Relations between kleptomania and anxiety: some notes on the role of negative reinforcement*

Author: Vinícius Garcia

While treating a case involving response classes that characterized the so-called kleptomania, I performed a functional assessment of the behavior of compulsive stealing. The results strongly suggested that the behavior of stealing occurred only when the client was feeling anxious for long periods. The chronic anxiety for prolonged times always preceded episodes of stealing. As is common in cases of kleptomania, the client, in most cases, used to steal objects of little or no value. From the beginning, it was quite clear that the stolen objects or values ​​did not bear any relation with the material needs of the client.

Throughout therapy, the client was able to describe that when he was feeling very anxious under anxiogenic stimuli, over which he had no control, he used to engage in behavior that also produced anxiogenic contexts, but on which he could have relative control. That is, when feeling constantly and chronically anxious under various contexts involving uncontrollability, he then used to involve himself in contexts that could produce sudden and acute anxiety. These contexts, however,  were controllable. In such controllable contexts, he could be caught when stealing or he could get away and feel immediate relief from anxiety. This kind of behavior did not result in lasting relief from anxiety, only in immediate alleviation. The kleptomaniac behavior was therefore maintained by negative reinforcement by soften momentarily the chronic anxiety produced by previous uncontrollable anxiogenic stimuli, through the cessation of controllable anxiogenic stimuli.

I will not go into the details of the case, but clinical observation suggests that anxiety respondent behaviors and negative reinforcement may be important factors in some cases involving kleptomaniac behavior. While searching on the internet about some similar clinical observation, I surprisingly found little material produced by behavior analysts and a reference quite similar to the observation described here, but made by a gestalt-therapist (1). The behavior analytic references to negative reinforcement in cases of kleptomania boil down to a few excerpts in some psychiatric manuals (2), clearly not written by behavior analysts (due to the absence of conceptual rigor). Such psychiatric manuals refer to a hypothesis called “theory of self-medication”, which involves negative reinforcement.

Some treatments based on behavior analysis involved the use of aversive stimulation and were cited by Hodgins and Peden, in an article that also describes cognitive-behavioral treatments (3). In such behavior analytic treatment, therapists used a technique called covert sensitization, which involved the imagination of aversive situations related to kleptomaniac behavior. In one case (4), the client reported a reduction in the behavior of stealing, but no change in his "urges to steal." Another client (5) reported that “her urges were nearly diminished”. However, there was a record of a relapse in a 14 months follow-up. In a third case (6), the client, during a monitoring period of 10 weeks, reported three episodes of relapse. Such examples, opposed to the clinical observation mentioned above at the beginning of this post, suggest possible problems arising from the use of techniques without the prior completion of a detailed functional assessment of kleptomaniac behavior in each case.

If kleptomaniac behavior is maintained by negative reinforcement by stopping or lessen momentarily anxiogenic stimulations, aversive techniques such as those used in the studies cited by Hodgins and Peden may exacerbate the problem, since they can produce increased anxiety.  A more appropriate treatment in these cases should involve learning alternative behaviors that would produce the cessation or lessening of anxiety, perhaps associated with the use of anxiolytic medications in more severe cases. Another promising line of action may involve the increasing of the client sensitivity to the delayed consequences of his behavior.

* The discussion of the clinical case with friend and behavior analyst Junio ​​Rezende contributed significantly to the refinement of the functional description briefly presented here.

References:

1) http://web4health.info/en/answers/anx-cause-treat-kleptomania.htm

2)  http://tinyurl.com/8traawh

3)  http://www.scielo.br/pdf/rbp/v30s1/en_art05.pdf

4) Guidry L, S. Use of covert punishing contingency in compulsive stealing. J Behav Ther Exp Psychiatry. 1975;6(2):169.

5) Gauthier, J. & Pellerin, D. Management of compulsive shoplifting through covert sensitization. J Behav Ther Exp Psychiatry. 1982;13(1):73-5.

6) Keutzer, C. S. Kleptomania: a direct approach to treatment. Br J Med Psychol. 1972;45(2):159-63.