With a detailed case report of a patient suffering from kleptomania with neurotic causes, we are trying to obtain more detailed information about such patients' psychodynamics. The case history is preceded by a discussion of the concept of kleptomania. We give a list of the descriptive-empirical papers which prove that one cannot speak of an independent clinical picture, but rather that the kleptomaniac actions may be a symptom of multiple causes. Following the case history, the psychodynamics of this patient is discussed and compared with the existing interpretations, based on depth psychology, of other patients. We confirm the opinion expressed by other authors that kleptomania with neurotic causes is to be classified amongst the impulse neuroses. We criticize the fact that in the presently existing psychodynamic interpretation the sexual symbolism of the theft actions and of the stolen goods themselves has been overvalued. In an ego-psychological consideration, we then draw the attention to these patients' desperate and greedy search for an object which helps them to maintain control over their own destructive aggressiveness and at the same time preserves the object. Subsequently, we suggest distinguishing between two groups of kleptomaniac patients who can be differentiated with regard to their symptoms and psychodynamics. Some kleptomaniacs seem to be "fixed" on special objects when stealing. Others give the impression of being "de-differentiated" by the way they steal. In the latter group the structural ego weakness is the most important feature. These psychodynamic considerations are included in the forensicpsychiatric discussion of kleptomania at the end of this paper. Several criteria are presented, e.g., the symptomatic character of the patients' behaviour, the compulsion to repeat, the progredience of the symptoms, the de-differentiation of personality, which are to contribute to the evaluation of the independence and the automatism of the action with regard to the possibility of a patients' ego control.
Adult Crisis Intervention