Psychiatric Comorbidities and Sociodemographics of Patients Diagnosed with Pyromania Admitted to a Community Psychiatric Hospital in Bronx, New York: Retrospective Chart Review

Abstract

Background:

Pyromania is an impulse-control disorder characterized by repeated, deliberate fire-setting accompanied by increasing tension and followed by a sense of immediate gratification afterwards, as defined in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, Text Revision (DSM-5-TR). Although rare, pyromania carries significant medicolegal consequences and occurs in the lifetime of approximately 3%–6% of psychiatric inpatients. This study evaluates socio-demographic characteristics, substance use patterns, and psychiatric comorbidities among individuals diagnosed with pyromania at a community hospital in the Bronx, New York.

Methods:

This retrospective observational study included patients aged 9 years or older admitted to the psychiatric center between December 2013 and 2023. Twelve individuals met the inclusion criteria and were diagnosed with pyromania based on clinical assessment documented in the electronic medical record. Extracted data included demographic characteristics, socioeconomic variables, substance use history, and co-occurring psychiatric diagnoses.

Results:

Included patients ranged in age from 9 to 59 years (mean 28.58 ± 16.21), and 75% were male. Most were US-born (83.33%), with 66.67% identifying as African American and 33.33% as Hispanic. All adults were single and unemployed. Psychotic disorders, primarily schizophrenia, were present in 58.33% of the sample, and 58.33% also had substance use disorders. Among youth, oppositional defiant disorder (ODD) and conduct disorder were common, while no adult met criteria for antisocial personality disorder.

Conclusions:

Pyromania frequently co-occurred with psychiatric comorbidities, especially psychotic disorders and substance use. Although the overall prevalence is low, this disorder carries notable clinical and legal implications, underscoring the importance of targeted assessment and intervention in urban mental health settings. To the best of our knowledge, this is the first observational study to describe the socio-demographic and clinical characteristics of individuals diagnosed with pyromania in New York, USA.

Key Messages:

• Question: What are the demographic factors, psychiatric comorbidities, and substance use associated with Pyromania?

• Findings: individuals diagnosed with pyromania are mainly male, single, unemployed, with a mean age of around 28 years. Psychotic disorders, substance use, and the African American race are factors associated with pyromania.

• Meaning: Pyromania is a rare disorder, but with high medicolegal implications, highlighting the need for additional research to better characterize its clinical features and associated factors.

According to the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, Text Revision (DSM-5-TR), Pyromania involves repeated and intentional fire-setting driven by psychological tension and relief rather than external motives such as financial gain or revenge. It reflects a pathological fascination with fire and cannot be explained by other psychiatric conditions or criminal intent. ¹ Classified within the category of Disruptive, Impulse-Control, and Conduct Disorders in DSM-5-TR, pyromania is distinct from arson, which typically involves purposeful, goal-directed motives such as financial gain or retaliation. ¹ Existing research on pyromania spans diverse samples, from small clinical groups (21 subjects) to population surveys of over 43,000 participants, and incorporates methodologies from inpatient units, outpatient services, law enforcement data, and national surveys such as the National Epidemiological Survey on Alcohol and Related Conditions (NESARC).^2–7 Population-based data suggest a prevalence of less than 1% in the United States, highlighting its rarity. ⁸ In contrast, approximately 23.1% of US adults experience some form of mental illness annually. ⁹ Among psychiatric inpatients, pyromania has been estimated to occur in 3%–6% of individuals. ¹⁰

Socio-demographic patterns have been noted in prior research. Pyromania occurs more commonly in males and typically begins during adolescence; affected individuals are often unemployed, unmarried,^11–13 and exposed to adverse social environments such as poverty, family conflict, and histories of trauma. ¹⁴ Although the condition is usually diagnosed in late adolescence or early adulthood, rare cases have been reported in children as young as three years old. It is also uncommon for older adults to present with pyromania in later life, as parents often recognize the behaviors and get them treated before they become a problem.^4,10,15 A previous study indicates that meaningful differentiation between impulsive, repetitive fire-setting and age-appropriate exploratory behavior becomes more clinically valid beginning in late childhood, typically around ages 9–10. Fire-setting behaviors before this age are generally developmentally normative (curiosity-driven) and do not reliably indicate psychopathology. ¹⁶

