NOTICES

Psychiatric Disorders and Shoplifting

This article sets out the types of psychiatric disorder associated with shoplifting and the appropriate treatment for each disorder.

Shoplifting is a serious problem for any modern country, in terms of economic loss. Yet much of this aberrant behaviour has not been well researched and unknown (notes 1, 2). Forensic psychiatrists and psychologists, given their limited resources, have concentrated their research on violent and aggressive offences. Shoplifting, being 'victimless', is usually not regarded as a serious offence.

There is rarely any co-ordinated research of shoplifting in any country. Shoplifters with psychiatric disorders are referred to different hospitals, psychiatrists, psychologists and psychotherapists. Hence, the recent statistics on shoplifters by the Subordinate Courts in Singapore is unique in this aspect. It showed that one in three shoplifters have emotional stress (note 3). This is affirmative of what is already known about shoplifting. Since the 1960s, research on shoplifting has consistently shown that there is always a group of individuals who are well off, could afford the items they stole and have psychiatric or psychological problems (note 2).

There is a tendency to equate kleptomania and shoplifting (note 1). Shoplifting is behaviour characterised by theft from a store regardless of the motivation or desire for the item. Kleptomania is a specific psychiatric disorder and it is only one of the many psychiatric disorders that cause shoplifting. Kleptomania is actually a relatively uncommon psychiatric disorder associated with shoplifting.

The recent High Court case involving a patient with kleptomania shows that the Courts can be sympathetic towards patients with kleptomania (note 4). To restrict a therapeutic disposal only to patients with kleptomania and not to other patients who have shoplifted does not make any clinical sense. A patient with major depressive disorder is similar to a person with kleptomania. Both illnesses have a biological basis, cause impulsive behaviours, are treatable and the risk of future re-offending is reduced. Patients may shoplift out of impulse, absentmindedness or forgetfulness.

Many psychiatric disorders are associated with shoplifting. The most common psychiatric disorder associated with shoplifting is depression. This has been borne out in many studies on shoplifting.
Depressive disorders

Anxiety disorders

Obsessive disorders including kleptomania

Personality disorders

Psychotic disorders such as schizophrenia and manic depressive disorders

Organic disorders such as dementia

Drug and alcohol abuse and intoxication
Mental retardation

Physical illnesses causing confusion

Side effects of medication

The list is not exhaustive, as there could be other causes of shoplifting. There could be psychological reasons why a person shoplifts, eg frustration and anger, conscious or unconscious manipulation, self-punishment and others. Cognitive deficits as a result of depressive disorder and dementia are common and often lead to absentmindedness.

The treatment of patients who shoplift should be targeted at the primary disease and the cause of the shoplifting (notes 5, 6, 7). Different patients will have different disorders. Each disorder can have a different underlying cause or causes. Even within the same disorder, the motivation for shoplifting can be different between patients. For example, kleptomania (the best known cause albeit among the least common), there is no single treatment as there are different causes and motivations for their behaviour.

Hence, treatment has to be individualised. There is no single specific treatment programme that can help all patients.

Our treatment programme consists of the following:

Assessment
This is to assess the type of disorder or disorders that the patient is suffering from. For example, depression is not one disease but a spectrum of disorders of which the symptoms are similar but with different presentations, causation and outcome. The degree of family support and motivation will also be assessed. More family support and strong motivation will result in a better outcome.

Each person requires different medication, education, support and psychotherapy.

Examples
A patient who had just lost a spouse and shoplifted from absentmindedness will require family support, grief counselling and medication.

A patient who has an impulse to steal whenever he is depressed will require medication. Education will be necessary to help him understand the relationship between his mood and the shoplifting.

A patient with kleptomania will need medication, cognitive behavioural therapy and education.

A patient who is depressed as a result of family dysfunction will require family therapy to help him recover from the depressive disorder.

A patient with a personality disorder and secondary depression may require more intensive psychotherapy.

The examples above cannot be exhaustive as each patient is different.

The assessment will be done by the psychiatrist; another assessment will be done by the psychotherapist to determine which kind of psychotherapy will be most appropriate.

Treatment
After assessment, the type of treatment will be individualised.

The intensity and frequency of treatment will be dependent on the severity of the depression. The most severe will need to be admitted to the psychiatric ward. Most cases can be treated as outpatients. The frequency of appointments is expected to be more frequent initially.

Psychiatric treatment, ie medication and supportive psychotherapy, will be provided by the psychiatrist. More specific treatment, such as cognitive behavioural therapy, family therapy and psychodynamic therapy, will be provided by the psychotherapist.

Prognosis and Outcome
As shoplifting is a behaviour caused by mental disorder, the prognosis and outcome will be dependent on the type of mental disorder, the success of treatment, the motivation of the patient, family and social support.

Certainly some mental disorders are easier to treat and to prevent future recurrences of shoplifting.

Examples
For recurrent depressive disorder, especially where the shoplifting is always related to relapses of the depressive episodes, the prognosis is favourable and future shoplifting can be prevented.

For personality disorder with depressive mood swings, the mood swings are difficult to prevent and hence prognosis is not as favourable.

Dr Tommy Tan
Augustine Tan
Tommy Tan Psychiatric Clinic
E-mail: tommykstan@hotmail.com

Notes
1 Blanco et al, 'Prevalence and Correlates of Shoplifting in the United States: Results from the National Epidemiologic Survey on Alcohol and Related Conditions' American Journal of Psychiatry April 2008.

2 Krasnosky and Lane, 'Shoplifting: a review of the literature' Aggression and Violent Behaviour Vol 31 1998.

3 'Shoplifting. More sentencing options for offenders' The Strait Times (10 May 2008).

4 Public Prosecutor v Goh Lee Yin (2007) SGHC 205.

5 Faulk, Basic Forensic Psychiatry (2nd ed), pp 86-93.

6 Chiswick and Cope, Seminars in Practical Forensic Psychiatry, pp 41-43.

7 Power, Curran and Hughes, Criminal Law and Forensic Psychiatry, p 318