Brief report
White matter integrity in kleptomania: A pilot study

https://doi.org/10.1016/j.pscychresns.2006.03.003Get rights and content

Abstract

This study's goal was to examine microstructural organization of frontal white matter in kleptomania. Ten females with DSM-IV kleptomania and 10 female controls underwent diffusion tensor imaging. Inferior frontal white matter was the a priori region of interest. Trace and fractional anisotropy (FA) were also calculated for frontal and posterior cortical regions in both subject groups. Kleptomania subjects had significantly higher mean frontal Trace, and significantly lower mean frontal FA than control subjects. Group differences remained significant when right and left frontal Trace and FA were analyzed. Groups did not differ significantly in posterior Trace or FA. Kleptomania may be associated with decreased white matter microstructural integrity in inferior frontal brain regions.

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

References (20)

  • P. Basser et al.

    MR diffusion tensor spectroscopy and imaging

    Biophysical Journal

    (1994)
  • M.J. Hoptman et al.

    Frontal white matter microstructure, aggression, and impulsivity in men with schizophrenia: a preliminary study

    Biological Psychiatry

    (2002)
  • P.J. Basser et al.

    Diffusion-tensor MRI: theory, experimental design and data analysis — a technical review

    NMR in Biomedicine

    (2002)
  • C. Beaulieu et al.

    Changes in water diffusion due to Wallerian degeneration in peripheral nerve

    Magnetic Resonance in Medicine

    (1996)
  • A. Bechara et al.

    Characterization of the decision-making deficit of patients with ventromedial prefrontal cortex lesions

    Brain

    (2000)
  • M.B. First et al.

    Structured Clinical Interview for DSM-IV—Patient Edition (SCID-I/P, Version 2.0)

    (1995)
  • M.B. First et al.

    Structured Clinical Interview for DSM-IV Axis II Personality Disorders (SCID-II): User's Guide

    (1997)
  • J.E. Grant

    Kleptomania

  • J.E. Grant et al.

    Temperament and early environmental influences in kleptomania

    Comprehensive Psychiatry

    (2002)
  • Grant, J.E., Kim, S.W., McCabe, J., in press. A structured clinical interview for kleptomania (SCI-K): preliminary...
There are more references available in the full text version of this article.

Cited by (42)

  • Disorders of impulse control

    2023, Encyclopedia of Mental Health, Third Edition: Volume 1-3
  • Association of excessive social media use with abnormal white matter integrity of the corpus callosum

    2018, Psychiatry Research - Neuroimaging
    Citation Excerpt :

    Indeed, reduced effectiveness of the corpus callosum has been demonstrated across many behaviors that involve deficient decision making. These include opiate addiction (Bora et al., 2012), alcoholism (Harris et al., 2008), marijuana use (Arnone et al., 2008), gambling (Joutsa et al., 2011b), substance abuse (Kaag et al., 2017), kleptomania (Grant et al., 2006) and trichotillomania (Chamberlain et al., 2010). Recent research has also demonstrated that corpus callosum white matter integrity can be associated with excessive use of technologies, including the Internet (Lin et al., 2012a; Shin et al., 2013; Yuan et al., 2011), videogames (Jeong et al., 2016; Weng et al.), and smartphones (Hu et al., 2017).

  • Stealing behavior and impulsivity in individuals with kleptomania who have been arrested for shoplifting

    2018, Comprehensive Psychiatry
    Citation Excerpt :

    Study inclusion criteria were: (1) primary diagnosis of current DSM-IV KM; (2) age 18 or older; and (3) able to be interviewed in person. The only exclusion criterion was the inability to understand and consent to the study, except as described in the neuroimaging [12] and pharmacological studies [16–18] above. Participants were grouped into two categories based on whether they had a lifetime history of shoplifting-related arrest (“KM arrestees”) or had no such history (“KM non-arrestees” or “controls”).

  • Behavioural addiction-A rising tide?

    2016, European Neuropsychopharmacology
    Citation Excerpt :

    In a pilot study, presented to date in conference proceedings only, kleptomania was associated with reduced platelet serotonin transporter levels as compared to controls (Marazziti et al., 2000). In a relatively small neuroimaging study, kleptomania was associated with significantly reduced fractal anisotropy (suggestive of disorganized and/or damaged white matter tracts) in frontal brain regions compared to controls (Grant et al., 2006b). To the knowledge of the authors, no other neuroimaging studies of kleptomania exist.

  • Kleptomania treated with tolcapone, a catechol-O-methyl-transferase (COMT) inhibitor

    2011, Progress in Neuro-Psychopharmacology and Biological Psychiatry
View all citing articles on Scopus
View full text