Psychiatric comorbidity is frequently reported among individuals diagnosed with pyromania, with prior US research documenting high rates of mood, anxiety, impulse-control, and substance use disorders. That same study also noted associations with neurodevelopmental and cognitive conditions, including ADHD, learning disabilities, dementia, and intellectual disability. ⁷ While pyromania cannot be diagnosed when fire-setting occurs under the influence of substances, concurrent substance use, particularly alcohol use, often exacerbates symptoms and impulsivity.^17,18

Recognizing socio-demographic fac-tors and associated psychiatric conditions is essential for improving screening, tailoring interventions, and preventing harmful outcomes related to fire-setting behavior, including property damage, risk to human life, and significant emotional distress. Mitigation of these risk factors can improve an individual’s quality of life at home and at work.^14,19

This study aims to evaluate the socio-demographic characteristics and psychiatric comorbidities of individuals diagnosed with pyromania in an inner-city community hospital in the Bronx. Given its rarity and clinical importance, a better understanding of these factors may enhance recognition, management, and prevention efforts.

Methods

Study Design

A retrospective study was conducted to evaluate trends in the diagnosis and characteristics of patients with a lifetime history of pyromania. Both individuals newly diagnosed with this condition and those with a prior documented diagnosis of pyromania were included. This study covered 10 years, from December 2013 to December 2023. All cases were identified through clinician-entered diagnoses in the Allscripts electronic medical record (EMR), based on DSM-aligned psychiatric evaluations performed across the Comprehensive Psychiatric Emergency Services (CPEP) (including the adult, child, and adolescent departments) and the Life Recovery Center (LRC), which provides inpatient detoxification and rehabilitation services for adults. This study was conducted at an inner-city community hospital in the Bronx, New York, which delivers mental healthcare to the underserved population of New York with an economically and educationally challenged population composed predominantly of non-white ethnicities.

Study Population

The study population included patients aged 9 years and older of all genders, who were evaluated in psychiatric emergency, inpatient psychiatric, or inpatient addiction services and were clinically diagnosed with pyromania according to DSM-based evaluation. The study was conducted at a community psychiatric hospital serving a catchment area within the South and Central Bronx. As of 2024, the Bronx had an estimated population of approximately 1,384,724 residents. The South Bronx population is estimated at roughly 715,000. Although specific 2024 data for the Central Bronx were not readily available, this region is generally considered part of the broader South Bronx catchment area.^20,21

Data Collection

Patient data and corresponding charts were extracted from the hospital’s EMR database (Allscripts) by the Information Technology (IT) team. Relevant clinical records included evaluation and admission notes documented by on-duty residents and attending psychiatrists. After applying the inclusion criteria, 12 cases met the criteria for analysis. Each chart was reviewed independently by at least two reviewers to confirm diagnosis and extract demographic characteristics, co-occurring psychiatric comorbidities, and substance use data.

Patients aged 9 years or older, of all genders, admitted to CPEP and/or LRC between December 2013 and December 2023, with a clinician-documented diagnosis of pyromania consistent with DSM criteria, were included. We excluded the (a) charts that lacked sufficient information to confirm a clinician-documented, DSM-consistent diagnosis of pyromania, (b) the encounters that occurred outside the study period (December 2013–December 2023), and the encounters that occurred outside the designated clinical settings (CPEP and/or LRC).

Variables of Interest

Socio-demographic characteristics include age, gender, race/ethnicity, nationality (US-born vs. foreign-born), marital status, place of residence, employment status, and education level. Clinical Data, including (a) co-morbid psychiatric diagnoses based on the DSM-5 criteria, ²² (b) substance use disorder, including alcohol use disorder, illicit substance use disorder, and tobacco dependence/use disorder.

Ethical Considerations

The study was conducted in compliance with institutional and ethical guidelines. The Institutional Review Board (IRB) approved the study protocol to ensure the protection of patient data and adherence to regulatory standards.

