Core features

• Recurrent failure to resist impulses to steal objects that are not needed for personal use or monetary value.
• Increasing sense of tension or arousal before the theft, and pleasure, relief or gratification at the time of committing the act.
• Stealing is not committed to express anger, for revenge, or in response to a delusion or hallucination.
• Stealing causes distress or impairment in social, occupational, or other important areas of functioning.

Etiology & associated factors

• Exact cause unknown — likely multifactorial: genetic vulnerability, impulsivity traits, serotonergic and dopaminergic dysregulation.
• Often comorbid with mood disorders, anxiety, substance use disorders, eating disorders (especially bulimia nervosa), and other impulse‑control disorders.
• May be preceded or reinforced by transient relief or excitement from stealing; some report poor impulse control and difficulties with delay of gratification.

Clinical assessment

1. Take a non‑judgemental history about the stealing behaviour: frequency, triggers, items taken, subjective urges and feelings before/after the act.
2. Assess for secondary gain, malingering, shoplifting as antisocial behaviour, substance involvement or psychosis which may explain behavior.
3. Screen for comorbid psychiatric disorders (depression, anxiety, OCD, eating disorders, SUD) and for legal consequences and safety issues.
4. Use validated scales where available (e.g., Kleptomania Symptom Assessment Scale) and assess impulsivity/compulsivity dimensions.

Differential diagnosis

• Ordinary shoplifting for material gain, economic need, or organized theft.
• Conduct disorder or antisocial personality disorder—look for pattern of other rule‑breaking behaviours and lack of remorse.
• Substance‑induced or psychotic-related stealing (delusions or hallucinations prompting theft).
• Impulse behaviours in the context of bipolar mania or ADHD impulsivity.

Treatment approaches

Psychological treatments

• Cognitive‑behavioural therapy (CBT) with focus on impulse control, stimulus control, cognitive restructuring, and relapse prevention shows the best evidence.
• Habit reversal and exposure/response prevention methods adapted to stealing urges can be helpful.
• Motivational interviewing to engage treatment, especially when legal consequences are present.

Pharmacotherapy

• Evidence is limited and mixed. SSRIs (fluoxetine, sertraline) have been used given overlap with OCD‑spectrum and impulsivity; some patients respond.
• Naltrexone (opioid antagonist) has shown benefit in reducing urges in some trials and case series—consider when comorbid addictive behaviours or strong reward‑seeking present.
• Other agents (mood stabilisers, antipsychotics) are considered based on comorbidity (e.g., mood disorder, psychosis) rather than as primary kleptomania treatments.

Shared decision‑making: discuss limited evidence, potential benefits and side effects; prefer CBT as first‑line when available.

Legal and ethical considerations

• Stealing often has legal consequences—coordinate care with legal representatives while maintaining confidentiality limits and mandatory reporting obligations.
• Consider diversion programs, mental health court options and linkage with social services where available.
• Clinicians should document risk, advice given, and safety plans, and support patients in addressing restitution and legal compliance.

Key takeaways

• Kleptomania is an impulse‑control disorder distinct from ordinary stealing—look for tension before and relief after acts, and lack of material motive.
• CBT is first‑line; pharmacotherapy (SSRIs, naltrexone) may be helpful in selected cases, especially with comorbidity.
• Address legal consequences, coordinate with services, and refer to specialist care when severe or complex.