Pyromania

Symptoms and DSM-5's Diagnostic Criteria

File photo. [Credit: Artvee]

Pyromania, derived from the Greek, pyr (means “fire”) and mania (means “a mental illness”), is marked by periods of great excitement or euphoria, delusions, hysteria.

It could also mean an obsession or a compulsive fixation and passion whereby the person experiences tension or becomes excited before setting a fire and shows a fascination with or unusual interest in fire and its contexts such as matches.

The person also experiences pleasure or relief when setting a fire, witnessing a fire, or participating in the aftermath of a fire. The fire-setting is done solely to satisfy this relief pleasure and not for other reasons such as to conceal a crime.

Importantly, those who set fires for political motives, out of anger or to seek vengeance, to conceal crimes, or to improve one’s living situation (for example, by claiming insurance benefits) do not have pyromania.

Likewise, the fire-setting cannot be in response to a psychosis or to impaired judgment from a neurocognitive disorder or drug abuse. Thus, an arsonist who sets fires for monetary gain or for political or criminal purposes would not merit the diagnosis.

A person setting an object on fire is not proof enough to draw a conclusion that s/he is a pyromaniac. One can only classify someone as a pyromaniac, when they repeatedly set things on fire. Just because pyromania can lead to dangerous situations, it does not mean that it always does.

Data show that around 1% of the general population report a life-time history of fire-setting, though this is only one component of pyromania. A study of psychiatric inpatients found that about 6% had a lifetime history of pyromania.

Pyromania is probably more common in men than women and usually begins in adolescence or early adulthood. Mood, substance use, and other ICDs are common in people with pyromania.

Individuals with pyromania often have a history of alcohol dependence or abuse. Juvenile fire setting is usually associated with conduct disorder or attention-deficit/hyperactivity disorder.

Fire-setting is considered a poor prognostic sign for children with conduct disorders and is associated with adult aggression. The course of pyromania is unknown, but clinical descriptions suggest that the course of pyromania is episodic and tends to wax and wane.

Before making the diagnosis, the clinician should rule out other causes of intentional fire-setting, including normal developmental experimentation (for example, playing with matches), antisocial personality disorder, and adult antisocial behavior. Accidental fire-setting, as might occur in a person with a neurocognitive disorder, substance abuse or intoxication, and psychosis, should be ruled out.

There are no standard treatment for pyromania. Much of the literature on the use of psychological treatments has focused on children and includes behavioral therapies, family therapy, and fire education. Case reports have suggested benefit from SSRIs, lithium, topiramate, olanzapine, and valproate.