Pyromania

There is a lack of training in, and knowledge of, pyromania among clinicians,^[5] as it is a very rare disorder and research on pyromania is scarce.^[6] Pyromania is often misdiagnosed, as firesetting can also be a symptom of other disorders, such as bipolar, substance use and personality disorders.^[5] Bipolar episodes include impulsive behaviours, so pyromania can be misdiagnosed as bipolar disorder if it is assumed that the firesetting is part of a bipolar episode. Substance use disorders and pyromania can occasionally be comorbid.^[5] In these cases, the two must occur independently; the DSM-V states that pyromania cannot be diagnosed if the firesetting is a result of substance use.^[7] At times, it is difficult to distinguish the difference between pyromania and experimentation in childhood because both involve receiving gratification from fire.^[8]

The prevalence of pyromania is reported to be 3–6% in psychiatric inpatients,^[9] though it is often undiagnosed in the general adult population.^[9][5] One reason for this is the shame and secrecy associated with firesetting behaviours, which makes individuals reluctant to disclose details to clinicians. It is thought that the secrecy is derived from the fact that intentionally setting fires is a criminal offence^[5] and fear that clinicians will have to report their behaviour. The shame is derived from the fact that individuals are not able to control their behaviours, because pyromania is an impulse-control disorder.^[5] Another reason for this failure to diagnose is clinician bias around firesetting. Because firesetting is often seen simply as a criminal offence, underlying motives for the behaviour may be ignored.^[5]

Pyromania is a rare disorder with an incidence of less than one percent in most studies. Pyromaniacs make up a very small proportion of psychiatric hospital admissions.^[15] 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 have pyromania. A preponderance of the individuals are male;^[16] one source states that ninety percent of those diagnosed with pyromania are male.^[2] Based on a survey of 9,282 Americans using the DSM-IV, impulse-control problems such as gambling, pyromania, and compulsive shopping collectively affect 9% of the population.^[17]

• Pyromania is more prevalent in males than females.^[6]
• The average age of pyromania onset is 18.^[6]
• Individuals with pyromania often observe fires near them and may spend time at nearby fire departments.^[6]
• Individuals may also become firefighters or volunteer to help them.^[6][9]
• It is very rare for individuals to light fires for sexual gratification. This could be considered pyrophilia.^[6]

Few arsonists are also classified as pyromaniacs, and while similar, the two are largely not comorbid.^[6][9][18] Arson is often committed to achieve a gain that has been planned before the act; 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,^[5][18] and it is specified in the DSM-5 that classified pyromaniacs do not set fires for financial advantage or for revenge.^[7] While no gain is planned, planning does still take place for the setting of the fire, such as gathering equipment or flammable items.^[9]

Most studied cases of pyromania occur in children and adolescents.^[2] There is a range of causes; common causes of pyromania can be categorized as environmental or individual. Pyromania may be influenced by factors such as individual temperament, parental psychopathology, and neurochemical predispositions.^[20]

The appropriate treatment for pyromania varies with the age of the patient and the severity of the condition. For children and adolescents, treatment is usually cognitive behavioural therapy (CBT) sessions in which the practitioner seeks to learn what may cause the impulsive behavior. Once the situation is diagnosed, repeated therapy sessions usually help lead to a recovery.^[1] Other treatments include parenting training; over-correction, satiation, or negative practice with corrective consequences; behavioural contracting or token reinforcement; special problem-solving skills training; relaxation training; covert sensitization; fire safety and prevention education, individual and family therapy; and medication.^[20] The prognosis for recovery in adolescents and children with pyromania depends on the environmental or individual factors, but is generally positive.^{[citation needed]}

Pyromania is generally harder to treat in adults "because of the lack of insight and cooperation on the part of most patients diagnosed with the disorder".^[1] Treatment usually consists of medication to prevent stress or emotional outbursts, in addition to long-term psychotherapy.^[1] In adults, the recovery rate is generally poor; if an adult does recover, it usually takes a longer period of time.^[1] For most adults, their diagnosis of pyromania is chronic, and if firesetting behaviour does go into remission, the behaviour is often substituted for another impulsive behaviour, such as gambling.^[9]

Researchers have acknowledged the lack of work on treatment for adult pyromaniacs.^[6][22] Cognitive-behavioural interventions to reduce the symptoms of pyromania in adults have shown some potential,^[9][22] especially when focused on improving social skills, relaxation, and positive reinforcement of alternative behaviours.^[22]

The term pyromania comes from the Greek word πῦρ (pyr, 'fire'). In the 1800s, pyromania was thought to be a concept involved with moral insanity and moral treatment, but it had not been categorized under impulse-control disorders.^{[citation needed]} In 1967, pyromania was categorized as the second-most common of four types of arson, alongside burning for profit, to cover up a criminal act, and for revenge.^[23] A 1951 study by Lewis and Yarnell, one of the largest epidemiological studies of pyromania, found that 39% of those who had intentionally set fires had been diagnosed with pyromania. These high rates of prevalence were not confirmed by later research.^[24] A 1979 study by the Law Enforcement Assistance Administration found that only 14% of fires were started by pyromaniacs and others with mental illness.^[25]

• Firefighter arson
• Macdonald triad
• Pyrophobia – the hatred or fear of fire