The urge to steal- kleptomania: Part 2

Like all things in mental health, the cause of kleptomania remains a puzzle. It is believed to be to an abnormality in one the brain neurotransmitters called serotonin. Kleptomania is rare but the actual numbers of people affected remain unknown. Less than 5% of people caught for shoplifting are kleptomaniacs. The disorder usually starts in early childhood and peaks in the 2^nd decade of life. Risk factors for kleptomania include head trauma, life stress, having a family member with a mental health disorder (mood disorder, addiction or impulsivity). Doctors use the criteria stated in DSM to make a diagnosis of kleptomania. If kleptomania is untreated, it usually leads to legal, financial and emotional problems. Most kleptomaniacs know that stealing is wrong but are powerless to resist the urge to steal. Many of them are left with residual feelings of remorse, disgrace, embarrassment and self-loathing. Often kleptomania is associated with other disorders like alcohol and drug abuse, eating disorders, compulsive gambling, social isolation, depression, anxiety and suicidal thoughts.

Kleptomania is difficult to overcome with self-treatment at home. There are no standard treatments for the disorder and doctors use a combination of medications and psychotherapy to help overcome the impulse to steal. Even though medications like anti depressants and mood stabilizers are used, there is no clinical evidence that these medications help overcome kleptomania. Moreover, the same medication does not work in all individuals. Most of the medications relieve stress, cause generalized sedation and diminish the urge to steal. The major thrust of treatment is psychotherapy. Cognitive behavioral therapy has been used to identify unhealthy negative behaviors and replace them with healthy positive attitudes. CBT can gradually help people overcome kleptomania, but the treatment is long term and expensive.

To prevent relapse, individuals are urged to develop a support system. This may means educating one's self about the disorder, adopting healthy attitudes, learning to relax and remaining focused. Since the cause of kleptomania is unknown, it is difficult to prevent it. The best way to treat it is to seek help early. Overall, the prognosis of kleptomania depends on the severity of the condition. Those in the early stages can overcome the disorder but those with a long history often end up in legal and financial problems.

The urge to steal- kleptomania: Part 1

Kleptomania is the overwhelming urge to steal items that one really does not need or have little value. Kleptomania is a serious social problem as it can create havoc in a person’s life if it is not treated early. The impulse to steal is very strong and people have no control over it. Unfortunately, because of the taboo associated with the diagnosis of “thief” most people with this disorder remain silent and never seek therapy. Most people only seek treatment when they are caught and in legal difficulties. 

The symptoms of kleptomania may include1) an irresistible urge to steal items not needed 2) a heightened stress just prior to the steeling 3) feeling delight to fulfillment while stealing and 4) feeling intense guilt or disgrace after the theft.

What must be understood is that unlike the typical shoplifter, kleptomaniacs do not steal for personal gain nor do they commit the theft as a means of revenge. The stealing is done because of the intense urge that is beyond control. Until they steal, these individuals feel anxious, tensed, and extremely hypersensitive. To resolve these feelings they steal.

Kleptomania occurs spontaneously and is rarely a planned event. Sometimes a simple argument may trigger an episode of kleptomania. Kleptomaniacs may steal from public places, from friends and family or from work. Men tend to steal “hard” items whereas many women steal jewelry, undergarments or private letters. In many cases, the same items are repeatedly stolen and there may be an ingredient of fetishism.

Schizoaffective Disorder: Part 2

Like most psychiatric disorders, diagnosis is based on clinical features. Most physicians will also perform laboratory tests to ensure that the effects are not due to illicit drugs or any other medical disorder like HIV, temporal lobe epilepsy, hypothyroidism or prolonged steroid usage.

Individuals with schizoaffective disorder usually require both medications and psychotherapy. Both anti psychotics and mood stabilizing drugs are used to treat these individuals. Psychotherapy can help diminish distorted or negative thoughts, improve social skills and boost self-confidence. Family or group therapy has been found to be more effective in helping people deal with real life issues. Family group therapies also provide a decrease in social isolation and helps maintain a check on the psychotic episodes.

The overall prognosis for patients with schizoaffective disorder is better than those with schizophrenia but treatment is life long. Unfortunately, most people tend to develop severe depression or mania and eventually become non-complaint with therapy. Many end up with legal problems and remain confined to psychiatric facilities.

Schizoaffective Disorder: Part 1

Schizoaffective disorder is a mental health disorder where an individual experiences a mixture of schizophrenia symptoms (hallucinations, paranoia or delusions) and of mood disorder symptoms (mania or depression).

The majority of individuals with schizoaffective disorder are loners and have difficulty holding jobs or attending school. Most end up living in a group homes or in a psychiatric facility. The symptoms of schizoaffective disorder are variable and range from paranoia, delusions, strange perceptions, hallucinations, disorganized thinking and paranoid thoughts — as well as a mood disturbance, such as depressed or manic mood. Other features may include bizarre thoughts like suicide or homicide, deficits in attention and memory, lack of concern for hygiene, change in appetite and profound sleep disturbances. These individuals are very antisocial and are usually shunned by people around them.  Most of these individuals are simply not able to function in society because the variety of symptoms which can be quite intense.

In many cases, the psychotic features and mood disturbances may appear in the same setting or may cycle on regular intervals. The major problem with schizoaffective individuals is that they rarely seek treatment on their own; most are brought to medical attention by concerned family members or law enforcement.

The cause of schizoaffective disorder is not known but believed to be due to an imbalance of certain brain neurotransmitters. Some experts speculate that exposure to chemicals during pregnancy or a viral illness may be responsible for the illness.

Agoraphobia: Fear of Spaces Part 2

While agoraphobia is not life threatening, it can severely limit one’s life style. Without treatment, many people are not able to leave their home. These individuals become entirely dependent on others for food, money or any other type of daily living activity. With time, depression and anxiety set in and many of these individuals turn to alcohol/substance abuse to help cope with the loneliness, seclusion and shame.

The treatment of agoraphobia is taxing and usually means facing one’s fears. The basic treatments include medications and psychotherapy. Current medications used to treat these individuals include SSRIs like Paxil, Zoloft or Prozac. Additional medications may include an anti anxiety medication like xanax or clonazepam. Drug treatment alone is seldom sufficient for control of agoraphobia and several types of psychotherapy may help. Cognitive behavior therapy helps change detrimental behaviors through desensitization. One also learns methods to cope with symptoms via relaxation techniques. For those who are afraid to leave the home to visit a psychotherapist, one can arrange treatment sessions at home or in a safe neighborhood.  Of course, this also adds to the expense and more importantly, psychotherapy is not cheap.
Self-care remedies that may help cope with agoraphobia include learning reassuring skills, practicing relaxation techniques, and not avoiding feared spaces. There are many online support groups where one can reach out for help. 

The overall prognosis of individuals with agoraphobia depends on the severity of symptoms. If medications are discontinued, relapse is common. Transient improvements do occur but overall most individuals lead a poor quality of life.