From Self - Feb.1994

ADDICTED TO STEALING

By BEN YAGODA

Kleptomaniacs crave theft. It doesn't matter what they take. It's the act that counts.

it started for Kate when she was 20. Forced by pregnancy into a marriage she wasn't sure she wanted, she began to shoplift without really knowing why. She never stole anything she needed-the important thing was the act. The first time she was caught, she found to her astonishment that she was experiencing an orgasm. She had never had one before.

The years went by-four of them, by her psychiatrist's count-and a pattern established itself. She would shoplift, be caught, undergo treatment (sometimes shock therapy, sometimes psychoanalysis) for kleptomania and depression. She would be all right until something happened in her life that she felt she couldn't handle: when her husband left her, for example, or when she took custody of their son, or when her second husband underwent heart surgery.

Then it would start again. She found that when she shoplifted, the inherent risk brought about an extreme sexual thrill. To maintain the state of arousal she would continue stealing-clothes, jewelry, it didn't matter until the tension became so unbearable that she would need to masturbate. The process was so sexually arousing, in fact, that a mere touch to her genital area would precipitate an orgasm.

Kate's case is an extreme one, to be sure, but anyone who has suffered from or known someone with kleptomania, defined in the psychiatric handbooks as "a recurrent failure to resist impulses to steal objects that are not needed for personal use or their monetary value," would recognize hallmarks in her story. There are shoplifters too numerous to count in the United States, some of whom need and can't afford to buy what they steal, some of whom can afford it and steal for various emotional reasons, and some of whom have what seems to be a shoplifting addiction. What distinguishes kleptomaniacs is the impulsive, illogical and all but involuntary nature of their stealing. They don't use the goods they take; instead they hoard them, discard them or give them away. That's because they don't care about things-what excites them so intensely is the act of stealing itself, which may also explain why they tend toward shoplifting instead of burglary, say. The thrill often comes from being able to pull off a theft in a very public setting without getting caught.

One significant obstacle to a full understanding of the disorder is the fact that, as a rule, kleptomaniacs would rather spend a month of Sundays in jail than talk about their problem. "Almost never does a patient come in complaining of this disorder," says Marcus Goldman, M.D., a Massachusetts psychiatrist who is writing a book on kleptomania. "It's a very secretive thing, like bulimia. It's more common that after a few months of treatment, a patient will say, 'By the way, I steal.' "

This secretiveness helps explain why you haven't seen Phil Donahue or Oprah Winfrey talking about this topic-Department store terrors! Tomorrow at four!-every November when a ratings boost is needed. "Every show in America has called, looking for shoplifters to put on the air," reports Peter Berlin, director of Shoplifters Anonymous, a rehabilitation service for first-time offenders and others. "I can never give them any names." Kleptomaniacs are far too ashamed to talk about their problem with their immediate families, much less with all of America. (Shoplifters Anonymous can be contacted for guidance and referrals at 380 North Broadway, Suite 206, Jericho, NY 11753.)

Most of what is known about the disorder comes from individuals who, having been apprehended for shoplifting, have been ordered by the courts to receive treatment. Studies of this subgroup indicate that less than 10 percent of repeat shoplifters fit the clinical definition of kleptomania. But this is not a negligible number, given that well over 1 million shoplifters are apprehended each year.

A recent survey of the literature revealed that 77 percent of all the reported cases of kleptomania involved females, a fact that is subject to various explanations. "Men with impulse control problems tend toward pyromania, pathological gambling and explosive behavior," Dr. Goldman says. "Women tend toward kleptomania and trichotillomania [compulsive pulling out of hair]. But there are more male kleptomaniacs than there might seem. A guy who steals bicycles and trucks, and abandons them-he's in jail. He's not called a kleptomaniac, but he probably is one." On the other hand, a 61year-old divorcee who repeatedly steals designer blouses from Neiman Marcus, and gets caught, is in treatment-not in San Quentin.

Three years ago, Susan L. McElroy, M.D., a psychiatrist then at the McLean Hospital in Belmont, Massachusetts, and several colleagues published an in-depth study of 20 kleptomaniacs. As small as the study might seem in terms of the number of subjects, it is noted among therapists who treat kleptomania because it apparently was the first to look at a collection of kleptomaniacs, as opposed to a single case study. The most striking finding was that, in the authors' words, "all patients exhibited psychopathology in addition to kleptomania." Ten of the 20 had at one time in their lives had substance abuse problems, 12 suffered from bulimia, 16 had anxiety disorders, and all of them had mood disorders, most commonly major depression.

This last appears to have some relation to the intense gratification felt during acts of stealing that is often a component of kleptomania. Some of Dr. McElroy's subjects described the feeling as "a rush," "a thrill," "high," "euphoric" or "manic." On the other hand, all the patients believed their stealing was wrong, and most felt guilt, shame and embarrassment after the theft. According to David A. Fishbain, M.D., associate professor of psychiatry and neurological surgery at the University of Miami, who treated Kate, "it appears that the act of stealing has antidepressant properties. The postulation is that maybe these people are doing it to self-treat their depression." What appears to confirm his hypothesis is that when he treated Kate with antidepressant drugs, she stopped stealing. When the medication was halted, she started again. Goldman says he has success with a triplepronged approach to treatment: medication, behavior modification techniques and the traditional "talking cure," in which the patient attempts to understand the roots of his or her behavior. When the last two have taken hold, he reports, he can generally drop the drugs. In the report of her findings, which was published in the American Journal of Psychiatry, McElroy listed the medications used in her subjects' treatment. Coincidentally or not, the column that lists medications given looks like a treatment chart that belongs to a psychiatrist who specializes in depression. Fluoxetine (Prozac), trazodone and lithium are all prominent. Despite the combination of medication and counseling, however, only seven of the 20 patients were reported to have gone into "remission" for kleptomania, and only one experienced remission for more than one year. This study shows a success rate for treatment that's far bleaker than what clinicians have found for panic disorder, for example, where up to 70 percent of patients improve while on medication.

