Running Head: AN ANALYSIS OF CLINICAL PYROMANIA

A Burning Obsession: An Analysis of Clinical Pyromania and Implications for Future Research.
Brandon McCormick
Pennsylvania State University

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Robbies problematic behavior started when he was very young. He began setting fires
when he was only two and a half years old and was referred to a counselor for treatment.
However, his fire-setting behavior grew increasingly problematic and dangerous, so much so
that, two months after his third birthday, he was hospitalized in a child psychiatric unit. Robbies
interest in fire kept growing. He frequently played with matches and lighters he found around the
home, he set fire to his sisters mattress, rugs, paper, and various household items. Robbie readily
admitted to setting the fires, and he told his therapist that he was extremely curious about fire and
that he enjoyed watching things burn. Robbie even attempted to set fire to the family pet and
other animals. Robbie was admitted to a second psychiatric unit after setting a fire in his house
that subsequently caused its complete destruction (Cox-Jones, Lubetsky, Fultz, & Kolko, 1990).
Many of Robbies symptoms are characteristic of the DSM-V diagnosis of Pyromania.
Fire-setting behavior is relatively common among psychiatric populations. In an analysis
of almost 300 psychiatric patients, the lifetime prevalence for fire-setting behavior was
approximately 30% (Geller, Fisher, & Moynihan, 1992). Furthermore, research conducted by
Ritchie and Huff (1999); found that 90% of arsonists in their study had a history of mental health
issues. However, the actual clinical diagnosis of Pyromania seems to be rare. In a study of 90
individuals who had multiple charges of arson, only 3.3% met the diagnostic criteria for
Pyromania (Grant & Kim, 2007). It is important to note, however, impulse control disorders,
including Pyromania, are believed to be under-diagnosed (Grant, Levine, Kim, & Potenza,
2005). The rareness of the disorder has contributed to a long-held debate regarding whether or
not Pyromania should be considered a unique diagnosis. Pyromania is poorly understood and has
not been the subject of widespread empirical analysis (Grant & Potenza, 2011). Currently,
professionals in the mental health field hold the opinion that Pyromania is its own unique
disorder with its own characteristic symptoms, comorbidity, etiology, and effective treatments.

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For centuries, medical professionals have tried to explain chronic fire-setting behavior. In
the early 19th century, British Physician James Cowles Prichard coined the term moral insanity.
Prichard believed that fire setting was just one manifestation of a deeper problem (Geller, Erlen,
& Pinkus, 1986). Prichards belief that chronic fire setting is a manifestation of another disorder
and not a unique diagnosis is characteristic of one side of a long held debate in the psychiatric
community. A contemporary of Prichard, Jean-Etienne Esquirol, held that repeated fire setting
was part of its own disorder that he referred to as incendiary monomania. He believed that the
cause of this disorder was an instinctive impulse independent of will (Grant & Potenza, 2011).
The debate continues to this day amongst mental health professionals in the United
States. In the first iteration of the Diagnostic and Statistical Manual of Mental Disorders (DSMI), Pyromania was listed under supplemental terms and was not its own, unique, diagnosis (APA,
1952). The term Pyromania was omitted entirely from the second edition of the DSM (APA,
1968). The American Psychiatric Association (APA) continued to side with Prichard in their third
manifestation of the Diagnostic Manual. In the DSM-III, the APA classified Pyromania as an
impulse control disorder not elsewhere classified (APA, 1980). The opinion of the APA shifted to
Esquirols side of the debate in the next edition of the DSM. The disorder was listed as its own
disorder in the DSM-IV-TR, in the impulse control disorder section of the Manual (APA, 2000).
The disorder was given the same status in the newest edition of the DSM (APA, 2013). It is
likely that Pyromania will continue to be considered a unique primary diagnosis in future
editions of the DSM.
According to the DSM-V, Pyromania is characterized by deliberate and purposeful fire
setting on more than one occasion. The second diagnostic criterion is that the patient must
experience tension or emotional arousal before the act of setting a fire. After committing the act,
the individual must have a feeling of pleasure, gratification, or relief. These feelings can be felt

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while setting the fire or while experiencing the aftermath of the act. The diagnosis of Pyromania
can only be given if the behavior is not better explained by a manic episode in patients with
Bipolar disorder, conduct disorder in children, or antisocial personality disorder in adults (APA,
2013). In the United Kingdom, in 2008 alone, over 53,000 fires were determined to be set
deliberately, resulting in over 2 billion Euros in damage and 451 fatalities. The most common
motive cited in these cases was anger or revenge (Tyler & Gannon, 2012). Therefore, most of the
perpetrators in these cases would not meet the DSM-V criteria. This is because, to meet the
clinical definition of Pyromania, the fires cannot be set for monetary gain (i.e. insurance fraud),
as an expression of political ideology (e.g. terrorism), as an expression of anger or vengeance, to
improve an individuals living circumstances, as a response to a delusion or hallucination, or as a
result of impaired judgment (e.g. intellectual disability, a neurocognitive disorder, substance
abuse etc.) (APA, 2013). Robbie displayed many of these symptoms. He had no external
motivation for lighting the fires (i.e. anger or monetary gain), his parents reported that he had
always had a fascination with fire, that he felt relief and pleasure after lighting fires, and that he
enjoyed watching things burn (Cox-Jones, Lubetsky, Fultz, & Kolko, 1990). Aside from the
primary diagnosis, many individuals with Pyromania, including Robbie, often have other clinical
and behavioral issues.
In an analysis of individuals that had the primary diagnosis of Pyromania, Grant and Kim
(2007), found that 95.2% had at least one other lifetime DSM diagnosis. More specifically, they
found that 47.6% met the diagnostic criteria for another impulse control disorder, and 33.3% had
a current substance abuse problem. In all patients with a comorbid substance abuse problem, the
symptoms of Pyromania preceded the onset of the substance abuse. Finally, 70% of the
individuals with Pyromania met the criteria for the diagnosis of major depressive disorder. This
is consistent with Robbies clinical history. Robbie had a history of behavioral problems such as

