Pyromania

What Causes Pyromania?

Doctors and researchers have not yet determined precisely what causes pyromania, but they have identified several risk factors that increase an individual’s likelihood of developing the disorder.

• Genetic Predisposition. Having a parent, sibling, or child who has been diagnosed with an impulse control disorder increases the chance that you will also be diagnosed with one of the disorders, including pyromania.
• Neurological Causes. People with impulse control disorders often have low levels of the neurotransmitter chemical serotonin. Pyromania may also be related to the release of dopamine, a brain chemical that causes feelings of pleasure. Dopamine is often associated with addictive behaviors, and it may play a role in kleptomania as well.
• Mental health-related issues. People with pyromania often have at least one other co-existing mental illness. People with learning disabilities or poor social skills may also be at increased risk.
• Environmental conditions. A history of abuse or neglect may put a person at risk for developing pyromania.
• Sex. Most people with pyromania are male.

Is Pyromania Hereditary?

Studies of people with impulse control disorders suggest that those with a close relative who also has one of the disorders are at increased risk. However, no definite association between the disorders and a gene (or genes) has yet been established by scientists.

How Is Pyromania Detected?

Some degree of curiosity about fire is a normal part of childhood development, but the symptoms of pyromania go beyond typical curiosity. Pyromania usually emerges in adolescence, but the behaviors sometimes appear early in childhood. Early detection is essential to avoid injuries, property damage, or the social and legal consequences of continued problematic behavior.

Warning signs of pyromania include:

• Possessing excessive fire-starting materials, such as lighters or matches
• Evidence of burn holes in clothing, rugs, and other fabrics
• Burnt paper or other materials in the trash or near the sink
• Excessive fascination with fires or firefighting
• Setting off false fire alarms

How Is Pyromania Diagnosed?

To diagnose pyromania, a doctor will first rule out other potential medical causes of the symptoms. If the symptoms seem to meet the diagnostic criteria for pyromania, the patient will likely be referred to a mental health professional for further assessment.

Diagnostic steps may include:

• A physical exam. This exam aims to rule out physical conditions that could be causing the symptoms.
• Blood tests. These tests will look at the patient’s blood chemistry for issues such as thyroid function. Screenings for drugs and alcohol may also be conducted to rule out symptoms caused by substance abuse.
• Psychological assessments. These assessments may take the form of questionnaires or talk sessions with a mental health professional to assess the patient’s mood, mental state, and mental health history. Family members or caregivers may also be asked to participate in these assessments.

The psychological assessments will be compared to the diagnostic criteria for pyromania in the Diagnostic and Statistical Manual of Mental Disorders. Comparing these criteria will help a mental health professional decide whether the symptoms indicate pyromania or another psychiatric problem (obsessive-compulsive personality disorder, anxiety disorders, or depression).

The diagnostic criteria for pyromania include:

• More than one incident of deliberate, purposeful fire-setting
• Fascination with or attraction to fires, firefighting, fire-making paraphernalia, or other things associated with fire
• Feelings of tension before setting a fire
• Pleasure or relief while setting fires or while witnessing effects of the fire
• Fire-setting is not motivated by financial gain, criminal activity, anger, revenge, hallucinations, or other impaired judgment (e.g., while intoxicated)
• Fire-setting behavior which isn’t better explained by antisocial personality disorder, conduct disorder, or mania

How Is Pyromania Treated?

Pyromania currently has no cure, but a combination of medications and psychotherapy may effectively reduce the severity of symptoms in many patients.

Medication

Several different medications may be used to treat and manage the symptoms of pyromania, and individual medication plans depend on the patient’s responsiveness to treatments and the severity of their symptoms.

• Antidepressants. Serotonin reuptake inhibitors (SSRIs) may be used to treat pyromania.
• Other Medications. Mood stabilizing drugs such as lithium, anti-convulsant, anti-psychotic, and anti-androgen (drugs that block testosterone) medications have all been proposed to treat pyromania.

Psychotherapy

The most commonly used therapeutic approach is cognitive-behavioral therapy (CBT). This process focuses on helping the patient identify a pattern of harmful thoughts and construct strategies and solutions for dealing with them that don’t interfere with functionality.

Other types of therapy sometimes used to treat pyromania include aversion therapy.

How Does Pyromania Progress?

When untreated, pyromania can produce severe, potentially life-threatening complications. Aside from the possible social, legal, and financial consequences of fire-setting, the disorder often leads to other serious mental illnesses.

Possible long-term complications of pyromania include:

• Arrest and/or incarceration
• Injury or death caused by fires
• Disruption of relationships
• Loss of employment or financial consequences
• Depression
• Substance abuse

How Is Pyromania Prevented?

Pyromania cannot be prevented, but early diagnosis and a consistent treatment plan can help manage symptoms and prevent them from becoming as disruptive as they would be if they were left untreated. Therefore, it’s essential for those diagnosed with pyromania to seek regular evaluation from their mental health providers and stick to any prescribed medication plan.

Pyromania Caregiver Tips

Many people with pyromania also suffer from other brain and mental health-related issues, a condition called co-morbidity. Here are a few of the disorders commonly associated with pyromania:

• More than half of people with pyromania also suffer from mood disorders such as depression.
• A third of people with pyromania have an anxiety disorder.
• Approximately two-thirds of people with pyromania also have another impulse control disorder, such as gambling disorder, intermittent explosive disorder, or kleptomania.
• About a third of people with pyromania also have a substance use disorder.