Kleptomania: past to present

The word kleptomania was coined early in the nineteenth century, and it was described to some degree by Franz Joseph Gall, a German neurophysiologist. After searching the medical literature of the time, he wrote of "Victor Amadis the first, King of Sardinia,
[who] on all occasions appropriated trifling articles," and he also described an educated Prussian officer who "had so decided a propensity to steal, that often on parade he took away the handkerchiefs of the officers. Afterwards, when asked for the articles he had taken, he returned them in good faith."

It wasn't until the Victorian Era when the introduction of department stores and their "display case provocations [that] exist in order to arouse desire" (in the words of a writer of the time) that kleptomania took a decidedly feminine tilt. In 1855, an article in the Times of London commented, "Everyone who is acquainted with London society could at once furnish a dozen names of ladies who have been notorious for abstracting articles of trifling value from the shops where they habitually dwelt."

Current medical thinking on kleptomania tends toward the eclectic, proceeding from the realization that the disorder can have a number of causes. Leading researchers have posited that kleptomania, major depression, bulimia, obsessive compulsive disorder and panic disorder are all "affective spectrum disorders," which spring from a common underlying disturbance. In the recently published Consumer's Guide to Psychotherapy, Jack Engler, Ph.D., and Daniel Goleman, Ph.D., describe kleptomania a little differently. They call it an "impulse control problem," a category that also includes running up huge debts through gambling, trichotillomania, having fits of explosive anger or setting fires. "One common feature of all these problems is the feeling of an inner pressure building and building, finally becoming so intense that the act...is virtually irresistible. All sense of self-control or of reining it in crumbles."

The lingering frustration for researchers like McElroy is that the potential for additional research to verify the findings is extremely slim. Her study of 20 willing subjects, while representing an advance in the scientific study of kleptomania, will prove exceedingly difficult to replicate, not to mention to fund.

While acknowledging one apparent physiological component of kleptomania-a deficiency of the neurotransmitter serotonin-many students of the disorder stress that the roots of kleptomania lie in an personal history. Will Cupchik, Ph.D., a Toronto clinical psychologist who has treated scores of shoplifters over a two-decade period and who is also working on a book on the subject, says, "In most cases, the person suffered a traumatic event long ago, most often related to loss." Dr. Cupchik describes one patient who exhibited symptoms of kleptomania as "a hardworking, religious" woman, a Russian immigrant who was arrested after stealing three dresses from a fashionable department store. Noting her erratic behavior, the police went to her home, where they found 200 dresses in a walk-in closet, their price tags still on. She told the police, "I've been getting nervous. If I take a chair into the closet and close the door, it calms me down."

"It turns out that when she was a child, the woman's father had died in her arms," Cupchik says. "Her mother was a dressmaker, but she got sick and couldn't earn any money. The girl had to knock on rich women's doors and offer to exchange her own dresses for food or money." The shame and humiliation were repressed for decades, until three weeks before her arrest, when her beloved dog was badly burned and had to be put to sleep. Apparently, the trauma of her pet's death jarred her out of that repression. Now she stole, it was assumed, to try to make things "whole again" at home.

Goldman, among others, believes strongly that kleptomania is often an outgrowth of early physical or sexual trauma. He points to research suggesting that those who have been exposed to severe stress will experience large increases in endogenous opiates-the powerful "drugs" within the body that, for example, create runner's high-in response. In other words, a kind of biochemical self-medication may be at work. "Perhaps the act itself is a repetitive trauma," Goldman says. "Each theft elicits a necessary physiological response, the positive reward of which becomes learned and repeated."

So, quite literally, kleptomania can be seen as an addiction. "It's an opiate rush," Goldman adds. "Lots of survivors of sexual abuse are desperately looking for ways to reduce stress. Sometimes they cut themselves to release endorphins. Maybe kleptomaniacs are doing the same thing."

That there is a cogent inner logic to this interpretation can be deduced and vividly felt in the work of Kathryn Harrison, a novelist whose recent book, Exposure, is a harrowing portrait of a kleptomaniac named Ann Rogers. According to Harrison (who herself shoplifted regularly when she was a teenager), Ann is a woman for whom "shoplifting is a sexual surrogate." Ann's shoplifting episodes, the author says, follow the arc of a sexual conquest: the selection and stalking of the desired object, the tension leading up to the act, the climactic moment, the blissful release, and then finally the feelings of guilt and shame the next morning.

Yet when she started the book, Harrison says, she had no idea that Ann was a compulsive shoplifter. The story shifts back and forth between Ann's early life and the present day, between the symbolic abuse Ann suffered at the hands of her father, a celebrated photographer who took exploitative pictures of her as a child, and the slow deterioration of her life as an adult. Her father had stopped photographing her when she began to look more like a woman than a child, and in the familiar paradox of victims of abuse, Ann was devastated by his rejection. She responded like the survivors described by Goldman; she started to cut and harm herself.

"1 turned in a partial draft," Harrison says, "and the editor said to me, 'What does she do now?' I said, 'Oh, I hadn't thought of that.'

"A few days later, it came to me. She steals."

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