Pyromania

Pyromania is an impulse-control disorder in which individuals repeatedly fail to resist impulses to deliberately start fires^[1] to relieve tension or for instant gratification. The term pyromania comes from the Greek word πῦρ (pyr, 'fire'). Pyromania is distinct from arson, which is the deliberate setting of fires for personal, monetary, or political gain.^[2] Pyromaniacs start fires to release anxiety and tension or for arousal.^[3] Other impulse-control disorders include kleptomania and intermittent explosive disorder.

SpecialtyPsychiatry, clinical psychology

SymptomsImpulsive starting of fires

CausesParental neglect, early physical or emotional abuse, early observation of inappropriate fire usage

PreventionCareful parental attention

Quick facts Specialty, Symptoms ...

Pyromania

Garbage container vandalised by using fire, the result of pyromaniac delinquency
Specialty	Psychiatry, clinical psychology
Symptoms	Impulsive starting of fires
Causes	Parental neglect, early physical or emotional abuse, early observation of inappropriate fire usage
Prevention	Careful parental attention

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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 or relief.^[4] 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; this is seen in teenagers' attitudes towards friends and family.^[5] At times it is difficult to distinguish the difference between pyromania and experimentation in childhood because both involve receiving gratification from fire.^[6]

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 in January 2022.^[7]^[8] It states the following about pyromania:^[9]

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.

— ICD-11, chapter 6, section C70

It also notes that pyromania has no relation to intellectual impairment, substance abuse, or other mental and behavioral disorders.^[9] ICD-11 was produced by professionals from 55 countries out of the 90 countries involved and is one of the most widely used references 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).^[8]

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.^[10]

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."^[11] 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.^[12]

Epidemiology

Pyromania is more prevalent in males than females.^[13]
The average age of pyromania onset is 18.^[13]
Pyromaniacs are often present at fires near them, as well as at nearby fire departments.^[13]
Pyromaniacs may also become firefighters or volunteer to help them.^[13]^[14]
It is very rare for pyromaniacs to light fires for sexual gratification. This could be considered pyrophilia.^[13]

Causes

Most studied cases of pyromania occur in children and teenagers.^[5] 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. These include the complex understanding of factors such as individual temperament, parental psychopathology, and possible neurochemical predispositions.^[15] Many studies have shown that patients with pyromania were in households without a father figure present.^[16]

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 early life. Other causes include early experiences of watching adults or teenagers using fire inappropriately and lighting fires as a stress reliever.^[4] Experiences of boredom or a lack of stimulation within the environment can also be an environmental factor which contributes to acts of pyromania.^[13]

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.^[14] 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.^[14] Patients with pyromania report urges, or intrinsic drives, to set fires.^[17] 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.^[17] While not always a cause of the initial fire setting behaviour itself, this tension and 'rush' act as a cause of pyromania once the initial behaviour has been performed because it drives the same behaviour in the future.^[17]

Arson and pyromania

Few arsonists are also classified as pyromaniacs, and while similar, the two are largely not comorbid.^[13]^[14]^[18] Arson is often committed to achieve a gain or advantage that 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.^[19] Conversely, pyromania is a psychiatric diagnosis,^[17]^[18] and it is specified in the DSM-5 that classified pyromaniacs do not set fires for financial advantage or for revenge.^[11] 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.^[14]

Common reasons for misdiagnosis and comorbidity

The prevalence of pyromania is reported to be 3–6% in psychiatric inpatients,^[14] though it is often undiagnosed in the general adult population.^[14]^[17] 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,^[17] 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.^[17] 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.^[17] There is also a lack of training in, and knowledge of, pyromania among clinicians,^[17] as it is a very rare disorder and research on pyromania is scarce.^[13]

Pyromania is often misdiagnosed.^[17] This is because fire setting can also be a symptom of other disorders, such as bipolar, substance use and personality disorders.^[17] 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 comorbid.^[17] 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.^[11]

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 is usually 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 lead to a recovery.^[4] Other important steps must be taken as well with the interventions and the cause of the impulsive 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.^[15] 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 a lack of cooperation by the patient. Treatment usually consists of more medication to prevent stress or emotional outbursts, in addition to long-term psychotherapy.^[4] In adults, however, the recovery rate is generally poor, and if an adult does recover, it usually takes a longer period of time.^[4] 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.^[14]

Researchers have acknowledged the lack of work on treatment for adult pyromaniacs.^[13]^[20] Cognitive-behavioural interventions to reduce the symptoms of pyromania in adults have shown some promise,^[14]^[20] especially when focused on improving social skills, relaxation, and positive reinforcement of alternative behaviours.^[20]

Drug treatments

Controlled drug treatments for pyromania are fairly limited.^[14] Treatments using selective serotonin reuptake inhibitors (SSRIs) have been proposed.^[13]^[14] SSRIs inhibit the reuptake of serotonin in the brain, meaning the amount of serotonin in the brain is increased by prolonging the duration it stays in the brain before being reabsorbed; and because of this function, they are a commonly used antidepressant.^[21] As serotonin dysregulation has been implicated in pyromania,^[17] a number of researchers have proposed that SSRIs be used to regulate serotonin levels, and these pharmacological treatments have shown promise.^[13]^[14]^[17] Other treatments using anti-epileptic medications such as topiramate, sodium valproate, lithium, and atypical antipsychotics have also been proposed.^[13]^[14]^[17] No drug treatments for pyromania have been approved by the Food and Drug Administration.^[17] When considering if a drug treatment might be appropriate, any potential comorbidities of the individual with pyromania must also be taken into account.^[13]

History

Pyromania was thought in the 1800s to be a concept involved with moral insanity and moral treatment, but it 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 a criminal act, and for revenge. Pyromania is the second most common type of arson.^[22] 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 make up a very small proportion of psychiatric hospital admissions.^[23] Pyromania can occur in children as young as age three, though such cases are rare. Only a small percentage^[quantify] of children and teenagers arrested for arson are child pyromaniacs. A preponderance of the individuals are male;^[24] one source states that ninety percent of those diagnosed with pyromania are male.^[5] 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.^[25] A 1979 study by the Law Enforcement Assistance Administration found that only 14% of fires were started by pyromaniacs and others with mental illness.^[26] 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.^[27] In the modern day, it is often stigmatized or treated as some sort of moral failing. This is unsubstantiated, and can be harmful or disrespectful. There is no proven link between being a bad person and pyromania. Many famous and successful people have suffered from this.