Two Case Reports of Kleptomania in Youth
Takahiko Inagaki, Tsunehiko Tanaka, Naoto Yamada
Department of Community Psychiatric Medicine, Shiga University of Medical Science
Different psychiatric disorders are known to cause behavioral problems, but there are few reports regarding kleptomania. Mood disorder, particularly Major Depressive
Disorder, anxiety disorder, eating disorder particularly Bulimia Nervosa, and personality disorder are considered as complications. The effect of treatment seems to be large for
the children with kleptomania. Nevertheless most of them do not receive attention in the healthcare setting, yet they receive judicial intervention in most cases.
We report our experience of treatment for kleptomania in our institute.
He came to us because of two theft cases that he had. In addition he had some
problems of smoking, fighting and so on. His first antisocial act occurred while he was 5th
grader. He filched money from his parents. When he was a 7th grader he came to resist his
parents too much. When he was an 8th grader he was in custody by police during smoking.
When he was a 9th grader he was caught by theft twice. There are no antisocial acts, but he
acts suddenly. He said that he did not steal anything because he wanted it but he wanted to do
nasty things.
Our findings at the initial contact were as follows;
General
Appearance
Insomnia
Depressive Mood
Anhedonia
Others
His Mother Said,
When he was
young
He came to us because of seven theft cases that he had from 9th grade. His mother
said that he stole what he had always. He said he wanted to commit a theft impulsively, and
antisocial activity is not usually manifested in him.
Our findings at the initial contact were as follows;
General
Appearance
Insomnia
• He was feeble and not seemed antisocial. He looked down, talked in a low
voice and very few words.
Hallucination
• Frequent halfway awakening. It aggravated for seven months.
Delusion of
Control
• He experienced strong depression just after getting up.
• He did not play with his friends for three months.
Thought
Broadcasting
• Suicide feeling and decreased appetite are absent.
Insertion of
Thoughts
• He was a very active child up to fourth grade. He lost energy in a fifth grade
suddenly. Problems started occurring from that time.
When he was
young
• In both the kindergarten and the elementary school, he was considered to be
a good and bright child.
We considered him as
based on DSM-IV-TR. His episodes of care are as follows;
7 weeks later
• His mother said that
his sleep was stable,
and he became
lively like old days.
Start of
therapy
• His mother said
that He came to be
positively active
and seemed to be
another person
compared to before
start of therapy.
• Originally he would sleep around seven hours, but since the days of 9th grade
he slept around only 5 hours.
• After having entered high school, he experienced auditory hallucinations as
comments on his behavior 6 or 7 times per day. He also sometimes had
auditory hallucination that somebody talked.
• He would fall sometimes because his body moves without permission.
• He felt always his thought leaked out.
• He felt some thought invaded from the outside frequently.
• He was pointed out in infants examination that his development is slow. But
at the age of 4 years old he was judged he had no problem. At 8th grade, his
social nature was not a problem.
We considered him as
DSM-IV-TR. His episodes of care are as follows;
•We started aripiprazole
3mg.
•We did Sleep Hygiene
Instruction to take the
sleep 7 hours or more
every day.
15 weeks later
• We started
sertraline
and
increased
gradually to
100 mg
• His conversation had light loose associations. Sometimes his reply avoided
engaging with the question asked of him.
• He told us “I realized
the careless mistakes
decreased and the
trouble in the school
did not occur. I feel
willpower and much
improved than 4
months ago.”
2 weeks later
•Auditory
hallucination
and daytime
sleepiness
disappeared
Start of therapy
based on
• We confirmed his 7 hours
sleeping per day continuously
with his sleep diary.
• He said that his concentration
was restored and his school
life became easy because his
hallucination disappeared.
5 weeks later
11 weeks later
We decided that he remitted. after which his kleptomania disappeared.
Kleptomania is an impulse control disorder.
Impulse control difficulty is
common as symptom of the
mental disorder.
We decided that he remitted. after which his kleptomania disappeared.
fig 1
We can expect that
secondary
kleptomania is
improved by
treatment for the
primary disease.
However, most of the children of the kleptomania do not receive medical care.
In Japan most children and adolescents performing criminal activity, including theft,
do not receive health care service. The Ministry of Education, Culture, Sports, Science and
Technology of Japan reported that medical care and welfare intervened in only 8% of such
youth cases; the school counselors in only 3%; but 11% receive judicial intervention. (fig1)
Recently it is reported that individuals with kleptomania have high rates of suicide
attempts.(Odlaug; 2012)
Correspondence of the school to child assailants
3%
8%
3%
6%
By police
By medical care
By child welfare
By police
By school counselor
12%
3%
12%
2%
2%
4%
5%
Junior high school
High school
Elementary school
3%
Elementary school
Correspondence of the school to child assailants
3%
Junior high school
4%
6%
High school
We propose the following:
1. We, as medical staff, should come more into contact with patients
suffering kleptomania.
2. When we diagnose and treat kleptomania, we should pay attention to
treatable complications.
3. Kleptomania may disappear if we administer appropriately the
treatment of the concurring complications.