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fighting with peers and adults, bullying, foul language, and other violent outbursts, had a history
of academic underachievement, had been caught shoplifting on multiple occasions, and showed
no remorse after burning his house down. These behaviors are all indicative of other impulse
control disorders such as conduct disorder, intermittent explosive disorder, and kleptomania.
Robbie also frequently abused substances such as airplane glue, aftershave, and bleach (CoxJones, Lubetsky, Fultz, & Kolko, 1990). Little empirical research has been done on the etiology
of Pyromania, but some experts have proposed potential causes for the disorder.
The average age of onset for Pyromania is 18 years old, but symptoms can occur in
children at very young ages (Grant & Kim, 2007). The ratio of males to females who have
chronic fire setters is believed to be around 6:1 (Bourget & Bradford, 1989), and the fire setting
is more common among Caucasians (Bennett & Hess, 1984). In many cases, individuals with
Pyromania have a history of parental abuse. This history of abuse may result in a loss of a feeling
of power, and some experts argue that individuals with Pyromania light fires to restore their
feelings of power (Grant & Potenza, 2011). Behavioral theorists have suggested that the act of
lighting fires is reinforced by the rush they feel after committing the act (Grant & Potenza,
2011). Fineman (1995) suggests that a lack of attention and supervision, lead some individuals to
light fires to gain attention. Research on adults with Pyromania shows that they tend to have
unsatisfying sex lives, a troubled relationship history, and insecure sexual identities (Rasanen,
Puumalainen, Janhonen, & Vaisanen, 1996). Gannon and Pina (2010) suggest a potential link
between attachment style and Pyromania, but further research is required to establish causality.
Frontal lobe abnormalities that inhibit impulse control have also been suggested as a possible
cause of Pyromania (Grant & Potenza, 2011). In Robbies case, his parents reportedly struggled
with alcohol abuse and provided Robbie with little supervision or affection. Also, his father had
struck Robbie and his mother while intoxicated (Cox-Jones, Lubetsky, Fultz, & Kolko, 1990).

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These factors could have combined with possible frontal lobe abnormalities to cause Robbies
symptoms. Unfortunately, the most effective treatment for Pyromania has not yet been
determined, but various treatment methods have been at least partially effective in Pyromania
patients.
To treat Robbies Pyromania, his therapist implemented a form of cognitive behavioral
therapy, in which his therapist first determined the motivations behind why Robbie played with
fire. Next, his therapist identified his thoughts and feelings about his family and friends. Then,
firefighters were brought in to teach Robbie aspects of fire safety, and the dangers associated
with lighting fires. Robbie was then accompanied on a trip to a burned down house so that he
could see the aftermath, seriousness, and permanence of lighting fires. Finally, Robbie underwent
social skills training and participated in role-playing activities in which he learned how to
effectively deal with his negative emotions (Cox-Jones, Lubetsky, Fultz, & Kolko, 1990).
Different forms of cognitive behavioral therapy are commonly used to treat individuals with
Pyromania. To date, there have been no clinical trials that have assessed the effectiveness of drug
treatments for Pyromania. However, many clinicians will prescribe medications such as SSRIs
to reduce comorbid issues such as mood disorders, but this does not seem to reduce the
symptoms of Pyromania in most cases (Grant & Potenza, 2011). More research is required to
determine the most effective treatment of Pyromania.
Setting fires is a common and problematic behavior among individuals with mental
disorders, but true Pyromania seems to be rare. This has contributed to the debate surrounding
the status of Pyromania as a unique diagnosis. Individuals diagnosed with Pyromania show
number of similar characteristics such as a history of parental abuse, and comorbid mood
disorders, impulse control disorders, and substance abuse disorders. The symptomology of
Pyromania includes a fascination with fire as well as a feeling of tension before lighting a fire,

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and a relief of that tension or feelings of pleasure after the act. Most individuals begin to show
symptoms during adulthood, but there are many cases involving young children. Robbie was one
such case, who started to show the symptoms when he was only 18 months old. Mental Health
experts have proposed various etiological theories for Pyromania including behavioral and
neurological explanations, however, it is likely that Pyromania is the result of many different
variables. Empirical research has not yet been conducted to determine the most effective
treatment for Pyromania, but forms of cognitive behavioral therapy has shown some promise in
reducing symptoms.
Pyromania can be a distressing, extremely destructive disorder, as it was in the case of
Robbie who burned his house down while playing with fire. In extreme cases, it can even be
lethal. Although it is a relatively rare disorder, there are thousands who individuals who struggle
with this disorder that can to destruction of property and even death. The literature on the causes
and treatments for Pyromania is severely lacking, and more research needs to be conducted
regarding the disorder. In a one year follow-up, Robbie reported to his therapist that he no longer
likes to set fires because Fires burn down houses and make me feel sad. He also reported that
he wanted to be a firefighter when he grew up so that he could help put out fires (Cox-Jones,
Lubetsky, Fultz, & Kolko, 1990). Cases like Robbies hold implications for future research, and
should be seen as a sign for hope for those suffering from Pyromania as well as their loved ones.

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