Wednesday, 18 September 2013

Pyromania: An Addiction To Fire

Definition

Pyromania is defined as a pattern of deliberate setting of fires for pleasure or satisfaction derived from the relief of tension experienced before the fire-setting. The name of the disorder comes from two Greek words that mean "fire" and "loss of reason" or "madness." 

The clinician's handbook, the Diagnostic and Statistical Manual of Mental Disorders , also known as the DSM, classifies pyromania as a disorder of impulse control, meaning that a person diagnosed with pyromania fails to resist the impulsive desire to set fires—as opposed to the organized planning of an arsonist or terrorist.

Although pyromania is considered to be a rare disorder in adults, repeated fire setting at the adolescent level is a growing social and economic problem that poses major risks to the health and safety of other people and the protection of their property. In the United States, fires set by children and adolescents are more likely to result in someone's death than any other type of household disaster. The National Fire Protection Association stated that for 1998, fires set by juveniles caused 6,215 deaths, 30,800 injuries, and $11 billion in property damage. It is significant that some European psychiatrists question the DSM-IV-TR definition of pyromania as a disorder of impulse control precisely because of the connection they find between adolescent firesetting and similar behavior in adults. One team of German researchers remarked, "Repeated firesetting, resulting from being fascinated by fire, etc., may be less a disturbance of impulse control but rather the manifestation of a psychoinfantilism, which, supported by alcohol abuse, extends into older age." Pyromania is considered a relatively rare impulse-control disorder in the adult population in North America.

Description

Firesetting in children and adolescents

Although most cases of firesetting in the United States involve children or adolescents rather than adults, the DSM-IV-TR criteria for pyromania are difficult to apply to this population. Most younger firesetters are diagnosed as having conduct disorders rather than pyromania as DSM-IV-TR defines it; significantly, most of the psychiatric literature dealing with this age group speaks of "firesetting" rather than using the term "pyromania" itself.
Some observers have attempted to classify children and adolescents who set fires as either pathological or nonpathological. Youngsters in the former group are motivated primarily by curiosity and the desire to experiment with fire; some are teenagers playing "scientist." Most are between five and 10 years of age, and do not understand the dangers of playing with fire. Few of them have major psychological problems.
Those who are considered to be pathological firesetters have been further subdivided into five categories, which are not mutually exclusive:
  • Firesetting as a cry for help. Youngsters in this category set fires as a way of calling attention to an intrapsychic problem such as depression, or an interpersonal problem, including parental separation and divorce or physical and sexual abuse.
  • Delinquent firesetters. Firesetters in this category are most likely to be between the ages of 11 and 15. Their firesetting is part of a larger pattern of aggression, and may include vandalism and hate crimes. They are, however, more likely to damage property with their firesetting than to injure people.
  • Severely disturbed firesetters. These youths are often diagnosed as either psychotic or paranoid, and appear to be reinforced by the sensory aspects of fire setting. Some set fires as part of suicide attempts.
  • Cognitively impaired firesetters. This group includes youngsters whose impulse control is damaged by a neurological or medical condition such as fetal alcohol syndrome.
  • Sociocultural firesetters. Youngsters in this group are influenced by antisocial adults in their community, and set fires in order to win their approval.

Pyromania in adults

Pyromania in adults resembles the other disorders of impulse control in having a high rate of co-morbidity with other disorders, including substance abuse disorders, obsessive-compulsive disorder (OCD), anxiety disorders, and mood disorders. As of 2002, however, few rigorously controlled studies using strict diagnostic criteria have been done on adult patients diagnosed with pyromania or other impulse-control disorders.

Causes and symptoms

Causes

Most studies of causation regarding pyromania have focused on children and adolescents who set fires. Early studies in the field used the categories of Freudian psychoanalysis to explain this behavior. Freud had hypothesized that firesetting represented a regression to a primitive desire to demonstrate power over nature. In addition, some researchers have tried to explain the fact that pyromania is predominantly a male disorder with reference to Freud's notion that fire has a special symbolic relationship to the male sexual urge. A study done in 1940 attributed firesetting to fears of castration in young males, and speculated that adolescents who set fires do so to gain power over adults. The 1940 study is important also because it introduced the notion of an "ego triad" of firesetting, enuresis (bed-wetting), and cruelty to animals as a predictor of violent behavior in adult life. Subsequent studies have found that a combination of firesetting and cruelty to animals is a significant predictor of violent behavior in adult life, but that the third member of the triad (bed-wetting) is not.

