DSM-5 Category: Disruptive, Impulse-Control, and

Conduct Disorders
Introduction
Disruptive, impulse-control, and conduct disorders are a class of diagnoses characterized by
difficulties controlling emotions and behaviors. These disorders frequently involve
uncontrolled impulses leading the individual to violate the rights of others through acts of
aggression or destruction, as is the case in pyromania (The American Psychiatric Association,
2013).
Pyromania remains a relatively under-researched and possibly under-reported impulse control
disorder. The strong urges to watch existing fires or to set new fires may lead individuals who
meet the criteria for pyromania to engage in acts of arson, often endangering their own lives
and the lives of others. This is considered a significant risk to the individual with pyromania
and those around them (The American Psychiatric Association, 2013).

Symptoms of Pyromania
Pyromania is hallmarked by fascination with and attraction to fire and fire-starting
paraphernalia, as well as the deliberate and repeated setting of fires. Individuals diagnosed
with pyromania often experience tension or affective arousal before setting a fire, and
feelings of pleasure, gratification, or relief during or after fire-starting. Fire setting is not done
for monetary or other gain, to conceal crimes, in response to delusion or hallucination, or as a
result of a lack of judgment. Additionally, the fire setting behaviors should not be better
explained by conduct disorder or other psychiatric illness (The American Psychiatric
Association, 2013).
Individuals with pyromania commonly spend time closely associated with fire departments,
even becoming firefighters, and are often seen watching any fires in their neighborhoods. It is
not uncommon for these individuals to set small fires or set off false alarms in order to see
firefighting equipment (The American Psychiatric Association, 2013).
Pyromania is diagnosed significantly more often in males, particularly in those with poor
social skills or other learning disabilities, though it is unclear why gender disparity remains
so strong (The American Psychiatric Association, 2013).

Diagnosis of Pyromania
Diagnosis of pyromania is typically based on criminal records of repeated or suspicious fire
setting and patient reports regarding their emotional relationship with fire. The mechanisms
behind pyromania are unclear, and patients often experience episodic remissions in firesetting urges (The American Psychiatric Association, 2013).
Patients should not be diagnosed with pyromania if their fire setting occurs as a result of
conduct disorder, antisocial personality disorder, as a result of hallucinations or other

neurological conditions or intellectual disabilities, substance intoxication, or with monetary,

revenge, or other malicious intent (The American Psychiatric Association, 2013).

Co-morbidity of Pyromania
Pyromania often occurs alongside a past history of alcohol use disorder, and is most
commonly comorbid with antisocial personality disorder, bipolar and depressive disorders,
substance use disorder, and pathological gambling. Pyromania very rarely appears as a
primary diagnosis (The American Psychiatric Association, 2013).
One study conducted evaluated twenty-one subjects diagnosed with pyromania (ten female,
eleven male), and concluded that the mean age of onset was 18 years, with fires set every 5.9
weeks on average. While many of the fires set by individuals in this study did not meet the
criteria for arson, they did match the emotional anticipation and release patterns consistent
with pyromania. Interestingly, over half (thirteen) of the twenty-one patients were also
diagnosed with comorbid Axis I mood disorders, and ten diagnosed with other impulsecontrol disorders (Gyant & Kim, 2007). As such, further research need to be conducted on
pyromania to clarify the possible etiologies and comorbidities associated with the disorder.

Prevalence of Pyromania
The true prevalence of pyromania is currently unknown. Pyromania has been estimated to
occur in approximately 1.13% of the population based on population sampling, and has been
diagnosed in only 3.3% of individuals incarcerated due to repeated fire setting. Therefore, it
is unclear just how many individuals in the general population may meet the criterion for
diagnosis with pyromania, while channeling their urges into safe fire-setting techniques (The
American Psychiatric Association, 2013).
Currently, over 40% of individuals arrested for arson in the United States are under 8 years of
age, indicating that fire-setting in adolescents is a significant concern despite the fact that
childhood diagnosis of pyromania remains quite rare. In these cases, it is important to
distinguish between the criteria for pyromania and fire-setting behaviors in conduct disorder,
attention-deficit/hyperactivity disorder, and other adjustment or impulse control disorders
(The American Psychiatric Association, 2013).
Further evaluations of fire scenes by forensic mental health experts, including but not limited
to those attributed to arson, may provide more extensive insight into the nature and
prevalence of pyromania and breakthroughs in potential treatments (Burton, McNiel, &
Binder, 2012). Through careful forensic analysis of fire scenes, experts may be able to
provide more accurate data regarding the prevalence of intentional fire setting and techniques
use in lighting these fires. This data may be useful when analyzing the tendency for
individuals with pyromania to obsess over paraphernalia related to fire, such as lighters.

Treatment of Pyromania
There is a strong indication that individuals diagnosed with impulse-control disorders,
including pyromania, may respond well to an approach including the use of
psychopharmaceuticals. Selective serotonin reuptake inhibitors (SSRIs), opiate antagonists,

mood stabilizers, and atypical use of antipsychotics may contribute to the successful
reduction in the symptoms of pyromania (McIntyre, Moral, Serradell, & Prous, 2006).
More recent research indicates that the use of naltrexone, beta blockers, antiandrogens,
lithium, and antiepileptics may also be successful in controlling the impulsive symptoms of
pyromania. While research into the use of antiepileptics is new and primarily based on case
reports, the initial results are promising and should be followed with double-blind clinical
trials (Roncero, Rodriguez-Urrutia, Grau-Lopez, & Casas, 2009).
Ultimately, there has not been a significant level of success in controlling the symptoms of
pyromania through any one specific treatment. There is a gap in the body of literature related
to treatment of impulse disorders, and may make treatment of pyromania difficult (Grant,
J.E., Schreiber, L.R.N., & Odiaug, B.L. (2013).

