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Compulsive Borrowing Behavior with Forensic Consequences in a Woman with Childhood Trauma and Resolved Seizure Disorder: A Case Report
*Corresponding author: Zubairu Umar, Department of Clinical Services, Federal Neuropsychiatric Hospital Kware, Sokoto, Nigeria. Zubairu.umar@npmcn.edu.ng
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Received: ,
Accepted: ,
How to cite this article: Umar Z, Baguda AS, Ibrahim AH, Shehu SN, Sarki J. Compulsive Borrowing Behavior with Forensic Consequences in a Woman with Childhood Trauma and Resolved Seizure Disorder: A Case Report. Acad Bull Ment Health. doi: 10.25259/ABMH_4_2026
Abstract
Impulse-control disorders are characterized by recurrent failures to resist behaviors that provide short-term relief but lead to significant psychosocial or legal consequences. While conditions such as kleptomania and gambling disorder are well described, compulsive borrowing behavior remains poorly documented, particularly in low-resource settings where such behaviors are often interpreted as criminality rather than psychopathology. We report the case of a 40-year-old married Nigerian woman with a childhood history of seizure disorder that resolved before adolescence, who presented with recurrent uncontrollable urges to obtain loans despite awareness of harmful consequences. The behavior was associated with increasing internal tension and transient relief after borrowing, resulting in severe social dysfunction and police detention over unresolved debts. Her psychosocial background was notable for parental divorce, upbringing by a stepmother, and repeated exposure to domestic violence during childhood. Mental state examination revealed depressive symptoms, excessive compliance, compulsive tidiness, emotional dysregulation, and occasional brief auditory perceptual experiences without sustained psychosis. A diagnosis of impulse-control disorder characterized by compulsive borrowing behavior was made, with comorbid persistent depressive disorder and trauma-related emotional dysregulation. Management included fluoxetine, risperidone, cognitive-behavioral therapy, trauma-focused supportive psychotherapy, and supervised financial restriction. Significant improvement in borrowing urges and mood was observed within four weeks, with no further police involvement. This case highlights compulsive borrowing as a potentially under-recognized form of impulse dysregulation with important forensic implications and emphasizes the need for early psychiatric recognition and integrated management.
Keywords
Behavioral addiction
Childhood trauma
Compulsive borrowing
Forensic psychiatry
Impulse-control disorder
INTRODUCTION
Impulse-control disorders involve repeated engagement in behaviors that are experienced as difficult to resist and are typically preceded by mounting internal tension and followed by relief, despite adverse consequences.[1,2] Although several such disorders are well established, maladaptive financial behaviors, particularly compulsive borrowing, remain sparsely described in psychiatric literature.[2,3]
In many African and other low-resource settings, these behaviors are commonly interpreted as moral failings or deliberate criminality rather than manifestations of psychopathology, resulting in delayed psychiatric intervention and increased interaction with law-enforcement systems.[4] Adverse childhood experiences, including exposure to domestic violence, are strongly associated with emotional dysregulation and impulsive behaviors in adulthood.[5,6] In addition, childhood seizure disorders have been linked to later affective and behavioral vulnerability.[7] This case report describes compulsive borrowing behavior complicated by police detention, highlighting diagnostic and management considerations relevant to mental health practice.
CASE REPORT
Sociodemographic and medical background
The patient is a 40-year-old Nigerian woman, married, with seven children, and currently unemployed. The patient denied any history of alcohol or substance use. The patient had a seizure disorder during childhood that resolved before adolescence, with no recurrence or ongoing neurological symptoms in adulthood.
Presenting complaints and purpose of visit
The patient presented voluntarily to the outpatient psychiatric clinic without any referral from legal authorities. Her primary purpose in visiting was to seek help with recurrent, uncontrollable urges to obtain loans, which the patient recognized as problematic. The patient expressed distress over escalating financial conflicts, social rejection, and a recent episode of police detention related to unresolved loan disputes. The patient actively requested assistance to prevent further borrowing, indicating good insight into the maladaptive nature of her behavior.
These urges were described as intrusive and distressing, accompanied by increasing psychological tension that was temporarily relieved after borrowing, a pattern consistent with impulse-control phenomenology.[1,2] Despite repeated efforts to stop and full awareness of the negative social and financial consequences, the patient reported an inability to resist the behavior.
Associated symptoms included persistent low mood, emotional exhaustion, excessive generosity even while indebted, poor interpersonal boundaries, compulsive tidiness, marked compliance in relationships, and increased religious preoccupation.
Psychosocial and developmental history
The patient’s parents divorced during her childhood. The patient was subsequently raised by a stepmother and reported witnessing recurrent domestic violence directed at her biological mother. Such early adverse experiences are well-established contributors to long-term emotional dysregulation and maladaptive coping behaviors.
Mental state examination
The patient appeared well-groomed and notably meticulous. Behavior was calm and cooperative. Speech was spontaneous, fluent, and coherent. The mood was depressed, with constricted but appropriate effect. Thought processes were logical and goal-directed.
The patient reported occasional brief auditory perceptual experiences consisting of hearing her name called, without associated delusions, formal thought disorder, negative symptoms, or functional decline. These experiences were infrequent and ego-dystonic. Cognition was intact. Insight was good, as evidenced by self-referral and willingness to accept financial restrictions. Judgment was selectively impaired in relation to impulse control.
