Pyromania
Synonyms and keywords: Impulse control disorder

# Overview
Pyromania is an intense obsession with fire, explosives, and their related effects. It is also an obsession with starting fires in an intentional fashion. An individual with pyromania is referred to as a pyromaniac or "pyro" for short. In colloquial English, the synonyms "firebug" and "firestarter" are sometimes used. Pyromaniacs are identified specifically as not having any other symptoms but obsession with fire causing their behavior.  It is distinct from arson, and pyromaniacs are also distinct from those who start fires because of psychosis, for personal, monetary or political gain, or for acts of revenge. Pyromaniacs start fires to induce euphoria, and often tend to fixate on institutions of fire control like fire stations and firefighters.

# Historical Perspective
Starting in 1850, Devin Amaercer started eight fires and developed this disease. There have been many arguments as to the cause of pyromania. Whether the condition arises from mental illness or moral deficiency has changed depending on the development of psychiatry and mental health care in general.

# Pathophysiology
Little is known about this impulse control disorder, except some research suggesting there is an environmental component arising in late childhood.
Few scientifically rigorous studies have been done on the subject, but psychosocial hypotheses suggest pyromania may be a form of communication from those with few social skills, or an ungratified sexuality for which setting fires is a symbolic solution. Medical research also suggests a possible link to reactive hypoglycemia or a decreased concentration of 3-methoxy-4-hydroxyphenylglycol and 5-hydroxyindoleacetic acid (5-HIAA) in the cerebrospinal fluid. Some biological similarities have been discovered, such as abnormalities in the levels of the neurotransmitters norepinephrine and serotonin, which could be related to problems of impulse control, and also low blood sugar levels. Children who are pyromaniacs often have a history of cruelty to animals. They also frequently suffer from other behavior disorders and have learning disabilities and attention disorders. It is also one of the supposed three early signs of developing psychopathy (the MacDonald Triad).  Other studies have linked pyromania to child abuse. 

# Differential Diagnosis
- Antisocial personality disorder
- Conduct disorder
- Delusion
- Developmental experimentation in childhood (playing with matches, lighters, or fire)
- Epilepsy
- Hallucination
- Impaired judgment
- Manic episode 

# Epidemiology and Demographics

## Prevalence
The prevalence of pyromania in the overall population is unknown.  Pyromania is a very rare disorder, and the incident of it is less than one percent in most studies; also, pyromaniacs are a very small proportion of psychiatric hospital admissions. Pyromania can occur in children as young as age three, but it is rare in adults and rarer in children. Only a small percentage of children and adolescents arrested for arson have pyromania. Ninety percent of those diagnosed with Pyromania are male. Based on a survey of 9282 Americans using the Diagnostic & Statistical Manual on Mental Disorders, 4th edition, impulse-control problems such as gambling, pyromania and compulsive shopping collectively affect 9% of the population. And a 1979 study by the Law Enforcement Assistance Administration found that only 14 percent of fires were started by pyromaniacs and others with mental illness.

# Risk Factors
- Learning difficulties
- Male gender
- Poor social skills

# Diagnosis

## Symptoms
Pyromaniacs are known to have feelings of sadness and loneliness, followed by rage, which leads to the setting of fires as an outlet. For a positive diagnosis, there must be purposeful setting of fire on at least two occasions. There is tension or arousal prior to the act, and gratification or relief when it is over. It is done for its own sake, and not for any other motivation.  In some cases it is all about the pleasure of seeing what other people have to do to extinguish the fire, and the pyromaniac may enjoy reading of the effects of what they have done.   Many sufferers claim that they just like to set fires for the sake of fires and the blaze of dancing flames. Many pyromaniacs feel a relief of stress in watching things burn or smolder, and the condition is fueled by the need to watch objects burn.
A lot of people diagnosed with pyromania have also committed other crimes such as, forcible rape (11%), nonviolent sexual offenses (18%) and vandalism of property (19%).

# Diagnostic Criteria

## DSM-V Diagnostic Criteria for Pyromania

# Treatment
Behavior modification is the usual treatment for pyromania. Other treatments include seeing the patient's actions as an unconscious process and analyzing it to help the patient get rid of the behavior. Often, this treatment is followed by a more psychodynamic approach that addresses the underlying problems that generated the negative emotions causing the mania. The prognosis for treatment is generally fair to poor. Treatment appears to work in 95% of children that exhibit signs of pyromania, which include family therapy and community intervention. Selective serotonin reuptake inhibitors (SSRIs) are also used to treat this condition. Studies have also shown there are therapeutic benefits associated with playing out the mania in a simulated environment.
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