Pyromania is said to affect less than 1% of the U.S. population. Because it affects such a small number of the population, pyromania treatment methods are still being researched. Known as a rare disorder, it is characterized by deliberate and persistent firesetting for the purpose of relieving tension and anxiety. Beyond a fascination with fire, pyromania affects men and women alike, though men appear to represent a larger number of fire starters. 

Classified under the disruptive, impulse-control and conduct disorder section of the Diagnostic and Statistical Manual of Mental Health Disorders, fifth edition (DSM-5), pyromania is a chronic condition if left untreated. 

Pyromania disorder treatment can lead to a positive prognosis and even the cessation of firesetting can be achieved with targeted treatment. 

Medications

Due to its rarity, pyromania treatment can vary among individuals. While there have not been any controlled trials of medication for pyromania, certain medications have been considered and used, especially in comorbid conditions. 

Proposed medications for pyromania can include:

  • Antidepressants: Antidepressants have been used in some cases under the rationale that the underlying cause of pyromania is likely to stem from traumatic events and feelings of depression or isolation. Some people theorize that by treating the emotional trigger for pyromania, a person may not feel the same level of intensity of desire to set fires. Research suggests that on a neurobiological level those with impulse-control disorders have abnormalities in serotonergic transmission pathways that affect impulsive behaviors. 
  • Mood stabilizers: Mood stabilizers, like antidepressants, have been utilized due to commonly accepted theories on what causes a person to develop pyromania. Medical professionals who advocate for the use of mood stabilizers for pyromania are focused on the impulse control aspect of the disorder. It has been suggested that if a pyromaniac no longer has significant mood swings, they may be less likely to feel the need to set fires to release emotional pain.
  • Antipsychotics: Some people believe that pyromaniac firesetting occurs as a form of psychotic behaviors. The thought is that antipsychotic medication may prevent a person from losing touch with reality and as a result, prevent firesetting behaviors.
  • Anticonvulsants: Clinical experience shows that antiepileptics can modulate impulsive behaviors such as pyromania. Limited case studies have revealed a response to anti-convulsant medication such as valproic acid and olanzapine with noted improvements. Two reports of children treated for epilepsy with associated pyromania behaviors showed a resolve in both conditions with the use of carbamazepine. 
  • Antiandrogens: Reports on clinical response to anti-androgenic medication shows that neurobiological processes other than just the serotonergic transmission may be affected in pyromania. Medication therapy appears to involve more than one type of medication to address various neurobiological processes and clinicians are making use of antiandrogens in the treatment of impulse control disorders
  • Naltrexone: Naltrexone has been used successfully in the treatment of impulse control disorders and showed a significant reduction in urges related to other impulse disorders such as kleptomania, gambling and trichotillomania. Four out of five studies had positive results and provide strong evidence for the use of naltrexone in other impulse control disorders such as pyromania.

Therapy for Pyromania

While there is no evidence-based therapeutic approach for treating pyromania, one of the most promising methods of treatment in pyromania therapy is cognitive behavioral therapy (CBT). As a therapy, CBT works to identify how a person’s thoughts, feelings and behaviors are intertwined. To create behavioral change, CBT involves challenging thoughts and beliefs that may be inaccurate. 

It has been suggested that if a pyromaniac is able to identify when they are experiencing the early stages of emotional tension building up, they can cope with and release these emotions in a healthier way. Through such pyromania behavior modification, it may be possible for a person to identify faulty thinking patterns that have led to their firesetting. If challenged and a new effective philosophy replaces the faulty belief, a person may no longer feel the compulsion to set fires. 

Some common CBT techniques used for impulse control disorders could include:

  • Covert sensitization: A technique where a person imagines a situation where they have an impulse or urge and then thinks about the possible negative consequences of taking that action. This technique can be practiced multiple times a day.
  • Imaginal desensitization: This technique, also a form of a relaxation technique, involves progressive muscle relaxation while imagining each step leading up to a particular impulse. Through the direction of a therapist, the person is able to identify the destructive nature of that behavior, control the urge and end the scene without completing the impulse.
  • Aversion therapy: This form of therapy requires pairing the unwanted behavior with discomfort. A person can think of the behavior while being exposed to something uncomfortable such as electric shocks, bad smells or even holding their breath. The goal is to associate the unwanted behavior with unpleasant sensations.

Lifestyle Modifications

With limited research surrounding pyromania treatment efficacy, it is important to address all aspects of an individual’s life to increase the likelihood of therapeutic response. Although pyromania is rare, the impact it can have on a person’s life is significant. Lifestyle modifications can help improve the overall outcome of pyromania treatment.

Social Skills Training

In one study that examined the prevalence of intentional fire-setting behavior in the U.S., a clear relationship was seen between firesetting and antisocial behavior. Conduct disorder was notable as well, as triggers such as stress, boredom, interpersonal conflict and feelings of inadequacy. 

In adolescents who are displaying firesetting behavior, as well as adults, it would be of benefit to address such behaviors as they relate to pyromania and the need for positive peer influence. Depending on the individual, group therapy can provide a means to practice social skills and develop practical life lessons.

Relaxation Techniques

Relaxation techniques are employed for a variety of health and mental health conditions and are used to induce a natural state of relaxation including slower breaths, lowered blood pressure and a feeling of well-being. 

Different forms of relaxation techniques can be of benefit for those with impulse control disorders, such as:

  • Deep breathing: the focus is on taking slow, even and deep breaths
  • Biofeedback-assisted relaxation: body functions are measured or monitored to assist in teaching a person how to control or produce changes in the body that lead to relaxation, such as decreased tension in muscles
  • Guided imagery: This practice is the focus on pleasant imagery instead of negative or stressful emotions. It can be done alone with a recording, or led by a health professional.
  • Autogenic training: the focus on physical sensations of the body, including heaviness, warmth and relaxation of different body parts
  • Progressive relaxation: This is a form of progressive muscle relaxation involving the tightening and relaxing of different muscles. It can be combined with breathing exercises and guided imagery, as seen with imaginal desensitization.

It has been noted that while such relaxation techniques are generally safe, some with psychiatric conditions have reported worsening of symptoms or increased anxiety and intrusive thoughts. 

Fire Safety Education

In addition to the fascination with fire, around one-third of patients with pyromania reported traveling to fires when they heard fire engines. One study even observed a link between volunteer firefighting and pyromania. 

In view of this obvious fascination with fire and the potential to start fires and cause harm, it’s essential to educate those with firesetting inclinations. Fire safety education can make an individual more aware of potential harm and dangerous circumstances to avoid. This type of education is especially of benefit to young firesetters who lack the life experience to fully understand the potential danger fire holds.

Treating Pyromania and Co-Occurring Disorders

When a diagnosis of pyromania is made, it is often not the only disorder or mental health condition present. Research has found high rates of psychiatric comorbidity association with pyromania, such as:

Therefore, the best pyromania treatment must include a thorough evaluation of the presence of other mental health conditions and include treatment for those individual disorders. A thorough approach will optimize the care given to individuals with pyromania. 

With over 90% of individuals reporting severe distress after starting fires, and one-third having considered suicide as a way to control firesetting behavior, many pyromaniacs want to overcome their firesetting behaviors, and therefore, need and deserve the best mental health support and treatment available. 

If you or someone you know is currently struggling with a drug or alcohol addiction and firesetting behaviors, contact The Recovery Village. One of our representatives can discuss a treatment plan that may be appropriate for you.

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