Diagnostic formulation
Primary diagnosis
The primary diagnosis was an impulse-control disorder characterized by compulsive borrowing behavior, based on core phenomenological features including failure to resist urges, rising tension prior to the act, relief following the act, and persistence despite adverse consequences.
Differentiation from obsessive-compulsive disorder (OCD)
A detailed history was obtained to differentiate the presentation from OCD. In OCD, compulsive behaviors are typically preceded by obsessional thoughts or rituals aimed at reducing anxiety or preventing a feared outcome, and the behaviors are often ego-dystonic. In contrast, the patient’s borrowing behavior was characterized by: (1) mounting impulsive tension rather than anxiety; (2) transient pleasure or relief rather than neutralization of an obsession; (3) absence of recurrent, intrusive thoughts or rituals; and (4) ego-syntonic nature at the time of the act, followed by post-hoc regret. Her compulsive tidiness was a distinct trait without associated obsessions or functional impairment and did not meet criteria for OCD.[1,8]
Comorbid conditions
Persistent depressive disorder; trauma-related emotional dysregulation; attenuated psychotic symptoms (isolated perceptual experiences)
Differential diagnoses considered
Obsessive–compulsive disorder, gambling disorder, antisocial personality disorder, and primary psychotic disorder were considered. The absence of obsessional ruminations, gambling behavior, pervasive antisocial traits, negative symptoms, or sustained psychosis supported the final diagnostic formulation.[1,8]
Management and outcome
Pharmacological intervention
Both fluoxetine and risperidone were initiated simultaneously on the first day of presentation. Fluoxetine was started and maintained at 20 mg once daily in the morning, based on clinical response and tolerability. Risperidone was started at 0.5 mg at night, with a planned increase to 1 mg after one week. The doses were increased as scheduled due to the absence of adverse effects and partial improvement in mood and impulsivity. Noticeable reduction in borrowing urges and improvement in mood were first reported by the patient at the end of week three. Complete resolution of auditory perceptual experiences occurred by week four. This approach targeted depressive symptoms and impulsivity, consistent with evidence supporting selective serotonin reuptake inhibitor use in impulse-control disorders, while risperidone addressed transient perceptual disturbances and emotional dysregulation.
Use of assessment scales
No standardized rating scale for impulsivity (e.g., Barratt impulsiveness scale, urgency, premeditation, perseverance, sensation seeking, positive urgency impulsive behavior scale) was administered at baseline or follow-up, as these tools are not routinely available in our low-resource clinical setting. However, clinical assessment of impulsivity was based on structured history-taking, collateral information from family members, and direct observation of the patient’s behavior and self-report over the four-week period. The treating clinician documented a clear reduction in the frequency and intensity of borrowing urges, improved ability to resist impulses, and resolution of loan-seeking behavior by week four.
Psychotherapeutic intervention
Cognitive-behavioral therapy focusing on impulse regulation and emotional awareness; trauma-focused supportive psychotherapy addressing early adverse experiences
Environmental and social interventions
Appointment of a financial guardian; community advisories discouraging the provision of loans and psychoeducation involving family members
Outcome
At the four-week follow-up, the patient reported reduced borrowing urges, improved mood, and resolution of auditory perceptual experiences. No further police involvement had occurred. Ongoing treatment and supervised financial management remain in place.
DISCUSSION
This case illustrates compulsive borrowing as a clinically significant but under-recognized manifestation of impulse dysregulation. In the absence of psychiatric recognition, such behaviors may be misclassified as intentional criminality, leading to avoidable forensic consequences.[4]
The patient’s history of childhood trauma likely contributed to impaired emotional regulation, while the resolved seizure disorder may reflect underlying neurodevelopmental vulnerability to later psychiatric symptoms.[5–7] The presence of isolated perceptual experiences without progression or functional decline is consistent with attenuated psychotic phenomena rather than a primary psychotic disorder.[9]
The absence of standardized impulsivity scales is a limitation of this report, reflecting real-world constraints in low-resource settings. Nevertheless, the clinical improvement observed supports the diagnostic formulation and integrated treatment approach. Effective management required an integrated approach combining pharmacotherapy, psychotherapy, and environmental restriction of access to credit, consistent with recommended strategies for impulse-control and behavioral addictive disorders.[3,10–12]
CONCLUSION
Compulsive borrowing may represent an overlooked expression of impulse-control pathology with the potential for serious social and legal consequences. Early psychiatric recognition and integrated treatment, including environmental financial controls, are essential to improving outcomes and preventing forensic escalation.
Author’s contributions
ZU: Conceptualization, patient assessment, manuscript drafting, literature review, and final approval of manuscript; ASB: Clinical management, manuscript revision, and intellectual input; AHI: Psychiatric evaluation, supervision of clinical management, and critical revision of manuscript; SNS: Literature review, data interpretation, and manuscript editing; JS: Clinical supervision, manuscript review, and final approval of manuscript.
Ethical approval
Institutional Review Board approval is not required.
Declaration of patient consent
The authors certify that they have obtained all appropriate patient consent forms. In the form, the patient has given consent for clinical information to be reported in the journal. The patient understands that the patient’s names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.
Conflicts of interest
There are no conflicts of interest.
Use of artificial intelligence (AI)-assisted technology for manuscript preparation
The author(s) confirms that they have used artificial intelligence (AI)-assisted technology for grammatical corrections.
Financial support and sponsorship: Nil.
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