Pyromania Impulse Control Disorder

Abstract
Pyromania is an impulse control disorder categorized by the DSM-5 as “deliberate and purposeful fire-setting on more than one occasion” combined with “tension or affective arousal”, “pleasure, gratification or relief when setting fires or when witnessing or participating in their aftermath” (American Psychiatric Association, 2013). Also, those diagnosed with pyromania aren’t setting fires for monetary gain, to conceal crimes, as an expression of emotion or ideology, or because of impaired judgment associated with disorders, disabilities or substance abuse (American Psychiatric Association, 2013). There have not been many quantitative studies on the prevalence of pyromania in the population nor its treatment. “…relatively few structured
examinations of youths have examined a broad spectrum of impulse-control disorders…” (Grant, Williams, & Potenza, 2007, p. 1584) even less studies have been conducted on adolescent fire-setting as attributed to pyromania as opposed to arson. This literature review will present the current criteria used to diagnose pyromania using the DSM-V to clarify it apart from arson, since many use the terms interchangeably. Additionally, a brief description of Cognitive-Behavioral Therapy (CBT) will be addressed as an evidence based treatment that has been found to be effective in treating other impulse control disorders such as kleptomania, gambling and compulsive buying. These disorders share the characteristics of the failure to resist urges to perform a harmful behavior, increasing tension or arousal that precedes the act, and pleasure or relief upon performing the act (Hodgins & Peden, 2008). This review will analyze the use of Cognitive-Behavioral Theory for treatment with adolescents diagnosed with pyromania based on its effective treatment of other impulse control disorders. Finally, the review will present suggestions for research that may provide further insight into assessment and treatment for adolescent fire-setting as it relates to pyromania. Introduction
Impulse control disorders (ICD) involve problems maintaining self-control; both behaviorally and emotionally that manifest in violations of others’ rights as well as conflicts with law enforcement, the collective society and authority figures (American Psychiatric Association, 2013). Impulse control disorders usually occur first during childhood or adolescence, which can provide difficulty in assessing symptoms to a specific diagnosis because it could be typical childhood behavior. Determining factors such as frequency, persistence and pervasiveness are important in considering diagnosis as well as age, gender and culture could have an effect on accurate assessments (American Psychiatric Association, 2013).
Pyromania, specifically is categorized by poor impulse control based on a specific behavior, fire-setting, to release an internal tension (American Psychiatric Association, 2013).
Pyromania, though observed for many years, still hasn’t yielded the level of research needed to truly assess the rate to which pyromania affects the public nor the necessary methods for treatment or prevention. Pyromania is an impulse control disorder categorized by the DSM-5 as (a) deliberate and purposeful fire-setting on more than one occasion (b) tension or affective arousal, (c) fascination with, interest in, curiosity about, or attraction to fire and its situational contexts, (d) pleasure, gratification or relief when setting fires or when witnessing or participating in their aftermath (e) the fire setting is not done for monetary gain, as an expression of sociopolitical ideology, to conceal criminal activity (f) the fire setting is not better explained by conduct disorder, a manic episode, or antisocial personality disorder (American Psychiatric Association, 2013). Population prevalence of pyromania is not known, most diagnosis has occurred as a comorbid condition rather than a primary diagnosis. Of those “reaching the criminal system with repeated fire setting, only 3.3% had symptoms that met full criteria for pyromania”, as cited by Lindberg et al. in 2005 in the DSM-V (American Psychiatric Association,
2013). Research, thus far, has focused on convicted arsonists rather than those that meet the clinical criteria for pyromania (Grant & Won Kim, 2007). Oftentimes arson and pyromania are used interchangeably, however, the defining characteristic for arson in contrast to pyromania is the intent (Grant & Won Kim, 2007). Pyromania intent is structured around the release of tension or arousal (American Psychiatric Association, 2013), while arson is centered on deliberately setting fire to property (Merriam-Webster, n.d.). Due to the lack of research on lifetime persistence from childhood to adulthood there is no longitudinal evidence on pyromania. Also, there isn’t enough evidence to determine a typical onset age, most likely attributed to childhood and adolescent pyromania diagnoses being rarely given. Of the limited research conducted, “the majority of epidemiological studies have focused on pyromania in childhood and adolescence and have reported the prevalence to be between 2.4% and 3.5%” (Dell’Osso, Altamura, Allen, Marazziti, & Hollander, 2006, p. 466). There is a range of adolescent ages where a higher percentage of youth are starting fires, “sixty percent of all fires in large U.S. cities are lit by individuals between 11 years and 18 years” (Dell’Osso et al., 2006, p. 466).
Cognitive-behavioral therapy is an “approach that includes the appreciation for and modification of cognitive influences on behavior” (Murdock, 2017, p.
231). CBT is a short-term, action focused psychotherapy treatment utilizing interventions that promote practical problem-solving. Dysfunctional thinking and behaviors are modified by learning new skills that challenge negative patterns. There is limited clinical research that examines cognitive-behavioral treatment on all ICDs, however with reference to kleptomania, compulsive buying and pathological gamblers “there is a general consensus in the literature that cognitive-behavioral therapies offer an effective model for intervention for all these disorders” (Hodgins & Peden, 2008, p. 32). CBT has been used in studies in the treatment of kleptomania, utilizing methods such as sensitization, aversion exercises and relaxation training (Hodgins & Peden, 2008). Alternative treatment models have been researched and include pharmacological therapies, however those double-blind studies have only focused on specific ICDs: pathological gambling, intermittent explosive disorder and compulsive shopping (Dell’Osso et al., 2006). Pyromania has yet to have a double-blind study conducted according to Table 3, however there has been some efficacy with non-pharmacological interventions like CBT (Dell’Osso et al.,
2006).