Pyromania and Fire-setting Behavior

Pyromania and Fire-setting Behavior

Definition

The primary characteristics of pyromania are recurrent, delib-erate fire-setting, the experience of tension or affective arousal before the fire-setting, an attraction or fascination with fire and its contexts, and a feeling of gratification or relief associated with the setting of a fire or its aftermath.

True pyromania is present in only a small subset of fire-setters. Multiple motivations are cited as causes for fire-setting behavior. These include arson for profit, crime concealment, re-venge, vandalism and political expression. In addition, fire-set-ting may be associated with other psychiatric diagnoses. But true pyromania is rare.

Fire-setting behavior may be a focus of clinical attention, even when criteria for pyromania are not present. Because the large majority of fire-setting events are not associated with true pyroma-nia, this section also addresses fire-setting behavior in general.

Fire-setting as a Planned, Nonimpulsive Behavior

The following motivations have been suggested for intentional arson: financial reward, to conceal another crime, for political purposes, as a means of revenge, as a symptom of other (nonpy-romania) psychiatric conditions (e.g., in response to a delusional belief), as attention-seeking behavior, as a means of deriving sexual satisfaction, and as an act of curiosity when committed by children. Revenge and anger appear to be the most common motivations for fire-setting.

Etiology and Pathophysiology

Arson has been the subject of several investigations of altered neuroamine function. These findings include the observation that platelet monoamine oxidase is negatively correlated with fire-setting behavior of adults who had been diagnosed with atten-tion-deficit disorder in childhood. Investigation of the function of serotonergic neurotransmission in individuals with aggressive and violent behaviors has included studies of CSF concentrations of 5-HIAA in individuals with a history of fire-setting. 5-HIAA is the primary metabolite of serotonin, and its concentration in the CSF is a valid marker of serotonin function in the brain. Virk-kunnen and colleagues (1994) demonstrated that impulsive fire-setting was associated with low CSF concentrations of 5-HIAA. This finding was consistent with other observations associating impulsive behaviors with low CSF 5-HIAA levels (such as im-pulsive violence and impulsive suicidal behavior). A history of suicide attempt strongly predicts recidivism of arson

Assessment and Differential Diagnosis

Presentation

The diagnosis of pyromania emphasizes the affective arousal, thrill, or tension preceding the act, as well as the feeling of ten-sion relief or pleasure in witnessing the outcome. This is useful in distinguishing between pyromania and fire-setting elicited by other motives (i.e., financial gain, concealment of other crimes, political, arson related to other mental illness, revenge, attention seeking, erotic pleasure, part of conduct disorder).

The onset of pyromania has been reported to occur as early as age 3 years, but the condition may initially present in adult-hood. Because of the legal implications of fire-setting, individu-als may not admit previous events, which may result in biased perceptions of the common age at onset. Men greatly outnumber women with the disorder. In children and adolescents, the most common elements are excitation caused by fires, enjoyment pro-duced by fires, relief of frustration by fire-setting and expression of anger through fire-setting.

Fire-setting behavior may be common among more im-paired psychiatric patients. In a study of 191 nongeriatric patients in a psychiatric hospital who were admitted for other reasons, 26 had some form of fire-setting behavior (including threats). Of these, 70% had actually set fires. None had a diagnosis of true pyromania (Soltys, 1992).

The Psychiatric Interview

The interviewer must bear in mind that the circumstances of ar-son, whatever the motive, may pose legal and criminal problems for the individual. This may provide motivation to skew the re-porting of events. Individuals who may be at risk for the legal consequences of fire-setting may be motivated to represent them-selves as victims of psychiatric illness, hoping that a presumedpsychiatric basis of the behavior may attenuate legal penalties. Therefore, the interviewer must maintain a guarded view of the information presented.

Epidemiology and Comorbidity

Prevalence and Incidence

No data are available on the prevalence or incidence of pyroma-nia, but it is apparently uncommon. Although pyromania is a rare event, fire-setting behavior is common in the histories of psychi-atric patients. Among children with psychiatric conditions, fire-setting behavior is apparently quite common.

Comorbidity

Limited data are available regarding individuals with pyromania. Reported data of comorbid diagnoses are generally derived from forensic samples and do not distinguish between criminally moti-vated fire-setters and compulsive fire-setters. Fire-setting behav-ior may be associated with other mental conditions. These include mental retardation, conduct disorder, alcohol and other substance use disorders personality disorders and schizophrenia.

Course

There are no data regarding the course of and prognosis for pyro-mania. However, the impulsive nature of the disorder suggests a repetitive pattern. Again, because legal consequences may occur, the individual may be motivated to represent the index episode as a unique event. Fire-setting for nonpsychiatric reasons may be more likely to be a single event.

Treatment

Treatment Goals

Because of the danger inherent in fire-setting behavior, the pri-mary goal is elimination of the behavior. The treatment literature does not distinguish between pyromania and fire-setting behav-ior of other causes. Much of the literature is focused on control-ling fire-setting behavior in children and adolescents.

Psychiatrist–Patient Relationship

Because of the potential legal risks for individuals who acknowl-edge fire-setting behavior, the psychiatrist must take particular pains to ensure an environment of empathy and confidentiality. A corollary concern involves obligations that may be incumbent on the psychiatrist. Because of the legal implications of these be-haviors and the potential for harm to another individual should fire-setting recur, the psychiatrist should be careful to consider both the ethical and the legal constraints that may follow from information learned in the course of treatment.

Pharmacotherapy and Psychosocial Treatments

There are no reports of pharmacological treatment of pyroma-nia. It has been estimated that up to 60% of childhood fire-set-ting is motivated by curiosity. Such behavior often responds to direct educational efforts. In children and adolescents, focus on interpersonal problems in the family and clarification of events preceding the behavior may help to control the behavior. The treatments described for fire-setting are largely behavioral or fo-cused on intervening in family or intrapersonal stresses that may precipitate episode of fire-setting.

One technique combines overcorrection, satiation and negative practice with corrective consequences. The child is su pervised in constructing a controlled, small fire in a safe location. The fire is then extinguished by the child. Throughout the pro-cess, the parent verbally instructs the child in safety techniques.

The graphing technique has been used as the basis of sev-eral intervention programs with fire-setters. The psychiatrist and the patient agree on a goal of stopping the fire-setting behavior. The psychiatrist and the patient construct a graph that details the events, feelings and behaviors associated with fire-setting epi-sodes. These factors are described on a chronological line graph. The graph is utilized to help the patient see the cause-and-effect relationships between personal events, feelings and subsequent behaviors. The specific intent is to educate patients so that they are able to identify the events that put them at risk for fire-setting. Then patients are equipped to label the feelings as a signal that may allow them to use alternative modes for discharging their feelings. This technique may help the individual curtail other maladaptive behaviors as well. Follow-up reports suggest that in-dividuals who have successfully completed a graphing interven-tion may be at substantially lower risk for future fire-setting.

Relaxation training may be used (or added to graphing techniques) to assist in the development of alternative modes of dealing with the stress that may precede fire-setting. Principles of cognitive–behavioral therapy have been recently applied to childhood fire-setting.