In the Prime Video series Dupahiya, the young protagonist Amavas is quickly concluded to be the village thief in Dhadakpur for years, judged and eventually expelled from the village without anyone pausing to ask why he steals unnecessary and even undesirable things for himself, or offering him the support to understand his own behaviour. However, this psychiatric condition that real people also suffer from is much more complicated than the villainous gold digger stereotype.
Kleptomania is defined as a recurrent failure to resist impulses to steal items that are not needed for personal use or their monetary value (American Psychiatric Association, 2013). In kleptomania, a person experiences the tension preceding the theft and subsequently feels better and calmer after the deed, whereas the desire to steal is not prompted by the need or intent to use the stolen items.
Kleptomania has specific symptoms and treatment modalities; this article will discuss the urge-thief-relief cycle, as well as guilt and associated conditions, elaborate on the rationale and effectiveness of the various treatments, and attempt to answer what help Amavas may require in the context of the show.
Understanding Kleptomania
According to DSM-5, kleptomania is “an impulse control disorder characterized by recurrent failures to resist impulses to steal items that are not needed or wanted,” and it does not entail the desire to harm others or to retaliate (American Psychiatric Association, 2013). The tension preceding the theft and satisfaction/calm after the act are key symptomatic features according to DSM-5 (American Psychiatric Association, 2013). McElroy et al. (1991) note that tension before the incident, satisfaction after it, and the possibility for stolen items to be unneeded or unwanted were critical diagnostic criteria in their case series of kleptomania patients. Furthermore, the authors add that the studied patients stole items, returned them, hid them, or did not know the owner, with the episodes per se not causing distress to the thieves (McElroy et al., 1991).
Kleptomania is diagnosed rarely (0.3-0.6%) and predominantly affects females, with a peak in adolescence (Grant & Odlaug, 2008). This disorder significantly impacts the lives of those diagnosed, as do shoplifting and other impulse control abnormalities (McElroy et al., 1991). Kleptomania patients, like Amavas, face challenges getting an accurate diagnosis with available treatments because society views this condition, incorrectly, as deliberate and dishonest behavior. Amavas reflects several of these exact criteria: the items he takes, such as a saree, hold no practical use or value for him personally, yet Dhadakpur reads his behaviour as calculated dishonesty rather than a symptom of a disorder he has never had named or explained to him.
The Cycle of Urge, Act, and Relief
Kleptomania is driven by the tension urge cycle wherein the sense of tension is only alleviated momentarily through stealing (Goldman, 1991). The feeling preceding the incident is difficult to describe but comparable to the craving addicts experience for a certain substance (Goldman, 1991). Researchers note tension, incident, and relief in kleptomania to be analogous to the same symptoms in substance addiction; thus, treatment for kleptomania largely overlaps with addiction treatment (Grant et al., 2010). Specifically, the opioid antagonist naltrexone is discussed in detail below.
The tension experienced before stealing is the most detrimental symptom of kleptomania and the core of the disorder (McElroy et al., 1991). Patients diagnosed with kleptomania report acquiring items for tension relief and describe a brief satisfaction following the incident (McElroy et al., 1991). The tension urge cycle of stealing causes only short-term relief because, typically, the benefits are fleeting, and the guilt ensuing upon the realization of the consequences does not outweigh them (Goldman, 1991). According to McElroy et al. (1991), people with kleptomania often describe their stealing as the only viable solution to their problems.
They further add that the guilt experienced alongside the tension before stealing and legal/social fallout after it are often additional stressors (McElroy et al., 1991). The tension-urge cycle is very similar to substance seeking/maintenance and the experience of substances for persons addicted to drugs (Grant et al., 2010). Amavas’s own restlessness in the moments before each theft, followed by a visible easing once the act is complete, mirrors this exact cycle, offering a dramatized but recognisable window into what the diagnostic literature describes in clinical terms.
The Weight of Guilt and What Conditions Commonly Come With It
The tension preceding stealing in kleptomania rarely ends by itself with the incident. First, the feeling of satisfaction that may be described as happiness or euphoria is short lived and soon turns into guilt for stealing, experiencing legal consequences, or both (Grant & Odlaug, 2008). Grant and Odlaug (2008) note that kleptomania causes “intense feelings of guilt, legal and social repercussions, and negative impact on family and occupational domains” (p. 211). The guilt associated with kleptomania is connected to patients’ awareness of the guilt being unwarranted, which does not alleviate the distress (Goldman, 1991). In other words, kleptomania causes guilt without the corresponding benefits associated with guilt (Goldman, 1991).
The co-occurrence of other psychiatric conditions with kleptomania ranges between 82 and 100% in the case series available in the literature. Specifically, patients with kleptomania frequently present to the clinician with mood, anxiety, and other impulse control disorders (Grant & Odlaug, 2008). Lifetime prevalence rates of mood disorders among kleptomania patients were as high as 45-100%, according to multiple studies reviewed by Grant and Odlaug (2008). The impact of these comorbidities is very detrimental, as evident from the study describing them (Odlaug et al., 2012).
The study in question used a sample of 107 young adults/kids with kleptomania and found that, as a result of their disorder or its consequences, nearly a quarter made suicide attempts, with legal, social, and guilt related problems being the cause of the attempts (Odlaug et al., 2012). Thus, the study provides evidence for guilt and the consequences of kleptomania being key drivers for suicidal thoughts.
