140 Pyromania (312.33)

Pyromania is characterized by multiple deliberate attempts at fire setting that can provide the individual with psychological gratification and relief (Bayer, 2000). The diagnosis of pyromania does not apply if a person sets fire because he or she is mentally retarded, intoxicated, or has impaired judgment due to a medical condition (Bayer, 2000). An individual is not diagnosed with pyromania if he or she sets fire because of some other psychological disorder (Bayer, 2000). People with pyromania do not set fires to express their emotions, to make money, or to support a political ideology (Bayer, 2000). Their intention is not to destroy evidence of criminal activity or to improve their living situation (Bayer, 2000). Additionally, their fire setting is not a response to a delusion or hallucination (Bayer, 2000).

People with pyromania are fascinated by fire and may be attracted to fire-related equipment such as fire trucks, hoses, and hydrants (Bayer, 2000). They may deliberately seek to observe fires, set false alarms, or associate with fire departments or firefighters (Bayer, 2000). They may spend a great deal of time preparing to set fires (Bayer, 2000). They may be indifferent to the loss of life and property that the fires cause (Bayer, 2000). They may even derive pleasure from thinking about the destruction, danger, and consequences of the fires (Bayer, 2000). Since the individual often derives pleasure from being near fires and the results, he or she often stays in the vicinity of the scene after a fire has been set (Bayer, 2000).

This impulse-control disorder is somewhat rare. Pyromania typically begins in childhood. Males are diagnosed more often than females, particularly males with poor social skills and learning difficulties (Bayer, 2000). The course of the disorder may wax and wane (Bayer, 2000). The disorder often lasts only a few years or during a specific period of an individual’s life (Bayer, 2000). Often, it initially appears during a crisis and disappears after the crisis has dissolved (Bayer, 2000).

Fire Play Versus Fire Setting:

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. They may make considerable advance preparation for starting a fire, and may be indifferent to the consequences of their actions. They may derive pleasure from the resulting destruction. 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 and learning disabilities and cruelty to animals.

Child vs. adult presentation

• The age of onset for pyromania is approximately 18 years of age. It is extremely rare for a child younger than adolescence to develop pyromania. It is also rare for an older adult to develop the disorder. Those older than adolescence tend to develop primarily pathological gambling.
• It is rare for children to have it, but it can occur in children as young as three years old. Most of the time, parents recognize the behaviors and get it treated before it becomes a problem.

Gender and cultural differences in presentation

Males have a much higher risk for developing pyromania than females. Approximately 90% of those diagnosed with pyromania are male. There are no cultural differences in the presentation of this disorder. People from many different cultures show the same symptoms.

Epidemiology

• It is a very rare disorder, with less than 1% of the population meeting the diagnostic criteria.
• 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 have impulse-control problems that include pyromania.
• Only 14% of fires are started by people with pyromania and other mental disorders.

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.
• Some suggest that pyromania may be a form of communication from those that have few social skills.

Empirically supported treatments

• Counseling and medication are both preferred for treating pyromania. So far, behavior modification has been found to be the best treatment this disorder.
• 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 (SSRI), but there have also been multiple case reports of tricyclic antidepressants and monamine oxidase inhibitors (MAIOs) being useful in impulse control disorders.
• Treatments work in 95% of children that exhibit signs of pyromania.