Mehmet BALTACIOĞLU, Altan EŞSİZOĞLU, Çınar YENİLMEZ, Cem KAPTANOĞLU

Differential diagnosis and psychodynamic approach in kleptomania: A case report

Kleptomani, kişisel ve ekonomik değeri ile ilişkisiz biçimde nesneleri çalma dürtüsünün engellenememesidir. Çoğunlukla gözden kaçan bir tanı olan kleptomani, anksiyete bozuklukları, yeme bozuklukları ve duygu durum bozuklukları ile birlikte görülür. Olgu, başka bir hastaneden sevk edilen 19 yaşında kadın hasta idi. Makyaj malzemeleri ve parfüm gibi nesneleri çalma isteğinden ve uygunsuz cinsel davranışlarda bulunmaktan yakınıyordu. Depresif ve obsesif-kompülsif belirtilere sahipti ve geçmiş yıllarda üç defa özkıyım girişiminde bulunmuştu. Aynı evde yaşamalarına rağmen babaannesini annesi olarak biliyordu. Klasik psikanalitik kurama göre; kleptomani, bilinçdışı dürtüler, istekler, çatışmalar ve gereksinimlere karşı bir savunmadır. Narsistik açıdan zedelenmeye yatkın kişi, çalma davranışı yoluyla benliğin parçalanmasını engellemeye çalışmaktadır. Psikodinamik kuramlardan ego psikolojisi, kendilik psikolojisi ve nesne ilişkileri kuramlarının da kleptomani için açıklamaları mevcuttur. Bu olgu kleptomani dışında diğer psikiyatrik bozukluklara ait belirti ve bulgulara da sahiptir. Bu nedenle, sunulan olgu, kategorik ve belirti odaklı yaklaşımın hastaları bir bütün olarak görmekten uzak olduğunun vurgulaması bakımından önemlidir.

Kleptomanide ayırıcı tanı ve psikodinamik yaklaşım: Bir olgu sunumu

Kleptomania is the inability to refrain from the urge to steal items for reasons other than personal use or financial gain. The disorder is frequently under-diagnosed and is regularly accompanied by other psychiatric disorders; particularly anxiety disorders, eating disorders and affective disorders. Our patient is a 19-year-old female, who was referred to our hospital from a general state hospital. She suffered from a desire to steal things such as makeup materials and perfume. She also complained carrying out inappropriate sexual behavior. She had depressive and obsessive-compulsive symptoms and attempted suicide three times in past years. She knew her grandmother as her mother, despite living in the same household. According to classical psychoanalytical theory; kleptomania is a defense against unconscious impulses, desires, conflicts and needs. The individual who is prone to narcissistic injury tries to prevent the self from disintegrating by the way of stealing behavior. Among psychodynamic theories, ego psychology, self-psychology and object relations theory also have explanations for kleptomania. This case has symptoms that belong to other psychiatric disorders. Thus, the case presented here is important for its emphasis on the fact that categorical and symptom oriented approaches are far from considering patients as a whole.

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1. Hocaoglu C, Kandemir G. The use of SSRI (Selective Serotonin Inhibitors) in kleptomanias treatment: case reports. Bull Clin Psychopharmacol 2004; 14:204-208.
2. Goldman MJ. Kleptomania: making sense of the nonsensical. Am J Psychiatry 1991; 148:986-996.
3. Ozmen E. Kleptomania (pathological stealing). Journal of Psychiatry World 2001; 5:59-61.
4. American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders (DSM-IV-TR). Text revision, Fourth ed., Washington DC: American Psychiatric Association, 2001.
5. American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders (DSM-V). Fifth ed., Washington DC: American Psychiatric Association, 2013.
6. Tamam L. Impulse Control Disorders. Ankara: Hekimler Yayin Birligi, 2009, 209-238. (Turkish)
7. Grant JE, Kim SW. Adolescent kleptomania treated with naltrexone--a case report. Eur Child Adolesc Psychiatry 2002; 11:92-95.
8. McElroy SL, Hudson JI, Pope HG, Keck PE. Kleptomania: clinical characteristics and associated psychopathology. Psychol Med 1991; 21:93-108.
9. Burt VK, Katzman JW. Impuls-Control Disorders Not Elsewhere Classified. In: Sadock BJ, Sadock VA (editors). Comprehensive Textbook of Psychiatry, Vol. 2. Seventh ed. Philadelphia, USA: Lippincott Wiliams & Willkins, 2000, 1701-1703.
10. Coccaro EF, Siever LJ, Klar HM, Maurer G, Cochrane K, Cooper TB, Mohs RC, Davis KL. Serotonergic studies in patients with affective and personality disorders: correlates with suicidal and impulsive aggressive behavior. Arch Gen Psychiatry 1989; 46:587-599.
11. DeCaria CM, Begaz T. Hollander E. Serotonergic and noradrenergic function in pathological gambling. CNS Spectr 1998; 3:38-47.
12. Blum K, Braverman ER, Holder JM, Lubar JF, Monastra VJ, Miller D, Lubar JO, Chen TJ, Comings DE. Reward deficiency syndrome: a biogenetic model for the diagnosis and treatment of impulsive, addictive, and compulsive behaviors. J Psychoactive Drugs 2000; 32(Suppl.i-iv):1-112.
13. Kmetz GF, McElroy SL, Collins DJ. Response of kleptomania and mixed mania to valproate. Am J Psychiatry 1997; 154:580- 581.
14. Burstein A. Fluoxetine-lithium treatment for kleptomania. J Clin Psychiatry 1992; 5:28-29.
15. Koroglu E, Gulec C. Basic Book of Psychiatry. Ankara: Hekimler Yayin Birligi, 2007, 479-480. (Turkish)
16. Zavitzianos G. Fetishism and exhibitionism in the female and their relationship to psychopathy and kleptomania. Int J Psychoanal 1971; 52:297-305.
17. Traub-Werner D. Discussion of Louise Kaplans paper: Perversion and Trauma: From Paradoxical Memory to Narrative Memory. Canadian Journal of Psychoanalysis 1995; 3:99-201.
18. Fenichel O. The Psychoanalytic Theory of Neurosis. New York: W. W. Norton, 1995.
19. Freud S. Mourning and Melancholia. In: Strachey J (editor). Standart Edition of the Complete Psychological Works of Sigmund Freud, Vol 14. London: Hogarth Press, 1964.
20. McWilliams N. Psychoanalytic Diagnosis. New York: Guilford Press, 2011.