Brief reportWhite matter integrity in kleptomania: A pilot study
Introduction
Kleptomania is characterized by the impulse to steal objects not needed for personal use or their monetary value and the inability to control that impulse (McElroy et al., 1991). Although there have been no brain-imaging studies of kleptomania, the literature suggests that damage to orbitofrontal–subcortical circuits may result in kleptomania (Nyffeler and Regard, 2001). Diffusion tensor imaging (DTI) is an MRI technique that measures the self-diffusion of water in brain tissue. DTI data can be visualized in a variety of ways such as image maps of scalar parameters including Trace, a measure of the magnitude of water diffusion in each image fractional; and fractional anisotropy (FA), a measure of the extent to which water diffusion in each voxel is directionally restricted. Typically, in damaged white matter, Trace values are higher and FA values lower than in normal white matter presumably owing to axonal degeneration (Beaulieu et al., 1996). Studies of white matter microstructure in impulsive schizophrenia patients using DTI showed that lower FA (i.e., axonal disorganization) in the right inferior frontal area was associated with greater impulsivity (Hoptman et al., 2002, Hoptman et al., 2004). Because frontal brain circuits, particularly the orbitofrontal circuit, are important in behavioral regulation (Mega and Cummings, 1994), we hypothesized that kleptomania subjects would show compromised white matter integrity (i.e., increased Trace and decreased FA) in inferior frontal regions compared with a healthy comparison group.
Section snippets
Subjects
Ten female subjects (mean age = 34.9 ± 18.0; range 18–60; all right-handed) with DSM-IV kleptomania were recruited from an outpatient clinic. The diagnosis was confirmed by the Structured Clinical Interview for Kleptomania, a valid and reliable instrument (Grant et al., in press). Inclusion criteria were 1) kleptomania as the primary Axis I disorder; 2) shoplifting at least one time per week; and 3) urges to steal at least one time per week. The sample was limited to females as early evidence
Results
The 10 kleptomania subjects reported a mean age of symptom onset of 18.0 ± 4.3 years (range 13–25). The mean duration of illness was 16.9 ± 10.3 years (range 4–39). Kleptomania subjects reported urges to shoplift 4.3 ±2.6 times per week and shoplifting 1.7 ± 0.9 times per week. All subjects reported an inability to resist the urge to shoplift. Six (60.0%) subjects had histories of arrest, although no subject had been arrested within the last year.
DTI data on three control subjects could not be
Discussion
These findings of compromised white matter microstructure in the inferior frontal regions using DTI are consistent with results reported previously in other impulsive behaviors (Hoptman et al., 2002) and with the hypothesis that the inferior frontal brain region is involved in impulsive behaviors that involve poor decision-making, such as stealing unnecessary items (Bechara et al., 2000). Kleptomania patients score high on tests of impulsivity (McElroy et al., 1991, Grant and Kim, 2002), and
Acknowledgments
This research was supported in part by a Young Investigator Award from the National Alliance for Research on Schizophrenia and Depression and a National Institute of Mental Health grant K23 MH069754-01A1 to JEG. Additional support by a grant from the National Institute of Aging (ZAGI FAS-5) to SC. This study was carried out at Butler Hospital/Brown Medical School, Providence, RI. The study was presented as a research poster at the 44th Annual Meeting of the American College of
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