INDIVIDUAL. The causes of firesetting among children and teenagers are complex and not well understood as of 2002. They can, however, be described in outline as either individual or environmental. Individual factors that contribute to firesetting include:
  • Antisocial behaviors and attitudes. Adolescent firesetters have often committed other crimes, including forcible rape (11%), nonviolent sexual offenses (18%), and vandalism of property (19%).
  • Sensation seeking. Some youths are attracted to firesetting out of boredom and a lack of other forms of recreation.
  • Attention seeking. Firesetting becomes a way of provoking reactions from parents and other authorities.
  • Lack of social skills. Many youths arrested for firesetting are described by others as "loners" and rarely have significant friendships.
  • Lack of fire-safety skills and ignorance of the dangers associated with firesetting.
There are discrepancies between adult researchers' understanding of individual factors in firesetting and reports from adolescents themselves. One study of 17 teenaged firesetters, 14 males and three females, found six different self-reported reasons for firesetting: revenge, crime concealment, peer group pressure, accidental firesetting, denial of intention, and fascination with fire. The motivations of revenge and crime concealment would exclude these teenagers from being diagnosed with pyromania according to DSM-IV-TR criteria.

ENVIRONMENTAL. Environmental factors in adolescent firesetting include:
  • Poor supervision on the part of parents and other significant adults.
  • Early learning experiences of watching adults use fire carelessly or inapproriately.
  • Parental neglect or emotional uninvolvement.
  • Parental psychopathology. Firesetters are significantly more likely to have been physically or sexually abused than children of similar economic or geographic backgrounds. They are also more likely to have witnessed their parents abusing drugs or acting violently.
  • Peer pressure. Having peers who smoke or play with fire is a risk factor for a child's setting fires himself.
  • Stressful life events. Some children and adolescents resort to firesetting as a way of coping with crises in their lives and/or limited family support for dealing with crises.

Symptoms

Firesetting among children and adolescents and pyromania in adults may be either chronic or episodic; some persons may set fires frequently as a way of relieving tension, others apparently do so only during periods of unusual stress in their lives.
In addition to the outward behavior of firesetting, pyromania in adults has been associated with symptoms that include depressed mood, thoughts of suicide, repeated conflicts in interpersonal relationships, and poor ability to cope with stress.

Demographics

The true incidence of pyromania in the general American population remains unknown. Of the six impulse-control disorders listed in DSM-IV-TR, only trichotillomania and pathological gambling appear to be common in the general population (4% and 3% respectively). Pyromania, like intermittent explosive disorder and pathological gambling, is diagnosed more frequently in men than in women.
Repeated firesetting appears to be more common in children and adolescents than in adult males. In addition, the incidence appears to be rising in these younger age groups: in 1992, males 18 and younger accounted for 40% of arrests for firesetting; in 2001, they accounted for 55%. As of 1999, 89% of juvenile arrests for firesetting involved males; 79% involved Caucasian juveniles. Within the group of male juveniles, 67% were younger than age 15, and 35% younger than age 12.
Less is known about the incidence of pyromania among adults. Some researchers have theorized that children and adolescents attracted to firesetting when they are younger "graduate" in adult life to more serious crimes with a "macho" image, including serial rape and murder. A number of serial killers, including David Berkowitz, the "Son of Sam" killer, and David Carpenter, the socalled Trailside Killer of the San Francisco Bay area, turned out to have been firesetters in their adolescence. David Berkowitz admitted having started more than 2,000 fires in Brooklyn-Queens in the early 1970s.
Another hypothesis regarding pyromania in adults is that it is more likely to emerge in the form of workplace violence. The recent rapid increase in the number of workplace killings and other violent incidents— a 55% rise between 1992 and 1996— is a source of great concern to employers. One of the complications in the situation is that the Americans with Disabilities Act (ADA), passed by Congress in 1990, forbids employers to discriminate against workers with mental or physical disabilities as long as they are qualified to perform their job. Since 1996, the Equal Employment Opportunities Commission (EEOC) reports that the third-largest category of civil rights claims alleging employer discrimination concerns psychiatric disabilities. In 1997, the EEOC issued a set of guidelines on the ADA and psychiatric disabilities. Significantly, the EEOC excluded pyromania (along with kleptomania, compulsive gambling, disorders of sexual behavior, and the use of illegal drugs) from the list of psychiatric conditions for which employers are expected to make "reasonable accommodation." The EEOC's exclusion of pyromania indicates that workers with this disorder are considered a sufficiently "direct threat" to other people and property that employers are allowed to screen them out during the hiring process.

