Pyromania

Pyromania is an impulse-control disorder in which individuals repeatedly fail to resist impulses to deliberately start fires,<ref name="BehaveNet">{{#invoke:citation/CS1|citation |CitationClass=web }}</ref> to relieve some tension or for instant gratification. The term pyromania comes from the Greek word {{#invoke:Lang|lang}} (pyr, 'fire'). Pyromania is distinct from arson, the deliberate setting of fires for personal, monetary or political gain.<ref>Template:Cite book</ref> Pyromaniacs start fires to release anxiety and tension, or for arousal.<ref name="WebMD">{{#invoke:citation/CS1|citation |CitationClass=web }}</ref> Other impulse-control disorders include kleptomania and intermittent explosive disorder.

There are specific symptoms that separate pyromaniacs from those who start fires for criminal purposes or due to emotional motivations not specifically related to fire. Someone with this disorder deliberately and purposely sets fires on more than one occasion, and before the act of lighting the fire the person usually experiences tension and an emotional buildup. When around fires, a person with pyromania gains intense interest or fascination and may also experience pleasure, gratification or relief.<ref name="frey">Template:Cite book</ref> Another long term contributor often linked with pyromania is the buildup of stress. When studying the lifestyle of someone with pyromania, a buildup of stress and emotion is often evident and this is seen in teens' attitudes towards friends and family.<ref name="gale1998">Template:Cite journal</ref> At times it is difficult to distinguish the difference between pyromania and experimentation in childhood because both involve pleasure from the fire.<ref name="FirstFrances2004">Template:Cite book</ref>

Classification

ICD

The World Health Organization's International Classification of Diseases (11th Revision) ICD-11, regarded as the global standard, was released in June 2018 and came into full effect from January 2022.<ref name="WHO 2021">{{#invoke:citation/CS1|citation |CitationClass=web }}</ref><ref name="Pickett & Anderson">Template:Cite report</ref> It states the following about pyromania:<ref name=icd11 >{{#invoke:citation/CS1|citation |CitationClass=web }}</ref>

Pyromania is characterised by a recurrent failure to control strong impulses to set fires, resulting in multiple acts of, or attempts at, setting fire to property or other objects, in the absence of an apparent motive (e.g., monetary gain, revenge, sabotage, political statement, attracting attention or recognition). There is an increasing sense of tension or affective arousal prior to instances of fire setting, persistent fascination or preoccupation with fire and related stimuli (e.g., watching fires, building fires, fascination with firefighting equipment), and a sense of pleasure, excitement, relief or gratification during, and immediately after the act of setting the fire, witnessing its effects, or participating in its aftermath.{{#if:chapter 6, section C70ICD-11|{{#if:|}}

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It also notes that pyromania has no relation to intellectual impairment, substance abuse, or other mental and behavioral disorder.<ref name=icd11 /> ICD-11 was produced by professionals from 55 countries out of the 90 countries involved and is one of the most widely used reference worldwide by clinicians, with the other being the Diagnostic and Statistical Manual of Mental Disorders (DSM-5-TR from 2022, DSM-5 from 2013, or their predecessors).<ref name="Pickett & Anderson" />

DSM

The American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders, First Edition (DSM-5), released in 1952, categorized pyromania as a subset of obsessive–compulsive disorder. In the Second Edition, the disorder was dropped. In the Third Edition, it returned under the category of impulse-control disorders.<ref name="Emergency Live">{{#invoke:citation/CS1|citation |CitationClass=web }}</ref>

The Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, Text Revision (DSM-5-TR), released in 2022, states that the essential feature of pyromania is "the presence of multiple episodes of deliberate and purposeful fire setting."<ref name = dsm>Template:Cite book</ref> Pyromania moved from the DSM-IV chapter "Impulse-Control Disorders Not Otherwise Specified," to the chapter "Disruptive, impulse-control, and conduct disorders" in the DSM-5.<ref name="DSM5 Changes">{{#invoke:citation/CS1|citation |CitationClass=web }}</ref>

Epidemiology

• Pyromania is more prevalent in males than females.<ref name=":0">Template:Cite journal</ref>
• The average age of pyromania onset is 18.<ref name=":0" />
• Pyromaniacs are often present at fires near them, as well as in nearby fire departments.<ref name=":0" />
• Pyromaniacs may also become firefighters or volunteer to help them.<ref name=":0" /><ref name=":1">Template:Cite journal</ref>
• It is very rare for pyromaniacs to light fires for sexual gratification. This could be considered Pyrophillia.<ref name=":0" />

