The San Francisco Chronicle
Sunday, November 10, 2002
November 8, 2002
(The San Francisco Chronicle) -- We're entering the stealing season, but things are off to a slow start for researchers at Stanford University who are conducting a study on kleptomaniacs.
It seems that people who steal impulsively are reluctant to stand up and be counted, even in a laboratory setting.
Still, psychiatrists at Stanford are embarking on the first controlled study looking at whether a drug approved for treatment of depression will work for kleptomania, a much misunderstood disorder suffered by, in their estimation, as many as 1.2 million Americans.
"People are hesitant to come forward because what they are doing is illegal and very stigmatized, and these are understandable reasons," said Dr. Elias Aboujaoude, a psychiatrist at Stanford University Medical Center who's part of a team conducting the study. "We're approaching it as an impulse control disorder. We look at it with a medical perspective."
The condition is considered rare, accounting for perhaps 5 percent of shoplifters, according to researchers. But it is by no means new.
A French textbook introduced the official diagnosis in 1838. St. Augustine, who wrote in A.D. 397 about how he "lusted to thieve," and Jane Austen's aunt, hauled into court for theft in 1799, both appeared to be kleptomaniacs, said Aboujaoude.
Now there is actress Winona Ryder, convicted Wednesday of stealing more than $5,000 worth of clothes and accessories from Saks Fifth Avenue. She reportedly told a Saks security guard that she was "getting in character for a role as a kleptomaniac." The term alone was enough to make television talk shows buzz.
Aboujaoude's team is working on a placebo-controlled study of whether a drug called Lexapro, which affects serotonin levels in the brain, works for kleptomania. Stanford researchers already have tested a similar drug to treat compulsive shoppers. In that study, nearly two-thirds receiving the drug significantly reduced binge shopping.
To find 24 true kleptomaniacs, the doctors at Stanford have appeared on local television and radio news programs and are planning to approach probation departments. Not all people who think they fit the "klepto" category actually have the disorder. It's been over-diagnosed, some experts believe.
"In the 450 cases I've assessed, probably only one or two of the people were kleptomaniacs," said Will Cupchik, a Toronto psychologist and author of "Why Honest People Shoplift or Commit Other Acts of Theft." "There is a huge problem even using the term," he said. "It's like the term paranoid. It's used all the time."
The disorder is commonly confused with compulsive shoplifting, the kind that usually peaks during the Christmas holiday season when both stress levels and the need to be in stores increase. The same could be true of kleptomaniacs, though no one knows for sure because there haven't been enough studies, Aboujaoude said.
However, unlike kleptomaniacs, compulsive shoplifters usually steal as a reaction to stress, anger or loss, which are reactions to external triggers. Cupchik prefers the term "atypical theft offender" for compulsive shoplifters who aren't kleptomaniacs.
Real kleptomania, experts say, is triggered internally by impulsive urges that may be symptomatic of an obsessive-compulsive disorder. Kleptomaniacs may respond to outside factors, such as the way store items are displayed, but their actions aren't premeditated or an expression of anger or vengeance. Sometimes, they aren't even aware of stealing, and most often they swipe things not intended for personal use.
Usually kleptomaniacs feel a surge of tension before they steal, then pleasure or relief during the theft. But the pleasure is short- lived. Later, they may feel deeply ashamed.
Terrence Shulman, an attorney and therapist who leads a support group in Michigan called Cleptomaniacs and Shoplifters Anonymous, said he started stealing in high school. He lifted art supplies, cassettes, magazines and food. Finally, after the second of two arrests, he started therapy.
"I started to realize it was an addictive behavior, just like alcoholism," he said. "It hit me like a lightning bolt."
His group, which has helped more than 600 people since it started in 1992, has included kleptomaniacs, he said, though most have been compulsive shoplifters like him. But both illnesses need more public understanding, he said, so he, unlike many others who steal, speaks openly.
"We had Betty Ford for addiction and Magic Johnson for HIV, but no one for shoplifting," said Shulman, who hopes that Ryder, if indeed she is a shoplifter, will step up to help others. "We need someone to come forward. I'm trying to do it, but I'm not famous."
Stanford doctors will keep the identities of the study subjects confidential, Aboujaoude said. All participants will get the drug for the first seven weeks. Those who respond well to it will be randomly assigned either a placebo or the medication for the next 17 weeks. They'll be asked to keep records of kleptomania incidents and urges.
Aboujaoude hopes the study will provide more general information about the disorder, including whether it plagues more men than previously thought. In court, it's usually women who are described as kleptomaniacs. Men are more likely to be deemed thieves or shoplifters with criminal intent, he said. And it's female kleptomaniacs who've been most studied.
They're women like the 45- year-old San Francisco architect who started shoplifting at age 12 and is now overwhelmed with guilt and fear that her husband and kids will find out what she's been doing.
The woman, who came for treatment at Stanford's Obsessive- Compulsive Disorders Clinic, was otherwise psychologically healthy. She couldn't figure out why she impulsively stole cosmetics, inexpensive bottles of wine, office supplies and other things she could obviously afford. She tried psychotherapy, but that didn't reduce her impulsive urges to steal.
The pleasure she got from stealing lasted only until she reached the parking lot, Dr. Aboujaoude said. Then came the guilt. Such a scenario is typical of kleptomania, he said.
"It's been around for hundreds of years," he said. "It's not as if we're jumping on the bandwagon because Hollywood is crazy about it."
Copyright 2002 The San Francisco Chronicle. All rights reserved.