Diagnosis

DSM-IV-TR specifies six criteria that must be met for a patient to be diagnosed with pyromania:
  • The patient must have set fires deliberately and purposefully on more than one occasion.
  • The patient must have experienced feelings of tension or emotional arousal before setting the fires.
  • The patient must indicate that he or she is fascinated with, attracted to, or curious about fire and situations surrounding fire (for example, the equipment associated with fire, the uses of fire, or the aftermath of firesetting).
  • The patient must experience relief, pleasure, or satisfaction from setting the fire or from witnessing or participating in the aftermath.
  • The patient does not have other motives for setting fires, such as financial motives; ideological convictions (such as terrorist or anarchist political beliefs); anger or revenge; a desire to cover up another crime; delusions or hallucinations ; or impaired judgment resulting from substance abuse, dementia ,mental retardation , or traumatic brain damage.
  • The fire setting cannot be better accounted for by anti-social personality disorder, a conduct disorder , or a manic episode.
Diagnosis of pyromania is complicated by a number of factors; one important factor is the adequacy of the diagnostic category itself. As was mentioned earlier, some psychiatrists are not convinced that the impulse-control disorders should be identified as a separate group, in that problems with self-control are part of the picture in many psychiatric disorders. Bulimia nervosa borderline personality disorder , and antisocial personality disorder are all defined in part by low levels of self-control.
Another complication in diagnosis is the lack of experience on the part of mental health professionals in dealing with firesetting. In many cases they are either unaware that the patient is repeatedly setting fires, or they regard the pattern as part of a cluster of antisocial or dysfunctional behaviors.

Treatments

Children and adolescents

Treatment of children and adolescents involved with repeated firesetting appears to be more effective when it follows a case-management approach rather than a medical model, because many young firesetters come from chaotic households. Treatment should begin with a structured interview with the parents as well as the child, in order to evaluate stresses on the family, patterns of supervision and discipline, and similar factors. The next stage in treatment should be tailored to the individual child and his or her home situation. A variety of treatment approaches, including problem-solving skills, anger management, communication skills, aggression replacement training, and cognitive restructuring may be necessary to address all the emotional and cognitive issues involved in each case.

Adults

Pyromania in adults is considered difficult to treat because of the lack of insight and cooperation on the part of most patients diagnosed with the disorder. Treatment usually consists of a combination of medication— usually one of the selective serotonin reuptake inhibitors— and long-term insight-oriented psychotherapy.

Prognosis

The prognosis for recovery from firesetting among children and adolescents depends on the mix of individual and environmental factors involved. Current understanding indicates that children and adolescents who set fires as a cry for help, or who fall into the cognitively impaired or sociocultural categories, benefit the most from therapy and have fairly positive prognoses. The severely disturbed and delinquent types of firesetters have a more guarded outlook.
The prognosis for adults diagnosed wih pyromania is generally poor. There are some cases of spontaneous remission among adults, but the rate of spontaneous recovery is not known.

Prevention

Prevention of pyromania requires a broad-based and flexible approach to treatment of children and adolescents who set fires. In addition to better assessments of young people and their families, fire-safety education is an important preventive strategy that is often overlooked.
In addition to preventive measures directed specifically at firesetting, recent research into self-control as a general character trait offers hope that it can be taught and practiced like many other human skills. If programs could be developed to improve people's capacity for self-control, they could potentially prevent a wide range of psychiatric disorders.

Read more: http://www.minddisorders.com/Py-Z/Pyromania.html#ixzz2fCmkTNUI
http://www.minddisorders.com/

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