Clinical Textbook of Addictive Disorders 3rd ed - R. Frances, S. Miller, A. Mack (Guilford, 2005) WW

314 IV. SPECIAL POPULATIONSLike individuals with SUDs, most with kleptomania try unsuccessfully tostop. In one study, all participants reported increased urges to steal when tryingto stop (Grant & Kim, 2002a). The diminished ability to stop often leads tofeelings of shame and guilt, reported in most (77.3%) subjects (Grant & Kim,2002a). Of married subjects, less than half had disclosed their behavior to theirspouses due to shame and guilt (Grant & Kim, 2002a).Although people with kleptomania often steal various items from multipleplaces, the majority steal from stores. In one study, 68.2% of patients reportedthat the value of stolen items had increased over time (Grant & Kim, 2002a), afinding suggestive of tolerance. Patients may keep, hoard, discard, give as gifts,or return stolen items (McElroy et al., 1991). Many (64–87%) have been apprehendedat some time due to their behavior (McElroy et al., 1991), and 15–23%report having been jailed (Grant & Kim, 2002a). Although the majority of thepatients who were apprehended reported that their urges to steal were diminishedafter the apprehension, their symptom remission generally lasted only fora few days or weeks (McElroy et al., 1991). Together, these findings demonstratea continued engagement in the problematic behavior despite adverseconsequences, a core feature of addiction.Co-Occurring Disorders and Family HistoryHigh rates of other psychiatric disorders have been found in patients with kleptomania.Rates of lifetime comorbid affective disorders range from 59% (Grant& Kim, 2002a) to 100% (McElroy et al., 1991). The rate of comorbid bipolardisorder has been reported as ranging from 9% (Grant & Kim, 2002a) to 60%(McElroy et al., 1991). Studies have also found high lifetime rates of comorbidanxiety disorders (60–80%; McElroy et al., 1991, 1992), ICDs (20–46%; Grant,2003), SUDs (23–50%; Grant & Kim, 2002a; McElroy et al., 1991), and eatingdisorders (60%; McElroy et al., 1991).Individuals with kleptomania are more likely to have a first-degree relativewith a psychiatric disorder compared to nonaffected controls (Grant, 2003), Inaddition, high rates of mood (20–35%) and substance use disorders (15–20%)have been observed in first-degree relatives of patients with kleptomania(McElroy et al., 1991).TreatmentPharmacotherapyOnly case reports, two small case series, and one open-label study of pharmacotherapyhave been performed for kleptomania. Given the high placebo responserates observed in the treatment of ICDs, findings from these studies should beinterpreted cautiously. Various medications have been studied in case reports or