In turn, this information provides evidence for the need for the treatment for kleptomania, as well as other disorders, being imperative for many diagnosed with kleptomania. Amavas’s own quiet, guilt-ridden demeanour after each incident, and the shame that visibly follows him through the village long before any formal diagnosis is ever considered, reflects exactly this pattern of guilt without the psychological relief that guilt is supposed to provide.
Read More: How Guilt and Regret Shape Our Decisions, Character, and Emotional Well-Being
Receiving Help: Treatment and Why Understanding Matters
In kleptomania, the treatment is psychotherapy and pharmacotherapy. However, the evidence for the effectiveness of pharmacologic treatment is limited to case series due to the difficulty of performing controlled studies in this area (McElroy et al., 1991). Cognitive behavioral therapy (CBT) is effective in the treatment of kleptomania. According to Kohn and Antonuccio (2002), the most effective forms are covert sensitization and behavioral therapy. The most effective pharmacologic treatment for kleptomania at present is naltrexone, an opioid receptor antagonist, whose effectiveness in decreasing urges and incidents is discussed below.
Naltrexone was tested on a sample of 33 kleptomania patients and was found to reduce symptoms compared to placebo. Thus, it was found effective in the treatment of kleptomania (Grant et al., 2009). The study by Grant et al. (2009) further demonstrates some similarity to substance use disorders by noting that patients in the naltrexone group reduced the number of stealing incidents by 50%, compared to 27% in the placebo group (Grant et al., 2009). The effect of naltrexone is substantial but relatively modest, and the study’s sample was small. Combined treatment, or the combination of CBT and pharmacologic treatment, is likely to be the most effective because it addresses both the cognitive and the behavioral parts of kleptomania. However, in all cases, the most crucial step in treating kleptomania is referring the patient to the specialized and qualified provider.
In Amavas’s case (Dupahiya), his family/community would be his source of help. Kleptomania is an impulse control abnormality, and the best treatment for it is the recognition of the disorder by his family/community. If the village labeled him the village thief, it may not understand the disorder as one and may not attempt to address the issue from the perspective of impulse control and the necessity to address it accordingly. The recognition by the family/community would entail understanding the tensions preceding Amavas’s stealing, the urge itself, the satisfaction or relief, and the guilt following it. Furthermore, the fact that the 17 year old uses the stolen item (saree) is further evidence of kleptomania. Addressing the issue of Amavas’s kleptomania would be a communal effort.
Conclusion
Kleptomania is a psychiatric condition not driven by greed or lack of morals, as it is often stereotyped, and can be effectively treated, as discussed. Kleptomania patients, such as Amavas from Dupahiya, are people who steal impulsively, experience tension before the incident, and subsequent satisfaction or euphoria. However, they also feel guilt for stealing, especially when the consequences of stealing are considered, such as legal ones.
Kleptomania treatment involves the application of CBT to alter the patients’ perspectives, as well as pharmacologic treatment using naltrexone, an opioid antagonist, to reduce urges. If Amavas’s family recognizes these symptoms and the condition, he may receive the help he needs. In real life, when such symptoms are suspected in a person, it is important to refer them to a professional, as kleptomania, like all mental disorders, is best treated individually and can only be overcome when the patient realizes that it is a problem.
References +
- American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). https://doi.org/10.1176/appi.books.9780890425596
- Goldman, M. J. (1991). Kleptomania: Making sense of the nonsensical. American Journal of Psychiatry, 148(8), 986–996. https://doi.org/10.1176/ajp.148.8.986
- Grant, J. E., Kim, S. W., & Odlaug, B. L. (2009). A double-blind, placebo-controlled study of the opiate antagonist, naltrexone, in the treatment of kleptomania. Biological Psychiatry, 65(7), 600–606. https://doi.org/10.1016/j.biopsych.2008.11.022
- Grant, J. E., & Odlaug, B. L. (2008). Kleptomania: Clinical characteristics and treatment. Revista Brasileira de Psiquiatria, 30(Suppl 1), S11–S15. https://doi.org/10.1590/S1516-44462006005000054
- Grant, J. E., Odlaug, B. L., & Kim, S. W. (2010). Kleptomania: Clinical characteristics and relationship to substance use disorders. American Journal of Drug and Alcohol Abuse, 36(5), 291–295. https://doi.org/10.3109/00952991003721100
- Kohn, C. S., & Antonuccio, D. O. (2002). Treatment of kleptomania using cognitive and behavioral strategies. Clinical Case Studies, 1(1), 25–38. https://doi.org/10.1177/1534650102001001003
- McElroy, S. L., Pope, H. G., Jr., Hudson, J. I., Keck, P. E., Jr., & White, K. L. (1991). Kleptomania: A report of 20 cases. American Journal of Psychiatry, 148(5), 652–657. https://doi.org/10.1176/ajp.148.5.652
- Odlaug, B. L., Grant, J. E., & Kim, S. W. (2012). Suicide attempts in 107 adolescents and adults with kleptomania. Archives of Suicide Research, 16(4), 348–359. https://doi.org/10.1080/13811118.2013.722058
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