Afterword: Beyond Diagnosis to Mourning and the Meaning of Symptoms.

Reports of destructive behavior by military personnel after demobilization have become more frequent; however, the pathways that might lead these individuals to commit such acts are not clear enough. This column presents the case of a retired soldier who reported the onset of pyromania after military service, and the relationship between dissociation and reenactment of the trauma is discussed. The main conclusions are that psychotherapy of traumatized patients should focus on helping them create a verbal representation of the trauma and that integrating ceremonies and rituals into treatment is a possible and significant option.

The Study of Developmental Risk Factors for Early Fire Involvement.

Child fireplay may be regarded as developmentally appropriate, yet can negatively impact those who engage in it and those around them. This study discusses the mental health, fire-specific, and psychosocial risk factors of children who set fires. Fifty-seven caregivers reported on their children's demographics, firesetting behaviors, mental health symptoms, and family history. Children were aged 2-6 years and the majority were male. Most children used lighters and matches on paper and small objects. The majority of the children were motivated by curiosity. Children who set more fires had more externalizing symptoms, and were more likely to have accomplices, to have been exposed to firesetting media, and to have been disciplined or punished for their firesetting behaviors. The study identifies important psychosocial risk factors among young children who set fires. Given the long-term implications of firesetting, understanding firesetting in children will set the foundation of intervention and prevention models.

A Potential Tension in DSM-5: The General Definition of Mental Disorder versus Some Specific Diagnostic Criteria.

The general concept of mental disorder specified in the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders is definitional in character: a mental disorder might be identified with a harmful dysfunction. The manual also contains the explicit claim that each individual mental disorder should meet the requirements posed by the definition. The aim of this article is two-fold. First, we shall analyze the definition of the superordinate concept of mental disorder to better understand what necessary (and sufficient) criteria actually characterize such a concept. Second, we shall consider the concepts of some individual mental disorders and show that they are in tension with the definition of the superordinate concept, taking pyromania and narcissistic personality disorder as case studies. Our main point is that an unexplained and not-operationalized dysfunction requirement that is included in the general definition, while being systematically violated by the diagnostic criteria of specific mental disorders, is a logical error. Then, either we unpack and operationalize the dysfunction requirement, and include explicit diagnostic criteria that can actually meet it, or we simply drop it.

[Arson and pyromania, update 2015]. / Incendiaires et pyromanes.

While the fire constitutes a threat and provokes avoidance by the entire animal world, its control as lighting and maintenance is inseparable from the history of humankind. For 1% of the population that use is turned to harm, repeatedly and without objective reason, responding to the historical definition of pyromania. The profile of arsonists does not appear to be different from that of the general criminal population: alcohol abuse, nicotine, marijuana and antisocial personality do not make fire setters a special case. However positive fire experience lived in childhood, emotional avoidance and expertise in fire settings' control seems to be specific, as recidivism risk below that of the general criminal population.

The relationship of DSM-IV pathological gambling to compulsive buying and other possible spectrum disorders: results from the Iowa PG family study.

This study investigates the possible relationship between pathological gambling (PG) and potential spectrum disorders including the DSM-IV impulse control disorders (intermittent explosive disorder, kleptomania, pyromania, trichotillomania) and several non-DSM disorders (compulsive buying disorder, compulsive sexual behavior, Internet addiction). PG probands, controls, and their first-degree relatives were assessed with instruments of known reliability. Detailed family history information was collected on relatives who were deceased or unavailable. Best estimate diagnoses were assigned blind to family status. The results were analyzed using logistic regression by the method of generalized estimating equations. The sample included 95 probands with PG, 91 controls, and 1075 first-degree relatives (537 PG, 538 controls). Compulsive buying disorder and having "any spectrum disorder" were more frequent in the PG probands and their first-degree relatives vs. controls and their relatives. Spectrum disorders were significantly more prevalent among PG relatives compared to control relatives (adjusted OR=8.37), though much of this difference was attributable to the contribution from compulsive buying disorder. We conclude that compulsive buying disorder is likely part of familial PG spectrum.

A Practical Guide to Assessing Adult Firesetters' Fire-Specific Treatment Needs Using the Four Factor Fire Scales.

OBJECTIVE: Practitioners working with offenders who have set fires have access to very few measures examining fire-specific treatment needs (e.g., fire interest, fire attitudes). In this article we examine the new Four Factor Fire Scales (Ó Ciardha et al., 2015), which may be used by practitioners to examine fire-specific treatment needs for offenders who have set deliberate fires. We present a standardized scoring procedure when using these scales, as well as an associated scoring template for practitioner use. METHOD: Norm data are based on male and female firesetters (n = 378) and nonfiresetters (n = 187) recruited from 19 prison establishments (including six female establishments, one young offender institution) and 12 secure mixed-gender mental health settings. RESULTS: We present a full overview of all data we have collected to date relating to the Four Factor Fire Scales across prison, mental health, and young offending participants. For each population, we present mean scores as well as associated cutoff scores and reliable change indices to aid practitioners in their interpretation of scores. CONCLUSIONS: The Four Factor Fire Scales provide professionals working in the area with a robust template for administering, scoring, and interpreting the fire-specific factors currently identified as playing a role in deliberate firesetting behavior. Strengths and limitations of the measure are discussed.