Causes

Most studied cases of pyromania occur in children and teenagers.Template:R There is a range of causes, but an understanding of the different motives and actions of fire setters can provide a platform for prevention. Common causes of pyromania can be broken down into two main groups: individual and environmental. This includes the complex understanding of factors such as individual temperament, parental psychopathology, and possible neurochemical predispositions.<ref name="psycnet.apa.org">Template:Cite journal</ref> Many studies have shown that patients with pyromania were in households without a father figure present.<ref name="google">Template:Cite book</ref>

Environmental

Environmental factors that may lead to pyromania include an event that the patient has experienced in the environment they live in. Environmental factors include neglect from parents and physical or emotional abuse in earlier life. Other causes include early experiences of watching adults or teenagers using fire inappropriately and lighting fires as a stress reliever.Template:R Experiences of boredom, or a lack of stimulation within the environment can also be an environmental factor which contributes to acts of pyromania.<ref name=":0" />

Individual

Individual factors contributing to pyromania include emotions and intrinsic drives. One individual factor that could lead to pyromania is feelings of inadequacy, where the individual has the perception that they are not good enough.<ref name=":1" /> This factor is related to the environment in that the perception of inadequacy is derived from environmental events, however when this perception is internalised it becomes an individual factor. Another factor contributing to pyromania is feelings of stress. This could be the buildup of stress over a duration of time or an isolated stressful event.<ref name=":1" /> Patients with pyromania report urges, or intrinsic drives, to set fires.<ref name=":2" /> These fire setting drives can lead to feelings of tension or stress within the individual, and fire setting resolves this tension. Fire setting has also been shown to provide a ‘rush’ of physiological arousal for patients, which produces pleasure. This arousal acts as a positive reinforcer which perpetuates the behaviour and motivates its recurrence.<ref name=":2">Template:Cite book</ref> While not always a cause of the initial fire setting behaviour itself, this tension, and ‘rush’, acts as a cause of pyromania once the initial behaviour has been performed because it drives the same behaviour in the future.<ref name=":2" />

Arson and pyromania

Few arsonists are also classified as pyromaniacs, and while similar, the two are largely not co-morbid.<ref name=":0" /><ref name=":1" /><ref name=":4">Template:Cite journal</ref> Arson is often committed to achieve a gain or advantage which has been planned before the act, where the motive is most often revenge or financial, with the intention to cause harm to property, people and infrastructure.<ref>Template:Cite journal</ref> Conversely, pyromania is a psychiatric diagnosis,<ref name=":2" /><ref name=":4" /> and it is specified in the DSM-5 that classified pyromaniacs do not set fires for financial advantages or for revenge.<ref name="dsm" /> While no gain is planned in advance, planning does still take place for the setting of the fire, such as gathering equipment or flammable items.<ref name=":1" />

Common reasons for misdiagnosis and comorbidity

The prevalence of pyromania is reported to be 3-6% in psychiatric inpatients,<ref name=":1" /> though often undiagnosed in the general adult population.<ref name=":1" /><ref name=":2" /> One reason for this is the shame and secrecy associated with pyromaniac behaviours, which makes individuals reluctant to disclose details about fire setting behaviours to clinicians. It is thought that the secrecy is derived from the fact that intentionally setting fires is a criminal offence,<ref name=":2" /> and fear that clinicians will have to report their behaviour, and the shame is derived from the fact that individuals are not able to control their behaviours, due to the fact that pyromania is an impulse-control disorder.<ref name=":2" /> Another reason for this failure to diagnose is a clinician bias around fire setting. This is because fire setting is often seen simply as a criminal offence leading to underlying motives for the behaviour being ignored.<ref name=":2" /> There is also a lack of training in, and knowledge of, pyromania within clinicians,<ref name=":2" /> as it is a very rare disorder and research on pyromania is scarce.<ref name=":0" />

Pyromania is often misdiagnosed.<ref name=":2" /> This is because fire setting can also be a symptom of other disorders, such as bipolar, substance use and personality disorders.<ref name=":2" /> Bipolar episodes include impulsive behaviours, of which fire setting is one, so pyromania can be misdiagnosed as bipolar disorder if it is assumed that the fire setting is part of a bipolar episode. Substance use disorders and pyromania can occasionally be co-morbid.<ref name=":2" /> In these cases, the two must occur independently: as the DSM-V states, pyromania cannot be diagnosed if the fire setting is a result of substance use.<ref name="dsm" />

