Showing posts with label shoplifting. Show all posts
Showing posts with label shoplifting. Show all posts

Monday, February 16, 2015

Troubling Link Between Shoplifting and Suicide


Compulsive theft can lead to tragic results.

In the fall of 2011, 71-year old Julia Grodinsky of London was convicted of shoplifting ornamental crystals and sentenced to 18 months of probation. What made the case unusual was that Grodinsky had been convicted of shoplifting 63 times over the past 60 years. It seems likely that the elderly thief will continue to steal, given her history of poor decision-making.

In The Republic, Plato asked whether thieves are made or born. It’s an excellent question. Kleptomania, as it is traditionally called, is a special class of theft behavior: a chronic condition marked by compulsive stealing, often committed by people who could easily afford to buy what they steal. Brian L. Odlaug, a visiting researcher with the faculty of health and medical sciences at the University of Copenhagen, believes that kleptomania’s primary feature is that it strikes "people who had a good marriage, nice home, great job—and yet could not stop from stealing inconsequential items." It is a rare disorder, he notes, “while sociopathy and theft for gain are quite common.”

Curiously, the stealing never seems to be about money: The most recent study measuring income and shoplifting shows that people in the United States with incomes over $70,000 shoplift 30 percent more than those earning less than $20,000 a year. Today, compulsive shoplifting is labeled in the DSM-IV as an impulse control disorder. But historically this controversial diagnosis was variously seen as a biological disorder brought on by female agitation in department stores, an expression of repressed Freudian sexual desire, or a socially constructed disease that blossomed as a reaction to modernity. (A modest majority of shoplifters are women). Some observers in the early 20th Century even described kleptomania as a clever trick by psychiatrists to worm their way into law courts as purveyors of expert testimony.

Researchers today are more likely to be interested in what researcher Jon E. Grant, professor of psychiatry and behavioral neuroscience at the University of Chicago’s Pritzker School of Medicine, calls the “neurocognitive sequelae of shoplifting.” Grant and Orlaug are part of a group of psychiatric researchers who have been studying compulsive shoplifting for more than a decade. In the Archives of Suicide Research, lead author Odlaug documented abnormally high suicide rates among a group of 107 participants with kleptomania, 24.3 percent of whom had reported at least one suicide attempt. That figure is “6 to 24 times higher than in the United States general population,” according to the report—roughly similar to the rate of suicide attempts among patients with schizophrenic disorders. It is higher than the rate of suicide attempts reported in cases of major depressive disorder (16.5 percent).

93 percent of the participants reported that their suicide attempt “was directly or indirectly due to their kleptomania symptoms (e.g., shame over the behavior; legal or personal problems resulting from shoplifting).” Believed to be the first attempt to survey the association between suicide and shoplifting, the study also teased out a strong association between bipolar spectrum disorder and kleptomania symptoms. The odds of a past suicide attempt were five times greater for kleptomania subjects who had also been diagnosed with bipolar disorder.

“The suicide data are very troubling,” says Grant. “No one screens for this behavior, or when they are told about, most clinicians are very dismissive of it. There is definitely an attitude about kleptomania that it is more of a criminal problem.”

Dr. Howard Shaffer, an associate professor at Harvard Medical School and director of the division on addiction at The Cambridge Health Alliance, who was not involved in the research, says that the work “seems a reasonable heads-up for clinicians to consider the role of impulsivity and its impact on suicidal ideation and behavior; kleptomania is one kind of proxy for impulsivity.”

Compulsive shoplifting is commonly associated with substance abuse, pathological gambling, personality disorders, and bipolar syndrome, while sometimes overlapping with other impulse control disorders. Does it share common neurobiological deficits with these conditions? In a report published in Comprehensive Psychiatry, Grant and co-workers recruited young adults with no history of substance abuse or recognized mental health disorders, and ran them through a barrage of psychological testing. For the investigators, the important question was whether compulsive stealing is associated with certain neuropsychological dysfunctions that make kleptomaniacs different from other people. As it turned out, people with kleptomania risked more points in a test called the Cambridge Gambling Task, with results “similar to previous reports in people with damage to the ventromedial prefrontal cortices.” It was an admittedly small study, but the researchers think the results show that shoplifting is not just a rash act, but one associated with “specific decision-making and working memory deficits.”

A small neuromaging study published by Grant in 2006 showed evidence of “compromised white matter microstructure in inferior frontal areas,” suggesting to Grant that the frontal parts of the brain involved in decision making “may not be as healthy.” For his part, Odlaug thinks this finding may help explain “why so many patients report an 'irresistible' impulse to steal and a failure to inhibit that impulse.” Odlaug cautions that while deficits of executive functioning appear to be involved, “I think it is far too early to suggest cognitive predictors of kleptomania or other disorders characterized by impulse control deficits.”

Neuroscientist Marc Lewis, professor of human development and applied psychology at Radboud University in Nijmegen, The Netherlands, and author of Memoirs of an Addicted Brain, also questions whether sufficient data existed for asserting a link between impulsive behavior and working memory deficits. However, Lewis agrees that kleptomania “is seemingly its own disorder,” and “overlaps only partially with other psychiatric categories.”

