidelines are suggested for each disorder.

OBJETIVOS: Este artigo revisa o tratamento da cleptomania, do comprar compulsivo e do jogo patológico. MÉTODO: Realizou-se uma revisão da literatura publicada. RESULTADOS: A pesquisa sobre o tratamento em todas essas áreas é limitada. As técnicas cognitivo-comportamentais utilizadas no tratamento da cleptomania compreendem sensibilização encoberta, dessensibilização imaginal, dessensibilização sistemática, terapia de aversão, treinamento de relaxamento e fontes alternativas de satisfação. Com relação ao comprar compulsivo, não existe amparo empírico para o tratamento, mas as técnicas comuns examinadas foram sensibilização encoberta, exposição e prevenção de resposta, controle do estímulo, reestruturação cognitiva e prevenção de recaída. O tratamento do jogo patológico teve êxito tanto no formato em grupo como no individual, utilizando técnicas tais como terapia aversiva, dessensibilização sistemática, dessensibilização imaginal e terapia comportamental multimodal (incluindo exposição in vivo, controle do estímulo e sensibilização encoberta), juntamente com técnicas cognitivas, tais como psicoeducação, reestruturação cognitiva e prevenção de recaída. CONCLUSÕES: Há um consenso geral na literatura de que as terapias cognitivo-comportamentais oferecem um modelo eficaz de intervenção em todos esses transtornos. Uma formulação de caso individualizada é apresentada com um exemplo de estudo de caso. Sugerem-se diretrizes para a prática clínica de cada transtorno.

Impulse control disorders : nosology and concept.

Impulse control disoders have long been recognized. Although included in nosological systems since two decades, their diagnostic validity individually, as well as a category remains in question. Conceptually, these have been linked to variety of other psychiatric or medical disorder viz. OCD, affective disorders, addictive disorders, organic mental conditions etc, but systematic studies have not been done. The present review focuses on the nosological and conceptual evolution of these disorders and highlights the overlap and boundaries with other psychiatric disorders.

Unsettled women.

SUMMARY Amy Bock (alias Percy Redwood) created a media sensation when "The Case of the Woman Bridegroom" hit the newspapers throughout New Zealand in 1909. She was hailed as the "queerest and most interesting character that has ever been before the New Zealand public" and "pitiable in her freakish exploits." Debates ensued as to whether her crimes were evidence of a mania, a disease, or simply due to a flawed, criminal character. This article focuses on media portrayals of women who did not conform to normative constructions of acceptable womanhood within the latter decades of the nineteenth century and the early twentieth century in New Zealand, as a means of tracing the mutable boundaries of intelligible genders. Newspaper debates and emergent discourses around the medicalisation of social de-viancy are drawn upon to demonstrate how normative constructions of gender were premised upon a defining matrix of mad/bad/woman.

Kleptomania presenting with major depressive disorder : a case report.

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.