Relations between kleptomania and anxiety: some notes on the role of negative reinforcement*
Autor: Círculo da Savassi | Publicado: 2012-10-04T18:27:00-07:00

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,&nbsp; 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.&nbsp; 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)&nbsp;http://web4health.info/en/answers/anx-cause-treat-kleptomania.htm



2)&nbsp;&nbsp;http://tinyurl.com/8traawh



3)&nbsp;&nbsp;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. &amp; 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.