Psych · General adult psychiatry — impulse control
Kleptomania and pyromania
Also known as Pathological stealing · Pathological fire-setting · Impulse-control disorder theft · Impulse-control disorder arson · Kleptomanic stealing · Pyromaniac fire-setting
Exam-exhaustive fellowship reference on kleptomania and pyromania — DSM-5-TR and ICD-11 criteria, urge–act–aftermath phenomenology, epidemiology and comorbidity, differentials from instrumental theft/arson mania SUD CD/ASPD, assessment and MIDI concept, CBT and stimulus control, Grant naltrexone RCT with LFT/opioid counselling, Koran escitalopram nuance, multi-agency arson risk and post-arrest suicide assessment. FRANZCP-primary, globally tagged.
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Target exams
Red flags
- Active arson intent, accelerants, or repeated fire-setting with public-safety risk — multi-agency response before nosology debates
- Post-arrest or post-disclosure suicidal crisis after shoplifting or fire-setting — structured suicide assessment is mandatory
- Theft or fire-setting only during mania, psychosis, or intoxication — do not diagnose primary kleptomania/pyromania without exclusion work-up
- Instrumental theft for need/gain or arson for revenge, fraud, protest, or crime concealment mislabelled as impulse-control disorder
- Starting naltrexone without baseline LFTs or while opioids are on board (precipitated withdrawal)
- Collusive family secrecy that leaves retail victims or the public at ongoing fire risk
Meet the patient
A 41-year-old primary school teacher is referred after her second arrest. Both times, the same supermarket. Both times, items she could afford and did not want: a jar of pickled walnuts, a phone charger for a phone she does not own. Both times, she paid for a full trolley of shopping on the way out.[3][4]
She describes the ten minutes before as a physical pressure building behind the sternum, the moment itself as relief, and the two days afterwards as unbearable. The pickled walnuts are still in the boot of her car, unopened, along with about forty other things.[4][14]
She has told nobody. Her partner found out from the police. She has been reading about how her registration might be affected. Two questions are live: does she meet criteria for kleptomania, and is she safe between now and the hearing? The second one is the one that kills people.[4][11]
References14ShowHide
- [1]Grant JE, Kim SW, Odlaug BL A double-blind, placebo-controlled study of the opiate antagonist, naltrexone, in the treatment of kleptomania Biol Psychiatry, 2009.PMID 19217077
- [2]Grant JE, Won Kim S Clinical characteristics and psychiatric comorbidity of pyromania J Clin Psychiatry, 2007.PMID 18052565
- [3]McElroy SL, Pope HG Jr, Hudson JI, et al. Kleptomania: a report of 20 cases Am J Psychiatry, 1991.PMID 2018170
- [4]Grant JE, Kim SW Clinical characteristics and associated psychopathology of 22 patients with kleptomania Compr Psychiatry, 2002.PMID 12216013
- [5]Koran LM, Aboujaoude EN, Gamel NN Escitalopram treatment of kleptomania: an open-label trial followed by double-blind discontinuation J Clin Psychiatry, 2007.PMID 17388713
- [6]Grant JE, Odlaug BL, Kim SW Kleptomania: clinical characteristics and relationship to substance use disorders Am J Drug Alcohol Abuse, 2010.PMID 20575650
- [7]Dell'Osso B, Altamura AC, Allen A, Marazziti D, Hollander E Epidemiologic and clinical updates on impulse control disorders: a critical review Eur Arch Psychiatry Clin Neurosci, 2006.PMID 16960655
- [8]Schreiber L, Odlaug BL, Grant JE Impulse control disorders: updated review of clinical characteristics and pharmacological management Front Psychiatry, 2011.PMID 21556272
- [9]Grant JE, Levine L, Kim D, Potenza MN Impulse control disorders in adult psychiatric inpatients Am J Psychiatry, 2005.PMID 16263865
- [10]Odlaug BL, Grant JE Impulse-control disorders in a college sample: results from the self-administered Minnesota Impulse Disorders Interview (MIDI) Prim Care Companion J Clin Psychiatry, 2010.PMID 20694115
- [11]Burton PRS, McNiel DE, Binder RL Firesetting, arson, pyromania, and the forensic mental health expert J Am Acad Psychiatry Law, 2012.PMID 22960918
- [12]Chamberlain SR, Grant JE Minnesota Impulse Disorders Interview (MIDI): Validation of a structured diagnostic clinical interview for impulse control disorders Psychiatry Res, 2018.PMID 29772488
- [13]Grant JE, Kim SW An open-label study of naltrexone in the treatment of kleptomania J Clin Psychiatry, 2002.PMID 12000210
- [14]Grant JE Understanding and treating kleptomania: new models and new treatments Isr J Psychiatry Relat Sci, 2006.PMID 16910369