147 Pyromania (312.33)

DSM-IV-TR criteria

A. Deliberate and purposeful fire setting on more than one occasion.

B. Tension or affection arousal before the act.

C. Fascination with, interest in, curiosity about, or attraction to fire and its situational contexts (e.g., paraphernalia, uses, consequences).

D. The fire setting is not done for monetary gain, as an expression of sociopolitical ideology, to conceal criminal activity, to express anger or vengeance, to improve one’s living circumstances, in response to a delusion or a hallucination, or as a result of impaired judgment (e.g., in dementia, Mental Retardation, Substance Intoxication).

E. The fire setting is not motivated by monetary gain, sociopolitical ideology, anger or revenge, psychotic thinking (delusions or hallucinations), or to conceal criminal activity.

The fire setting is not better accounted for by Conduct Disorder, a Manic Episode, or Antisocial Personality Disorder.

Associated features

• Individuals with pyromania often have a difficult time controlling themselves, specifically in situations that are harmful to themselves and others. Those with head injuries or epilepsy are at an increased risk of developing and impulse control disorder. Researchers have noticed an increase in impulse control disorders in older patients with Parkinson’s disease due to the effect of the dopaminergic drugs. There has also been a correlation with pyromania to learning disabilities, as well as cruelty to animals; these problems could suggest a higher risk of violence in the future. There is also high comorbidity with disorders, such as: substance abuse disorders, obsessive compulsive disorder, anxiety disorders, and mood disorders.
• In one study, arsonists have more often received psychiatric treatment, prior to committing their index offence, and had a history of severe alcohol abuse more often in comparison to the controls. The arsonists turned out to be less likely to suffer from a major psychotic disorder.

Child vs. adult presentation( Labree, Nijman, van Marie, & Rassin, 2010).

• The age of onset for pyromania is approximately 18 years. It is extremely rare for a child younger than adolescence to develop Pyromania. It is also rare for older adults to develop pyromania.
• Fire setting in children may be a way of relieving tension or stress. This outward expression of tension/stress may be associated with depression, suicidal thoughts, poor coping abilities, and repeated interpersonal conflicts.
• It is rare for children to have it, but it can occur in children as young as three. Most of the time, parents recognize the behaviors and get it treated before it becomes a problem.
• Features such as temperament, parental psychopathology, social and environmental factors and possible neurochemical predispositions have been hypothesized to cause childhood pyromania.

Gender and cultural differences in presentation

• Males have a much higher risk for developing pyromania. Approximately 90% of those diagnosed with Pyromania are male. There are no cultural differences in presentation of this disorder. People from many different cultures will show the same symptoms.
• Pyromania in childhood appears to be rare. Juvenile fire setting is usually associated with Conduct Disorder, Attention-Deficit/Hyperactivity Disorder, or Adjustment Disorder.
• Pyromania occurs much more often in males, especially those with poorer social skills and learning difficulties.

Epidemiology

• It is a very rare disorder, about less than 1% of the populations has it.
• Most of the research done on Pyromania has not focused on the epidemiology. It is only known that there is a higher prevalence of Pyromania in men than women.
• It is known that about 9% of the population has impulse control problems which include pyromania.
• Only 14% of fires are started by people with pyromania and other mental disorders.
• The majority of epidemiological studies have focused on pyromania in childhood and adolescence, and have reported prevalence rates to be between 2.4% and 3.5% (Dell’Osso, Altamaura, Allen, Marazziti and Hollander 2006).

Etiology

Although little research has been done on the etiology of Pyromania, it is believed that the cause can be targeted during childhood. Many researchers say that possible causes can be an abusive family environment or mild brain trauma. Other factors of pyromania are: antisocial behaviors and attitudes, people seeking sensation and adventure, people seeking attention, a lack of social skills with others, and a lack of fire-safety knowledge and/or ignorance of the dangers involved. Environmental factors include things such as: poor supervision from parents, peer pressure, and stressful life events.

Empirically supported treatments

• Counseling and medication are both preferred for treating pyromania. Behavior modification is the best treatment found so far for treating this disorder in hopes of getting a response to social limits.
• Treatment of adults and children with pyromania is often individualized based on the patient’s presenting problems and history. Treatment of children with this disorder often begins with an assessment of the child’s life and includes the evaluation of such factors as stressors on the child, home discipline, and supervision of the child. This assessment is generally followed by a case-management approach, rather than a medicinal approach, where the treatment is tailored to the child and involves a variety of approaches, such as anger management and communication skills.
• Treatment of adults with pyromania is often approached differently. Because adult patients with this disorder tend to be uncooperative, they are generally treated with a combination of medication and psychotherapy. Usually the patient is treated with a selective serotonin reuptake inhibitor, but there have also been multiple case reports of tricyclic antidepressants and mon-amine oxidase inhibitors being useful in impulse control disorders. There haven’t been very many carefully controlled studies that use strict diagnostic criteria on adult patients diagnosed with pyromania or other impulse-control disorders.
• Treatments work in 95% of children that exhibit signs and symptoms of pyromania.