Can kleptomania be cured, or treated successfully? In 2009, in an article for Biological Psychiatry, Grant and colleagues recorded the results of their work with 25 patients with kleptomania who were given high doses of naltrexone, a drug that blocks opioid receptors and is used to treat alcoholism and heroin addiction. All of the participants had been arrested, and had spent at least one hour per week stealing. The 8-week study, believed to be the first placebo-controlled trial of a drug for the treatment of shoplifting, resulted in a remission of symptoms in two-thirds of those on naltrexone. Says Odlaug: “With such a dearth of treatment data available, naltrexone appears to be the first-line treatment at this time. We have found that naltrexone at slightly higher doses is beneficial for a number of folks with kleptomania.” Some researchers are also investigating use of cognitive behavioral therapies.

“Kleptomania is thought of as a behavioral addiction within addiction circles,” Odlaug adds, while conceding that not everyone agrees with the concept of addiction to behaviors rather than substances. The neuropsychological approach to uncontrollable shoplifting as by no means unanimous. Writing in Global Society, Thomas Lenz and Rachel MagShamhrain argue that kleptomania is an “invented disease,” coinciding with the rise of the department store and strong beliefs in feminine “hysteria.”

“I think the general view,” says Grant, “is that criminal issues, or potential criminal issues, are not as biological as, say, depression. It then becomes a vicious cycle, as lack of research then continues to justify why people say it is not really biological or psychological.”

Lamentably, the connection between bipolar syndrome and shoplifting did not become apparent until recently, because people with bipolar symptoms are routinely ruled out of clinical studies of impulse control disorders. “Screening for people with co-occurring bipolar affective disorder and kleptomania is extremely important,” Odlaug stresses. “Especially in psychiatric settings where kleptomania and other impulse control disorders often go unrecognized by clinicians.”

(By Dirk Hanson. Originally published February 11, 2013, by the Dana Foundation.)


Thursday, September 1, 2011

Is Shoplifting the Opiate of the Masses?


Another look at "behavioral addictions" and the DSM-V.

The DSM-V, when it debuts it 2012, is set to replace the category of “Substance-Related Disorders” with a new category entitled "Addiction and Related Disorders."  Gambling is the only behavioral addiction currently recommended for inclusion, but some experts have set their sights on shoplifting—an activity that is even more difficult to picture as a legitimate addiction than gambling. Or is it?

Long before gambling was widely looked upon as an addictive disorder, compulsive shoplifting already had a name: kleptomania. The National Association for Shoplifting Prevention claims that about 9-10% of the population show a “lifetime prevalence” for shoplifting. This is remarkably similar to the percentages commonly bandied about for alcoholics, drug addicts, unipolar depressives,  compulsive gamblers, and compulsive overeaters.

A recent University of Florida survey pegged shoplifting losses, or “shrink,” in 2009 at more $11 billion annually. Plato, in The Republic, wanted to know whether thieves are made or born. It’s a good question. Curiously, the stealing doesn’t seem to be about money: The most recent study measuring income and shoplifting shows that Americans with incomes over $70,000 shoplift 30% more more than their fellow citizens earning less than $20,000 a year. And the actual items stolen by compulsive shoplifters often seem nonsensical, or even surreal. As director John Waters said of Pink Flamingos’ star and compulsive shoplifter Divine: “I saw him walk out of a store once with a chain saw and a TV.”

There is a definite “rush” to the act of stealing, writes Rachel Shteir in The Steal, her informative book about shoplifting. One shoplifter said it was equal to drugs but only lasted a few minutes—“And you’re back to yourself again. In your mind, you think, It was all for a stupid blouse, or stupid soap. For this, I risked everything.” Another source quoted in the book says, “I shoplifted every day, like someone with a drug addiction.”  Seconds before another women is arrested, she quizzes herself: “All she needs in the world is one crummy formal dress so why is there a blue silk jacket, one that she doesn’t particularly like, in her camera bag?” And a shoplifting Lee Grant says in the movie Detective Story: “I didn’t need it. I didn’t even like it.” The objects seem to lose their intrinsic value once they have been stolen, and the shoplifter must get high again with another theft.

If, as some neurobiological researchers insist, addictive disorders are not independent disorders, but outward manifestations of an underlying disease pathology called addiction syndrome, then the definition might be stretched to include gambling, shoplifting, and certain other “activity-based expressions of addiction.” Sometimes the alcoholic, the drug addict, the depressive, the compulsive gambler, and the obsessive overeater are all one and the same person. And drug addicts show a remarkably ability to substitute one drug for another. Perhaps a recovering cocaine addict might hope to assuage that sense of craving, of inchoate need, through excessive gambling. Or a shoplifter might use alcohol as a means of dampening the impulse to steal compulsively. While we don’t use the term kleptomania anymore, “shoplifting crops up as a symptom of many types of mental illnesses—bipolar disorders and anxiety disorders as well as substance abuse, eating disorders, and depression,” writes Shteir. Compulsive shoplifting, Shteir concludes, is “as difficult to stamp out as oil spills or alcoholism.”

For some, shoplifting brings a rush “similar to a cocaine or heroin high,” according to psychiatist Jon Grant at the University of Minnesota School of Medicine. To find out just how similar, psychiatrists there tried treating shoplifters with naltrexone, a drug that blocks opioid receptors and is used to treat alcoholism and heroin addiction. In 2009, in an article for the April issue of Biological Psychiatry, Grant and colleagues at the University of Minnesota School of Medicine recorded the results of their work with 25 kleptomaniacs, most of them women. All of the participants had been arrested for shoplifting at least once, and spent at least one hour per week stealing. The 8-week study is believed to be the first placebo-controlled trial of a drug for the treatment of shoplifting. In the April 10 issue of Science, Grant said that “Two-thirds of those on naltrexone had complete remission of their symptoms.”

Photo Credit: http://www.zawaj.com
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