Review Question - QID 220746

This patient with arousal after starting a fire but no other ulterior motives or desires to harm others most likely has pyromania.

Pyromania is an impulse control disorder in which patients experience a strong and dysfunctional fascination related to the setting of fires. Typically, patients will describe a tension that develops when they are not setting fires. The tension rises to an uncontrollable urge that is satiated when a fire is started. Patients will also experience relief and sometimes arousal related to the fires that they start. Patients with pyromania have an intrinsic motivation for starting fires and do not have secondary gain (such as monetary incentives with insurance fraud) or vengeance (such as arson) as a motivation. Patients with pyromania may be well-behaved otherwise and do not exhibit violence towards others or animals.

Blum et al. studied the cognitive differences between patients with pyromania and controls. They found that patients with pyromania demonstrate cognitive inflexibility. They recommend appropriate screening for this patient population.

Figure/Illustration A is a clinical photograph demonstrating burns on the trunk (red circle). These findings are consistent with burns in a patient who presents with pyromania.

Incorrect Answers:
Answer 1: Antisocial personality disorder presents with disregard for and a violation of the rights of others with a lack of remorse. While these patients may also set fires, the reason for their fires is to inflict pain or destruction rather than having an intrinsic fascination with fires. Antisocial personality disorder is diagnosed at the age of 18 years or older.

Answer 2: Borderline personality disorder presents with unstable interpersonal relationships, impulsive behavior, and a sense of emptiness due to a fear of abandonment. While patients with borderline personality disorder may engage in dramatic acts such as setting fires, the purpose of these fires is to gain the attention of others. Self-harm behaviors, emotional outbursts, and splitting are commonly seen in this condition.

Answer 3: Conduct disorder presents in childhood with disregard for others and aggressive behavior that violates the rights of others. It can only be diagnosed in patients less than 18 years old. While patients with conduct disorder may set fires, the reason for setting fires is to hurt others. At the age of 18, the diagnosis becomes antisocial personality disorder.

Answer 4: Oppositional defiant disorder is a childhood disorder that presents with an angry and irritable mood that is accompanied by acts of resisting authority. These patients do not violate social norms and/or harm others. Often, their behaviors are directed at resisting authority figures.

Bullet Summary:
Patients with pyromania have a fascination with fires that they set in order to release intrinsic tension and achieve arousal.