Kleptomania

Disease Description (Causes and Symptoms)

• Definition: A personality disorder characterized by overall instability of self-image (ego), emotions, and interpersonal relationships, as well as high impulsivity; marked by severe mood swings, chronic feelings of emptiness, and unstable interpersonal relationships.
• Main causes (multifactorial)
  • Psychosocial factors: Childhood abuse or neglect, attachment problems, inconsistent parenting, etc.
  • Biological/genetic factors: Possible functional and structural changes in brain regions involved in emotional regulation (the amygdala, prefrontal cortex, etc.), changes in neurotransmitters (such as serotonin), and changes in the stress axis (HPA axis)
  • Interaction between genetic vulnerability and environmental stress
• Pathophysiology (summary): Amygdala hyperactivation that excessively triggers emotional responses, reduced regulatory function of the prefrontal cortex that inhibits these responses, and hypersensitivity of the stress response are involved in the underlying mechanisms of emotional instability, impulsivity, and interpersonal problems.
• Main symptoms
  • Rapid fluctuations in emotions (anger, sadness, feelings of emptiness, etc.)
  • Extreme idealization↔devaluation (unstable relationships)
  • Impulsive and self-destructive behaviors (substance abuse, binge eating, gambling, reckless driving, etc.)
  • Repeated self-harm, suicide attempts, or threats
  • Chronic feelings of emptiness and identity confusion (unstable self-image)
  • Transient delusional thinking and dissociative symptoms (during severe stress)
• Diagnosis: There is no standardized test; diagnosis is clinical (based on criteria such as those in the DSM-5). Symptoms usually begin in early to mid-adulthood, and diagnosis is made by identifying patterns that persist across multiple situations.
• Common comorbidities: Depression, bipolar disorder, anxiety disorders, substance use disorder, other personality disorders (such as antisocial or paranoid personality disorder), and dissociative disorders

Treatment Methods

• First-line treatment: Psychotherapy (psychosocial intervention)
  • Evidence-based treatment: Dialectical behavior therapy (DBT) — effective for managing impulsive self-harm and suicide risk
  • Mentalization-based treatment (MBT), transference-focused psychotherapy (TFP), schema therapy, and others are also used
• Medication treatment
  • Used as an adjunct to alleviate core symptoms (there is no medication that changes the core personality traits themselves)
  • Examples of symptom-specific prescriptions: Antidepressants (for depression and anxiety), mood stabilizers (for affective fluctuations and impulsivity), antipsychotics (for severe impulsivity and perceptual abnormalities)
  • Medication should be prescribed cautiously, taking the risks of suicide and overdose into consideration
• Emergency and inpatient treatment
  • Short-term hospitalization or ensuring safety is necessary in cases of suicide risk or serious self-destructive behavior
• Lifestyle management and supportive treatment
  • Regular sleep, meals, and exercise; avoidance of drugs and alcohol; stress management; and structuring a stable daily routine
  • Family education and family therapy (strengthening the support system and setting boundaries)
• Precautions (during treatment)
  • Consistency and stability in the therapeutic relationship are important (to prevent premature discontinuation of treatment)
  • Medication is intended to alleviate symptoms, and more active management is needed when there is suicide risk
  • Establishing coordination between hospitals and clinics (emergency contact information and a crisis response plan) is recommended
• Risk of complications
  • Repeated self-harm, suicide attempts and death (some literature reports high suicide rates in a proportion of cases), chronic impairment in occupational and relationship functioning, and substance abuse

Checklist Before an Outpatient Visit (Including Example Questions)

• Items to bring
  • A list of medications currently being taken (including those recently discontinued) and their dosages
  • Records related to past diagnoses, hospitalizations, suicide attempts, and self-harm (including dates and course, if possible)
  • A record of recent symptom changes (mood fluctuations, examples of impulsive behaviors, and triggers)
  • Whether alcohol or drugs are being used and the frequency of use
  • Lifestyle patterns (sleep, meals, work, and interpersonal circumstances)
  • Emergency contact information (family and acquaintances) and treatments already being used (type and frequency of psychotherapy)
• Things to consider in advance before the outpatient visit
  • Immediately report whether there have recently been thoughts of self-harm or a suicide plan or behavior
  • Current risk status (e.g., access to tools for self-harm)
• Example questions to use during an outpatient visit (to be prepared by the patient or caregiver)
  • "How often have you recently had thoughts of self-harm or suicide? Do you have a plan?"
  • "Have you recently engaged in impulsive behavior (such as substance abuse or excessive spending)?"
  • "In what situations do your emotions become highly unstable? Are there any triggers?"

Examples of General Questions to Ask the Doctor

• How will this treatment (the recommended psychotherapy) help my symptoms? How long will treatment take, and what level of benefit can I expect?
• What are the main side effects of the prescribed medication? What safety instructions are related to the risk of overdose?
• What immediate action should be taken when suicide risk is high? What are the emergency contact details or criteria for hospitalization?

Examples of Condition-Specific Questions

• Are there any institutions (or groups) where I can receive DBT (dialectical behavior therapy)? What are the enrollment and waiting-list procedures?
• In my case (e.g., repeated self-harm or severe substance abuse), how should medication treatment and psychotherapy be combined?

(Note: Diagnosis and treatment may vary depending on the individual’s condition. Please consult your treating specialist for an accurate evaluation and treatment plan.)