Developing an assessment of fire-setting to guide treatment in secure settings: the St Andrew's Fire and Arson Risk Instrument (SAFARI).

BACKGROUND: Arson and fire-setting are highly prevalent among patients in secure psychiatric settings but there is an absence of valid and reliable assessment instruments and no evidence of a significant approach to intervention. AIMS: To develop a semi-structured interview assessment specifically for fire-setting to augment structured assessments of risk and need. METHOD: The extant literature was used to frame interview questions relating to the antecedents, behaviour and consequences necessary to formulate a functional analysis. Questions also covered readiness to change, fire-setting self-efficacy, the probability of future fire-setting, barriers to change, and understanding of fire-setting behaviour. The assessment concludes with indications for assessment and a treatment action plan. The inventory was piloted with a sample of women in secure care and was assessed for comprehensibility, reliability and validity. RESULTS: Staff rated the St Andrews Fire and Risk Instrument (SAFARI) as acceptable to patients and easy to administer. SAFARI was found to be comprehensible by over 95% of the general population, to have good acceptance, high internal reliability, substantial test-retest reliability and validity. CONCLUSIONS: SAFARI helps to provide a clear explanation of fire-setting in terms of the complex interplay of antecedents and consequences and facilitates the design of an individually tailored treatment programme in sympathy with a cognitive-behavioural approach. Further studies are needed to verify the reliability and validity of SAFARI with male populations and across settings.

Firesetting, arson, pyromania, and the forensic mental health expert.

Firesetting is a common behavior that is frequently encountered by forensic mental health experts when consulting on criminal and civil legal cases. Despite its prevalence, minimal attention has been paid in the literature to conducting firesetting-related forensic evaluations. In this article, we discuss the differences in the behavior of firesetting, the crime of arson, and the diagnosis of pyromania. The literature on adult firesetter characteristics, classification systems, recidivism, and treatment is reviewed. Several types of common criminal and civil firesetting-related evaluations referred to forensic mental health experts are discussed, along with case examples illustrating how the courts have approached such assessments. To our knowledge, this article is the first in 20 years to address firesetting-related forensic evaluations within the psychiatry literature. It also represents the first comprehensive discussion of civil evaluations related to firesetting.

The Pictorial Fire Stroop: a measure of processing bias for fire-related stimuli.

Fire interest is a risk factor for firesetting. This study tested whether a fire-specific emotional Stroop task can effectively measure an information-processing bias for fire-related stimuli. Clinic-referred and nonreferred adolescents (aged 13-16 years) completed a pictorial "Fire Stroop," as well as a self-report fire interest questionnaire and several control tasks. Results showed (a) comparatively greater fire-specific attentional bias among referred adolescent firesetters, (b) a negative relationship between Fire Stroop attentional bias and self-reported fire interest, and (c) positive correspondence between Fire Stroop attentional bias and self-reported firesetting frequency. These findings suggest that instruments that measure an automatic bias for fire-specific stimuli may usefully supplement self-report measures in the assessment and understanding of firesetting behavior.

Clinical characteristics and psychiatric comorbidity of pyromania.

BACKGROUND: There have been few systematic studies of individuals with pyromania, and this paucity of research has hindered our understanding and treatment of this disorder. This study details the demographic and phenomenological features of individuals with DSM-IV lifetime pyromania. METHOD: Twenty-one adult and adolescent subjects (recruited from inpatient and outpatient studies of impulse-control disorders) with lifetime DSM-IV pyromania were administered a semi-structured interview to elicit demographic data and information on the phenomenology, age at onset, and associated features of the disorder. Data were collected from October 2003 to September 2006. RESULTS: Twenty-one subjects (10 female [47.6%]) with lifetime pyromania (mean +/- SD age = 26.1 +/- 11.8 years; range, 15-49 years) were studied. The mean +/- SD age at onset for pyromania was 18.1 +/- 5.8 years. Eighteen subjects (85.7%) reported urges to set fires. Subjects reported a mean +/- SD frequency of setting 1 fire every 5.9 +/- 3.8 weeks. Much of the fire setting did not meet the legal definition of arson. Thirteen (61.9%) had a current comorbid Axis I mood disorder, and 10 (47.6%) met criteria for a current impulse-control disorder. CONCLUSION: Pyromania appears to be associated with high rates of psychiatric comorbidity. Research is needed to optimize patient care for individuals with this disorder.

