Definition and clinical features

Pyromania is defined in DSM-IV as follows: deliberate and purposeful fire-setting on more than one occasion (criterion A) that is associated with tension or affective arousal before the act (criterion B), fascination with, interest in, curiosity about, or attraction to fire and its situational contexts (criterion C), and pleasure, gratification, or relief when setting fires, or when witnessing or participating in their aftermath (criterion D). Also, the fire-setting is not done for monetary gain, as an expression of sociopolitical ideology, to conceal criminal activity, to express anger or vengeance, to improve one's living circumstances, in response to a delusion or hallucination, or as a result of impaired judgement (criterion E), and is not better accounted for by conduct disorder, a manic episode, or antisocial personality disorder (criterion F). In ICD-10, pyromania (or pathological fire-setting) is defined as multiple acts of, or attempts at, setting fire to property or other objects, without apparent motive, and by a persistent preoccupation with subjects related to fire and burning. The essential features are as follows:

• repeated fire-setting without any obvious motive such as monetary gain, revenge, or political extremism

• an intense interest in watching fires burn

• reported feelings of increasing tension before the act, and intense excitement immediately after it has been carried out.

Although the authors were unable to locate any systematic reports of a group of people with rigorously diagnosed pyromania, there are numerous case reports of people with repetitive fire-setting behaviour who would probably meet the DSM-IV or ICD-10 criteria for pyromania. For example, in what is still probably the largest study of pathological fire-setting, in 1951, Lewis and Yarnell (29 evaluated 1145 of 2000 American case records of males 16 years of age and older from the National Board of Fire Underwriters (selection criteria were otherwise not clearly specified). They concluded that 688 of these males were best classified as 'pyromaniacs' as 'they set fires for no practical reason and received no material profit from the act, their only motive being to obtain some sort of sensual satisfaction'. Although Lewis and Yarnell did not provide quantitative data summarizing these 688 cases, they stated that 50 of these subjects 'approached true pyromania', in that they were able to give a 'classical description of the irresistible impulse'. Specifically, before they set fires, these subjects described 'mounting tension; ... restlessness; the urge for motion; ... conversion symptoms such as headaches, palpitations, ringing in the ears, and the gradual merging of their identity into a state of unreality'.

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