Pyromania

Abstract: Behavioral addictions, such as pathological gambling, kleptomania, pyromania, compulsive buying, and compulsive sexual behavior, represent significant public health concerns and are associated with high rates of psychiatric comorbidity and mortality. Although research into the biology of these behaviors is still in the early stages, recent advances in the understanding of motivation, reward, and addiction have provided insight into the possible pathophysiology of these disorders. Biochemical, functional neuroimaging, genetic studies, and treatment research have suggested a strong neurobiological link between behavioral addictions and substance use disorders. Given the substantial co-occurrence of these groups of disorders, improved understanding of their relationship has important implications not only for further understanding the neurobiology of both categories of disorders but also for improving prevention and treatment strategies.

Abstract: Objective: The authors reviewed available studies of DSM-III-R impulse control disorders not elsewhere classified in order to determine the relationship ofthese disorders to one another and to other psychiatric disorders. Method: The review focused on the demographic and clinical characteristics, phenomenology, family history, biology, and response to treatment of individuals with intermittent explosive disorder, kleptomania, pathological gambling, pyromania, and trichotillomania. Analysis was restricted to reports which either indicated use of operational diagnostic criteria or provided descriptions of the impulsive behavior detailed enough that patients could be judged as probably meeting the DSM-III-R criteria. Results: Although different impulse control disorders have different sex ratios, all have similar ages at onset and courses. Studies on phenomenology, family history, and response to treatment suggest that intermittent explosive disorder, kleptomania, pathologicalgambling, pyromania, and trichotillomania may be related to mood disorders, alcohol and psychoactive substance abuse, and anxiety disorders (especially obsessive-compulsive disorder). Biological studies indicate that intermittent explosive disorder and pyromania may share serotonergic abnormalities similar to those reported in mood disorders. Conclusions: The impulse control disorders not elsewhere classified appear to be related to one another and to mood, anxiety, and psychoactive substance use disorders. Thus, like major depression, obsessive-compulsive disorder, panic disorder, bulimia nervosa, and attention deficit hyperactivity disorder, they may represent f orms of “affective spectrum disorder.” (Am J Psychiatry 1992; 149:318-327)

Abstract: OBJECTIVE The authors' objective was to provide phenomenologic, family history, and treatment response data on a group of rigorously diagnosed patients with kleptomania. METHOD Twenty consecutive inpatients and outpatients met DSM-III-R criteria for current kleptomania or a past history of kleptomania. These patients were given structured diagnostic interviews, and their family histories of psychiatric disorders were assessed blindly. The patients' responses to psychosocial and biological treatments were also assessed. RESULTS All of the kleptomanic patients had lifetime diagnoses of major mood disorders, 16 had lifetime diagnoses of anxiety disorders, and 12 had lifetime diagnoses of eating disorders. A high morbid risk of major mood disorders (0.31) was found in their first-degree relatives. Ten of 18 patients receiving thymoleptic medications reported reduction or remission of their stealing behavior. CONCLUSIONS Kleptomania may be related to major mood disorder and perhaps may represent another form of "affective spectrum disorder."