BACKGROUND: Kleptomania (compulsive stealing) remains poorly understood, with limited data regarding its underlying pathophysiology and appropriate treatment choices.

METHODS: Participants (N = 112) age 18 to 65 with a primary, current diagnosis of kleptomania were assessed for the severity of their stealing behavior and urges to steal, as well as related mental health symptoms. To identify clinical and demographic measures associated with variation in disease severity, we utilized the statistical technique of partial least squares.

RESULTS: Greater kleptomania symptom severity was associated with having more frequent urges to steal, feeling excited by stealing, having a current eating disorder, and having a current diagnosis of obsessive-compulsive disorder (OCD). Worse symptom severity was associated with a shorter transition time (between first stealing and diagnosis of kleptomania), as well as with a higher chance of stealing from relatives and seeking treatment at some point.

CONCLUSIONS: Feeling a sense of reward from stealing and co-occurrence of certain disorders associated with compulsivity (eg, OCD, anorexia nervosa) were strongly associated with worse illness severity in kleptomania. Treatment approaches should incorporate these disorders as possible treatment targets. These data also may support conceptualizing kleptomania as an obsessive-compulsive–related disorder rather than being allied to substance use or impulsive disorders.