Outcomes for Pyromania

Interest in fire and the presence of antisocial behavior are significantly and positively
correlated, with antisocial behavior strongly predictive of recidivism in fire-starting behavior.
This indicates that children, adolescents, and adults who demonstrate antisocial behaviors and
interest in fire should be monitored and kept in treatment to prevent the urges associated with
pyromania from emerging in a dangerous manner (MacKay, et al., 2006).
Due to the potentially dangerous, or even fatal, consequences of pyromania, not to mention
the possibility of conviction and incarceration for arson, individuals should remain in lifelong
contact with qualified psychiatric personnel.

References
American Psychiatric Association, The (2013). Diagnostic and statistical manual of mental
disorders (5th ed.). Arlington, VA: American Psychiatric Publishing.
Burton, P.R.S., McNiel, D.E., & Binder, R.L. (2012). Firesetting, arson, pyromania, and the
forensic mental health expert. Journal of the American Academy of Psychiatry and the Law,
40(3), 355-365.
Grant, J.E., Schreiber, L.R.N., & Odiaug, B.L. (2013). Phenomenology and treatment of
behavioural addictions. Canadian Journal of Psychiatry, 58(5), 252-259.
Gyant, J.E., & Kim, S.W. (2007). Clinical characteristics and psychiatric comorbidity of
pyromania. Journal of Clinical Psychiatry, 68(11), 1717-1722.
MacKay, S., Henderson, J., Del Bove, G., Marton, P., Warling, D., & Root, C. (2006). Fire
interest and antisociality as risk factors in the severity and persistence of juvenile firesetting.
Journal of the American Academy of Child and Adolescent Psychiatry, 45(9), 1077-1084.
McIntyre, J., Moral, M.A., Serradell, N., & Prous, J.R. (2006). Psychopharmacology of
impulse-control disorders. Drugs of the Future, 31(3), 245-258.

Roncero, C., Rodriguez-Urrutia, A., Grau-Lopez, L., & Casas, M. (2009). Antiepileptic drugs
in the control of the impulses disorders. ACTAS Espanolas de Psiquitria, 37(4), 205-212.

Pyromania

Defining Pyromania

Pyromania is an impulse control disorder in which the patients are unable to control their
urge to start fires. Pyromania is like kleptomania in that the patients commit criminal
activities out of impulse and not for any perceived gain. People feel a sense of gratification
and relief after starting a fire.
This is very different from arson, which is mostly committed to achieve a financial/personal
gain. Pyromaniacs usually set fire deliberately to induce euphoria, mostly evident right before
the fire gets started. They feel excited and aroused watching the effect of the fire, watching it
spread. When the fire is out they may become upset that the fire has burned out and have the
desire to start another one to being back the thrill. Pyromania is common in people who
struggle with personal issues and aggression. Additionally, some pyromaniacs start fires
because they are fixated upon fire-fighting institutes and fire fighters, and they cause fires
just to see these people in action.
There are a number of theories revolving around the psychological functioning behind such a
fixation; however, there has been no consensus in the scientific community about it. Some
other behavoral disorders are Anorexia Nervosa, Bulimia Nervosa, Kleptomania,
Trichotillomania, etc.
Signs and Symptoms of Pyromania

Impulsive behavior

Unsafe and risky indulgences like unprotected sex, rash driving etc.

Awareness of destructive behavior and feeling unable to change it

Massive mood swings

Short and intense periods of anxiety and stress

Domestic violence

Suicidal behavior

Feeling hopeless and often misunderstood

Self-hate and self-detestation

Causes and Risk Factors

The exact cause of pyromania and other impulse control disorders is still not ascertained;
however, scientists and researchers attribute the exact causes of to a combination of factors.
Genetics, by far, play the most pivotal role in causing such disorders. Genetic mutations can
affect neurotransmitters in the brain that can inhibit the regular social functioning and prompt
individuals to start fires.
Environmental factors also play an important role in activating the fight or flight
mechanism of the human brain. It is during these instances of extreme stress and anxiety that
the patients brain that may lead to the desire for thrill and excitement, leading to disorders
like pyromania.
Neurobiology and general defects in the brain also cause abnormalities. Certain parts,
especially those in the hypothalamus of the brain may get damaged due to a stressful
encounter, a life threatening situation or an accident.
Patients of pyromania are exposed to many risks, including:

Criminal conviction on charges of arson

Social alleviation

Risk seeking behavior

Distress

Progression into complete mental imbalance

Treatment

Because the exact causes of pyromania are unclear, the exact treatment alternatives are also
hazy. However, there are a number of ways in which treatment can be administered based on
documented case studies from the past. The intensity of the treatment is a function of the
severity of the condition and the age of the patient.
Cognitive behavioral therapy (CBT) is the most well recognized treatment for pyromania.
CBT aims at making the user aware of his condition and the exact fallouts of his impulsive
behavior. CBT is a step by step process in which the patient is exposed to his urges and urged
to control his impulses. This conditions the patients mind to check his actions before he
commits the act of lighting the fire.

Long term psychotherapy is also employed to treat pyromania. Patients of pyromania can also
seek treatment in a professional treatment center. Treatment centers can also be helpful in
helping patients overcome the symptoms and fallouts of withdrawal from their condition.
It is best to visit a rehabilitation facility for treatment of pyromania. It is important to contact
the preferred center before checking in to make sure that they have the treatments offered for
pyromania available.