ICD-116C70	PYROMANIA Pyromania
ICD-10F63.1	Pathological fire-setting [pyromania]
DSM-5-TRF63.1	Pyromania

1. Definition and nosology

Pyromania (ICD-11: 6C70; DSM-5-TR: F63.1) — deliberate, purposeful fire-setting behavior; tension or emotional arousal before the act, relief or pleasure after the act. Without financial gain, revenge, or ideological motive; a rare impulse control disorder.

2. History

• In the 1830s, Marc — ‘monomanie incendiaire’.
• DSM-III (1980) — Within impulse control disorders.
• ICD-11 (2019) — within the impulse control disorders category.

3. Epidemiology

• Rare — only ~3–10% of arson incidents meet criteria for pyromania (most arson has financial, revenge, or other motivation).
• Sex: higher in males.
• Onset: adolescence.
• Comorbidity: conduct disorder, ASPD, ID, ADHD, other substance use.

4. Aetiology and pathogenesis

• Multiple factors — neurobiological impulse control, cognitive deficit, family dysfunction.
• Comorbid disorders are typical.

5. Clinical features

• Repeated deliberate fire-setting.
• Pre-act tension/emotional arousal.
• Admiration for the fire, its attributes (flame, tools).
• Post-act pleasure, relief.
• No financial gain, revenge, ideological goal, or psychotic compulsion (delusion).

6. Diagnosis

6.1 Unified diagnostic criteria

A. Deliberately setting fires on more than one occasion.

B. Pre-act tension or emotional arousal.

C. Fever, attribution, fascination with context.

D. The act, its observation, or its outcome provides pleasure.

E. The fire is not motivated by financial, revenge, ideological, socio-political, or psychotic motives.

F. Conduct disorder, not better explained by manic episode, ASPD

6.2 Source-specific clarifications

• DSM-5-TR / ICD-11 — same.
• Rare in clinical practice; most firesetting is motivation-based.

6.3 Diagnostic algorithm

1. Clinical interview + family/witness information.
2. Motivational history — compatibility with pyromania criteria.
3. Comorbidity (ASPD, conduct disorder, manic, psychosis, ID, ADHD).
4. Legal context — forensic psychiatry consultation.

6.4 Differential diagnosis

7. Examination and assessment

• Psychiatric interview.
• Intellectual assessment.
• Impulsivity scales (Barratt Impulsiveness Scale).
• Structured risk assessment in forensic context (HCR-20, VRAG).

8. Treatment

1. Evidence base is limited (rare disorder).
2. CBT — impulse control, trigger management, exposure to alternative behavior.
3. Treatment of comorbid disorders (therapeutic limit in ASPD, behavioral intervention in ID, stimulant in ADHD).
4. SSRI — off-label for impulse control.
5. Legal-psychiatric coordination (hospitalization, court order).

Treatment methods

1. CBT for impulse control — Trigger identification, behavior replacement.
2. Comorbidity treatment — Behavioral intervention, specific for ID, ADHD.
3. Forensic risk assessment — HCR-20, VRAG.

9. Prognosis

• Evidence base is limited; comorbid disorder and psychosocial support determine prognosis.

10. Myths and misconceptions

Myth 1: “All fire-setters are pyromaniacs”

Evidence: Most arson motivation-based (financial, revenge) — pyromania not; ~3–10% meet clinical diagnosis.

Myth 2: “Pyromania is only a childhood phenomenon”

Evidence: onset typically in adolescence, but can persist into adulthood.

Myth 3: “There is specific effective pharmacotherapy”

Evidence: No FDA approval; SSRIs off-label, evidence base limited.

Myth 4: “Legal punishment alone is sufficient”

Evidence: Clinical intervention and comorbidity treatment reduce relapse risk.

11. Sources

1. WHO. ICD-11. 6C70 Pyromania. 2024.
2. APA. DSM-5-TR. 2022.
3. Burton P.R., McNiel D.E., Binder R.L. Firesetting, arson, pyromania, and the forensic mental health expert. J Am Acad Psychiatry Law 2012;40(3):355–365.