Snapshot A 15-year-old girl is brought to pediatrician by her parents for a routine physical before starting a new school year. The patient describes feeling extremely worried about classes and having to deal with the "drama" of being social back at school. Her parents ask whether her feelings of anxiety may have any relation to the fact that she has been acting "out of character" and committing various acts of petty theft in the past months. The patient was caught stealing several containers of toothpicks at the grocery store earlier in the week, and had an incident where she was almost arrested for tucking away several pairs of stockings into her bag at the mall last month. Introduction Overview kleptomania is the inability to resist the urge to steal items that may not be necessary nor valuable to the person Epidemiology incidence ~6 per 1000 people estimated to account for ~5% of shoplifting demographics female:male ratio is ~3:1 age of onset is usually in adolesence Pathophysiology unknown cause Associated conditions family history higher rates of obsessive-compulsive disorder and substance use disorders in relatives of people with kleptomania have psychiatric comorbidity (i.e. major depressive disorder, anxiety disorder, eating disorder, or alcohol use disorder) Presentation Symptoms inability to resist powerful urges to steal items that one does not need rising sense of tension leading up to theft pleasure, relief, or gratification while stealing guilt, remorse, shame, or fear after theft Differential diagnosis Shoplifting key distinguishing factor typical shoplifters steal for personal gain or out of rebellion, unlike patients with kleptomania who steal because they cannot resist the strong temptation Treatment Lifestyle cognitive behavioral therapy involves techniques to help control kleptomania urges Medical naltrexone opioid antagonist may ↓ urges and pleasure associated with stealing selective serotonin reuptake inhibitors may be indicated if patient also has depression Complications Severe emotional, family, work, and financial problems may result in depression, eating disorders, and anxiety relatives of people with kleptomania have higher rates of obsessive-compulsive, and substance use disorders psychiatric comorbidity is common major depressive disorder, bulimia nervosa, anxiety disorder, alcohol use disorder etc.