Pyromania Brain Science

Researchers have searched for the brain chemicals responsible for behaviors in people with pyromania and other impulse control disorders. Two likely candidates are serotonin, a brain chemical essential for regulating mood, and dopamine, which produces feelings of pleasure when released in the brain. Scientists have not yet determined precisely how either of these chemicals might work to create the behaviors, but some suspect that a complex interaction of both might be responsible.

Some studies have suggested that low serotonin levels might cause restlessness and impulsivity, both of which are critical components of fire-setting behaviors in pyromania.

Impulse-control behaviors, such as compulsive gambling, shopping, or eating, have also been observed in Parkinson’s disease patients who are taking drugs that increase their dopamine levels. 

In some ways, pyromania and other impulse control disorders resemble substance use disorders, which are driven by the dopamine response. Over time, some addictive substances decrease the user’s response to dopamine, motivating them to use the substance more often to achieve the same effect. Some scientists believe that a similar process might be at play in pyromania.

Pyromania Research

Title: Serotonin in Impulse Control Disorders in Parkinson’s Disease (Park-IMPULSE)

Stage: Recruiting

Principal investigator: Stéphane Thosbois, PhD

Hospices Civils de Lyon

Bron, France

Impulse control disorders are frequent and troublesome in patients with Parkinson’s disease. However, the cerebral functional alterations related to impulse control disorders in Parkinson’s disease are poorly understood and may involve the serotoninergic system besides alterations in the dopaminergic system.

The primary objective of this study is to investigate the cerebral functional alterations in the serotoninergic system in patients with Parkinson’s disease and impulse control disorders using Positron Emission Tomography with highly specific radiotracers of serotonin transporter (SERT) using [11 Carbon]-3-amino-4-(2-dimethylaminomethylphenylsulfanyl)-benzonitrile ([11C]-DASB) and of serotonin 5-Hydroxytryptamine 2A (5-HT2A) receptor using [18 Fluorine]-altanserin ([18F]-altanserin), in comparison to patients with Parkinson’s disease without impulse control disorders and healthy volunteers.

Title: Randomized Placebo-Controlled Trial Evaluating the Efficacy of Pimavanserin, a Selective Serotonin 5-HydroxyTryptamine-2A (5HT2A) Inverse Agonist, to Treat Impulse Control Disorders in Parkinson’s Disease. (PIMPARK)

Stage: Recruiting

Contact: Mathieu Anheim, MD

CHU de Strasbourg

Strasbourg, France

There is no consensus on the treatment of Impulse Control Disorder (ICD) in Parkinson’s Disease (PD) though it is recommended to reduce the dosage of dopamine agonists (DA).

Reduction of DA frequently leads to a worsening of motor signs (parkinsonism or dyskinesias due to the concomitant increase of levodopa doses) and non-motor signs with the appearance of a DA withdrawal syndrome (DAWS).

Chronic stimulation of the sub-thalamic nuclei may reduce ICD but is restricted to a minority of patients, and cases of new-onset ICD symptoms post-stimulation have been reported. The benefit of amantadine in pathological gambling is controversial, and the efficacy of clozapine has been reported in a few cases but with serious safety limitations. Very recently, naltrexone did not significantly improve ICD.

Thus, an efficacious and safe treatment of ICD in PD remains an unmet need for clinical practice.

Recently, it has been reported that pimavanserin, a selective serotonin 5-HT2A inverse agonist with a satisfactory safety profile without motor side effects, was efficient in improving psychosis, insomnia, and day-time sleep in PD.

Pimavanserin, marketed under the tradename NUPLAZID®, was approved in 2016 by the U.S. Food and Drug Administration (FDA) for the treatment of hallucinations and delusions associated with Parkinson’s disease psychosis.

The link between serotonin and ICD has been well established, since the enhancement of 5HT2A receptors stimulation is associated with ICD, since serotonin modulates mesolimbic dopaminergic reward system transmission, and given that serotonin neurotransmission is increased during chronic intake of dopamine agonist such as pramipexole which is well-known to induce ICD in PD patients. Thus, a large body of evidence suggests that the decrease of the 5HT2A activity could be efficient in reducing ICD in PD. This further supports the concept of testing the efficacy of pimavanserin (a selective 5HT2A inverse agonist) for treating ICD in PD. Researchers aim to conduct a study evaluating the efficacy and safety of pimavanserin on ICD in PD.

Title: Clinical Response of Impulsivity After Brain Stimulation in Parkinson’s Disease (CRIPS)

Stage: Not Yet Recruiting

King’s College London

London, UK

The study will record outcomes related to ICBs for PD patients who have already been selected for DBS therapy as a routine clinical treatment in participating in DBS operating center.

It is routine practice to assess ICBs before DBS decisions are made, but the manner varies across DBS operating centers. The only additional factor to the routine DBS clinical pathway in this study is that the centers involved will perform assessments in a uniform manner to allow data to be combined. A unified set of clinical assessment scales for Impulsive Control Disorders ICDs and ICBs, as well as other relevant neuropsychiatric symptom assessments, will be added to routine pre- and post-operational clinical assessments for participants.

The study’s primary endpoint is the change in the severity of ICBs. If subjects score above 1 in any of the given questions on QUIP-RS, or if subjects had a disagreement with carers regarding scores, The Parkinson’s Impulse-Control Scale, PICs will be triggered. Our trained research fellow (AA) will then administer PICs over the phone or in the clinic.