Looking for pyromania: characteristics of a consecutive sample of Finnish male criminals with histories of recidivist fire-setting between 1973 and 1993.

BACKGROUND: As pyromania is a rare diagnosis with questionable validity, we aimed to describe a forensic psychiatric population of arson recidivists. METHODS: The medical records as well as the forensic psychiatric examination statements of 90 arson recidivists referred for pretrial psychiatric assessment in Helsinki University Hospital Department of Forensic Psychiatry between 1973 and 1993 were reviewed. RESULTS: The most important diagnostic categories of arson recidivists were personality disorders, psychosis and mental retardation, often with comorbid alcoholism. In all, 68% of arsonists were under alcohol intoxication during the index crime. Psychotic as well as mentally retarded persons with repeated fire-setting behaviour were mostly "pure arsonists"--persons guilty only of arsons during their criminal careers. Arson recidivists with personality disorder, in contrast, often exhibited various types of criminal behaviour and arson appeared to be only one expression of a wide range of criminal activity. Comorbid alcoholism was apparently a more rarely observed phenomenon among pure arsonists than in "nonpure arsonists". We found only three subjects fulfilling the present diagnostic criteria for pyromania. CONCLUSION: Using the criteria of the DSM-IV-TR, pyromania must be regarded as an extremely rare phenomenon. Especially the question of substance intoxication as an exclusion criterion for pyromania should be reconsidered.

["Operationalised psychodynamic diagnostics in childhood and adolescence" (OPD-CA) in practice]. / Die "Operationalisierte Psychodynamische Diagnostik im Kindes- und Jugendalter" (OPD-KJ) in der Praxis.

"Operationalised psychodynamic diagnostics in childhood and adolescence" (OPD-CA) has been completed in its first version after years of development. In a first interview with a 13-year-old boy, the diagnostic instruments of OPD-CA are presented by means of examples. The text passages of the transcribed first interview are evaluated in four sections by representatives of the respective working groups regarding the axes--relationships, conflict, structure and preconditions for treatment--and the diagnostic conclusions resulting from this are presented, thus providing a direct insight into the specific psychodynamic diagnostics of OPD-CA.

Criminal psychological profiling of serial arson crimes.

The practice of criminal psychological profiling is frequently cited as being applicable to serial arson crimes. Despite this claim, there does not appear to be any empirical research that examines serial arson offence behaviors in the context of profiling. This study seeks to develop an empirical model of serial arsonist behaviors that can be systematically associated with probable offender characteristics. Analysis has produced a model of offence behaviors that identify four discrete behavior patterns, all of which share a constellation of common nondiscriminatory behaviors. The inherent behavioral themes of each of these patterns are explored with discussion of their broader implications for our understanding of serial arson and directions for future research.

Impulse control disorders and depression.

This study assessed the frequency of impulse control disorders (ICDs) and their association with bulimia, compulsive buying, and suicide attempts in a population of depressed inpatients. We investigated ICDs using the Minnesota Impulsive Disorders Interview. Patients answered the Zuckerman Sensation-Seeking Scale and the Barratt Impulsivity Rating Scale. Among the 31 depressed patients who met criteria for ICD (ICD+ group), we found 18 cases of intermittent explosive disorder, three cases of pathological gambling, four cases of kleptomania, three cases of pyromania, and three cases of trichotillomania. Patients with co-occurring ICDs were significantly younger (mean age = 37.7 versus 42.8 years). Patients with kleptomania had a higher number of previous depressive episodes (5.7 versus 1.3), and patients with pyromania had a higher number of previous depressions (3.3 versus 1.3, p =.01). Bipolar disorders were more frequent in the ICD+ group than in the ICD- group (19% versus 1.3%, p =.002), whereas antisocial personality was not (3% versus 1%, p = ns). Bulimia (42% versus 10.5%, p =.005) and compulsive buying (51% versus 22%, p =.006) were significantly more frequent in the ICD+ group. Patients from the ICD+ group had higher scores of motor impulsivity assessed with the Barratt Impulsivity rating scale (p =.01).

The use of vapour phase ultra-violet spectroscopy for the analysis of arson accelerants in fire scene debris.

A method has been developed for the analysis of arson accelerants in fire scene debris by vapour phase ultra-violet (UV) spectroscopy. The method is rapid, inexpensive, simple to use and is sufficiently sensitive and discriminating to be of use for the analysis of crime scene samples. Application to casework samples is described. On occasion, the method offers additional information to that which can be obtained by gas chromatography-flame ionisation detection (GC-FID) and gas chromatography-mass spectrometry (GC-MS) and represents a useful adjunct to these techniques. In addition, the method offers advantages where the use of GC-MS analysis of arson accelerants in fire scene debris is not a practical proposition.