PYROMANIA

_________________________________________________________________
Diagnostic Criteria 312.33 (F63.1)
______________________________________________________________________________________________________________________________

A. Deliberate and purposeful fire setting on more than one occasion.

B. Tension or affective arousal before the act.

C. Fascination with, interest in, curiosity about, or attraction to fire and its
situational contexts

(e.g., paraphernalia, uses, consequences).

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 socio-
political 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 judgment.
(e.g., in major neurocognitive disorder, intellectual disability [intellectual
developmental disorder], substance intoxication).

F. The fire setting is not better explained by conduct disorder, a manic

episode, or antisocial personality disorder.
ETIOLOGY
Although the exact cause is unknown, pyromania is often associated with
other psychiatric conditions, such as mood disorders, problems with impulse-
control, or substance abuse. People with pyromania set fires to release the
build-up of an inner tension; the intent is not to commit a crime, seek revenge,
or secure material gain of any kind.
Because it is a rare condition, not many studies have been performed to
investigate the roots of pyromania. Some research has likened pyromania and
other impulse-control disorders to behavioral addictions, and suggests there
may be a genetic link.
PREVALENCE
The population prevalence of pyromania is not known. The lifetime
prevalence of fire setting, which is just one component of pyromania and not
sufficient for a diagnosis by itself, was reported as 1.13% in a population
sample, but the most common comorbidities were antisocial personality
disorder, substance use disorder, bipolar disorder, and pathological gambling
(gambling disorder). In contrast, pyromania as a primary diagnosis appears to
be very rare. Among a sample of persons reaching the criminal system with
repeated fire setting, only 3.3% had symptoms that met full criteria for
pyromania.
 GENDER-RELATED
DIAGNOSTIC ISSUES
Pyromania occurs much more often in males, especially those
with poorer social skills and learning difficulties.
DIFFERENTIAL DIAGNOSIS

Other causes of intentional fire setting.

It is important to rule out other causes of firesetting before giving the diagnosis
of pyromania. Intentional fire setting may occur for-profit, sabotage, or revenge;
to conceal a crime; to make a political statement
(e.g., an act of terrorism or protest); or to attract attention or recognition (e.g.,
setting a fire in order to discover it and save the day).

Fire setting may also occur as part of developmental experimentation in

childhood (e.g., playing with matches, lighters, or fire).
Other mental disorders.
A separate diagnosis of pyromania is not given when fire setting occurs as part
of conduct disorder, a manic episode, or antisocial personality disorder, or if it
occurs in response to a delusion or a hallucination
(e.g., in schizophrenia) or is attributable to the physiological effects of another
medical condition (e.g., epilepsy).
The diagnosis of pyromania should also not be given when fire setting results
from impaired judgment associated with major neurocognitive disorder,
intellectual disability, or substance intoxication.
COMORBIDITY

There appears to be a high co-occurrence of substance use disorders,

gambling disorder, depressive and bipolar disorders, and other
disruptive, impulse-control, and conduct disorders with pyromania.
 KLEPTOMANIA
________________________________________________________________________________________________________
Diagnostic Criteria 312.32 (F63.3)
_______________________________________________________________________________________________________

A. Recurrent failure to resist impulses to steal objects that are not needed for
personal use or for their monetary value.

B. Increasing sense of tension immediately before committing the theft.

C. Pleasure, gratification, or relief at the time of committing the theft.

D. The stealing is not committed to express anger or vengeance and is not in
response to a delusion or a hallucination.

E. The stealing is not better explained by conduct disorder, a manic episode,

or antisocial personality disorder.
 ETIOLOGY
The cause of kleptomania is not known. Several theories suggest that
changes in the brain may be at the root of kleptomania. More research
is needed to better understand these possible causes, but kleptomania
may be linked to:

Problems with a naturally occurring brain chemical

(neurotransmitter) called serotonin. Serotonin helps regulate moods
and emotions. Low levels of serotonin are common in people prone to
impulsive behaviors.
 Addictive disorders. Stealing may cause the release of dopamine (another
neurotransmitter). Dopamine causes pleasurable feelings, and some people
seek this rewarding feeling again and again.

The brain's opioid system. Urges are regulated by the brain's opioid system.
An imbalance in this system could make it harder to resist urges.
PREVALENCE
Kleptomania occurs in about 4%-24% of individuals arrested for shoplifting. Its
prevalence in the general population is very rare, at approximately 0.3%-0.6%.
Females outnumber males at a ratio of 3:1.
 RISK AND PROGNOSTIC
FACTORS
Genetic and physiological. There are no controlled family history
studies of kleptomania.
However, first-degree relatives of individuals with kleptomania may have
higher rates of obsessive-compulsive disorder than the general
population. There also appears to be a higher rate of substance use
disorders, including alcohol use disorder, in relatives of individuals with
kleptomania than in the general population.
DIFFERENTIAL DIAGNOSIS
Ordinary theft.
Kleptomania should be distinguished from ordinary acts of theft or
shoplifting. Ordinary theft (whether planned or impulsive) is deliberate and is
motivated by the usefulness of the object or its monetary worth. Some
individuals, especially adolescents, may also steal on a dare, as an act of
rebellion, or as a rite of passage.
The diagnosis is not made unless other characteristic features of kleptomania
are also present. Kleptomaniais exceedingly rare, whereas shoplifting is
relatively common.
Malingering. In malingering, individuals may simulate the symptoms of
kleptomania to avoid criminal prosecution.

Antisocial personality disorder and conduct disorder. Antisocial personality

disorderand conduct disorder are distinguished from kleptomania by a general
pattern of antisocial behavior.

Manic episodes, psychotic episodes, and major neurocognitive disorder.

Kleptomaniashould be distinguished from intentional or inadvertent stealing
that may occur during amanic episode, in response to delusions or
hallucinations (as in, e.g., schizophrenia), or asa result of a major neurocognitive
disorder.
COMORBIDITY

Kleptomania may be associated with compulsive buying as well as with

depressive andbipolar disorders (especially major depressive disorder),
anxiety disorders, eating disorders(particularly bulimia nervosa), personality
disorders, substance use disorders (especially alcohol use disorder), and
other disruptive, impulse-control, and conduct disorders.
FIRE INTEREST AND ANTISOCIALITY AS RISK FACTORS
IN THE SEVERITY AND PERSISTENCE OF JUVENILE
FIRESETTING.

MacKay S1, Henderson J, Del Bove G, Marton P,Warling D, Root C.

J Am Acad Child Adolesc Psychiatry. 2006 Sep;45(9):1077-84.

 OBJECTIVE:
In the DSM-IV-TR, firesetting is included as a criterion for the diagnoses of
conduct disorder and pyromania. The link between firesetting and antisocial
behavior is well established in the empirical literature. Although theoretical
models of firesetting often include fire interest as a putative risk factor, there is
little research on the role of fire interest in firesetting or on the construct of
pyromania.
METHOD:
The present study evaluated a sample of children and adolescents referred to
an outpatient specialty program for juvenile firesetters with firesetting as the
primary presenting problem. By assessing fire interest and antisocial behavior
concurrently, the contribution of fire interest to firesetting after controlling for
the role of conduct problems was evaluated.
 RESULTS:
Results revealed that fire interest and antisocial behavior were significantly
and positively correlated. Moreover, variations in fire interest added to the
prediction of firesetting severity at assessment and firesetting recidivism at
18-month follow-up above and beyond what was predicted by antisociality
alone.

CONCLUSIONS:
These findings have implications for an empirically derived taxonomy of
pathological firesetting.