Treatment and prognosis

The appropriate treatment for pyromania varies with the age of the patient and the seriousness of the condition. For children and adolescents treatment usually is cognitive behavioral therapy sessions in which the patient's situation is diagnosed to find out what may have caused this impulsive behavior. Once the situation is diagnosed, repeated therapy sessions usually help continue to a recovery.Template:R Other important steps must be taken as well with the interventions and the cause of the impulse behavior. Some other treatments include parenting training, over-correction/satiation/negative practice with corrective consequences, behavior contracting/token reinforcement, special problem-solving skills training, relaxation training, covert sensitization, fire safety and prevention education, individual and family therapy, and medication.<ref name="psycnet.apa.org"/> The prognosis for recovery in adolescents and children with pyromania depends on the environmental or individual factors in play, but is generally positive.

Pyromania is generally harder to treat in adults, often due to lack of cooperation by the patient. Treatment usually consists of more medication to prevent stress or emotional outbursts, in addition to long-term psychotherapy.Template:R In adults, however, the recovery rate is generally poor, and if an adult does recover, it usually takes a longer period of time.Template:R For most adults, their diagnosis of pyromania is chronic, and if fire setting behaviour does go into remission, the behaviour is often substituted for another impulsive behaviour, such as gambling. <ref name=":1" />

Researchers have acknowledged the lack of work on treatment for adult pyromaniacs.<ref name=":0" /><ref name=":3">Template:Citation</ref> Cognitive-behavioural interventions to reduce the symptoms of pyromania in adults have shown some promise,<ref name=":1" /><ref name=":3" /> especially when focused on improving social skills, relaxation and positive reinforcement of alternative behaviours.<ref name=":3" />

Drug Treatments

Controlled drug treatments for pyromania are fairly limited.<ref name=":1" /> Treatments using selective serotonin reuptake inhibitors (SSRIs) have been proposed.<ref name=":0" /><ref name=":1" /> SSRIs inhibit the reuptake of serotonin in the brain, meaning the amount of serotonin in the brain is increased through prolonging the duration it stays in the brain before being reabsorbed, and because of this function they are a commonly used antidepressant.<ref>{{#invoke:citation/CS1|citation |CitationClass=web }}</ref> As serotonin dysregulation has been implicated in pyromania,<ref name=":2" /> a number of researchers have proposed that SSRIs be used to regulate serotonin levels, and these pharmacological treatments have shown promise.<ref name=":0" /><ref name=":1" /><ref name=":2" /> Other treatments using anti-epileptic medications such as topiramate and sodium valproate, lithium and atypical antipsychotics have also been proposed.<ref name=":0" /><ref name=":1" /><ref name=":2" /> No drug treatments for pyromania have been approved by the Food and Drug Administration.<ref name=":2" /> When considering if a drug treatment might be appropriate, any potential co-morbidities of the individual with pyromania must also be taken into account.<ref name=":0" />

History

Pyromania was thought in the 1800s to be a concept involved with moral insanity and moral treatment, but had not been categorized under impulse-control disorders. Pyromania is one of the four recognized types of arson alongside burning for profit, to cover up an act of crime, and for revenge. Pyromania is the second most common type of arson.<ref>Template:Cite journal</ref> Common synonyms for pyromaniacs in colloquial English include firebug (US) and fire raiser (UK), but these also refer to arsonists. Pyromania is a rare disorder with an incidence of less than one percent in most studies; also, pyromaniacs hold a very small proportion of psychiatric hospital admissions.<ref>{{#invoke:citation/CS1|citation |CitationClass=web }}</ref> Pyromania can occur in children as young as age three, though such cases are rare. Only a small percentageTemplate:Quantify of children and teenagers arrested for arson are child pyromaniacs. A preponderance of the individuals are male;<ref>Template:Cite book</ref> one source states that ninety percent of those diagnosed with pyromania are male.Template:R Based on a survey of 9,282 Americans using the Diagnostic and Statistical Manual of Mental Disorders, 4th edition, impulse-control problems such as gambling, pyromania and compulsive shopping collectively affect 9% of the population.<ref>Template:Cite journal</ref> A 1979 study by the Law Enforcement Assistance Administration found that only 14% of fires were started by pyromaniacs and others with mental illness.<ref>Template:Cite journal</ref> A 1951 study by Lewis and Yarnell, one of the largest epidemiological studies conducted, found that 39% of those who had intentionally set fires had been diagnosed with pyromania.<ref>Template:Cite book</ref>

See also

• Child pyromaniac
• Firefighter arson
• Macdonald triad
• Pyrophobia – the hatred or fear of fire
• Pyrophilia – arousal or sexual gratification involving fire