Results

Our review identified 12 individuals with a lifetime clinical diagnosis of pyromania, based on structured clinical interviews, DSM-consistent diagnostic criteria, and prior clinical documentation. The history of pyromania was verified through the Psychiatric Services and Clinical Knowledge Enhancement System (PSYCKES), a statewide database that integrates behavioral health records across New York State. ²³ Individuals with a documented pyromania diagnosis in PSYCKES were included regardless of whether their current presentation at the time of admission involved fire-setting behavior. Among the 12 individuals included in our study, eight were adults, and four were children or adolescents. Seven individuals presented with current fire-setting behaviors, whereas five had a previously recorded diagnosis of pyromania. Table 1 outlines the key characteristics of these cases. While cases #3, 9, 10, 11, and 12 had a documented history of pyromania listed under past psychiatric diagnoses, the available records did not provide details regarding the onset or initial presentation of their pyromania symptoms.

Table 1.

Pertinent Findings of 12 Cases with Lifetime History of Pyromania.

Case #	Age (in Years), Gender	Presenting Symptoms	Diagnosis	Medication
1	9, female	Attacked teachers and students in school and had set a doll and a towel on fire at home.	Disruptive Mood Dysregulation (DMDD), Pyromania	N/A
2	10, male	Homicidal ideation to kill his family and set the house on fire.	Attention-Deficit/Hyperactivity Disorder (ADHD), Oppositional Defiant Disorder (ODD), Conduct Disorder, Pyromania	Guanfacine, Risperidone, Methylphenidate
3	12, male	Aggressive and erratic behavior, non-command Auditory Hallucinations. Past history of pyromania.	ADHD, ODD, DMDD, Posttraumatic Stress Disorder (PTSD), Pyromania	Adderall, Clonidine, Celexa, Guanfacine
4	14, male	Wanted to kill himself with a knife as he could not stop putting things on fire.	ADHD, ODD, Conduct Disorder, Pyromania	Guanfacine, Methylphenidate
5	23, male	Erratic behavior, became upset, and set a mattress on fire.	Autism Spectrum Disorder (ASD), Intellectual Disability (ID), Schizophrenia, Anxiety, PTSD, Substance Use Disorder (Alcohol, Cannabis), Pyromania	Divalproex DR, Risperidone, Aripiprazole maintenance
6	23, female	Played with a lighter and burned a hole in the comforter.	ADHD, PTSD, Pyromania	Methylphenidate
7	28, male	Violent behavior destroyed his mother’s property, set fire to the apartment, and caused him to cut himself.	Schizoaffective Disorder, Anxiety, Substance Use Disorder (Cannabis), Pyromania	Haloperidol Decanoate, Benztropine
8	32, transgender (male to female)	Attempted to set the apartment on fire.	Schizophrenia, Anxiety, Bipolar Disorder, PTSD, Substance Use Disorder (Cocaine), Pyromania	Divalproex DR, Risperidone
9	33, male	Persecutory paranoia and disorganized behavior. Past history of pyromania.	Schizophrenia, Bipolar Disorder, Substance Use Disorder (Alcohol, Cannabis), Pyromania	Haloperidol Decanoate, Benztropine, Trazodone
10	49, male	Suicidality by setting himself on fire. Past history of pyromania.	Schizophrenia, Bipolar Disorder, Substance Use Disorder (Alcohol, Opioid, Crack Cocaine), Pyromania	Divalproex DR, Risperidone
11	51, male	Depression and suicidal ideation. Past history of pyromania.	Bipolar Depression, Cannabis Use Disorder, Pyromania	Quetiapine, Mirtazapine
12	59, male	Aggressive behavior, paranoia, homicidal ideation. Past history of pyromania.	Schizoaffective Disorder-Bipolar Type, Substance Use Disorder (Cocaine, Opioid), Pyromania	Haloperidol, Benztropine, Lithium carbonate, Trazodone

Individuals in the study ranged in age from 9 to 59 years (mean 28.58 ± 16.21), as pyromania can occur across a wide age range. The ages were not normally distributed, with a median of 25.5 years and an interquartile range of 28 years. Most were male (75%). Ten individuals (83.33%) were US-born. The cohort was predominantly African American (66.67%) and Hispanic (33.33%), aligning with the hospital’s catchment demographics. ²⁴ All children and adolescents (33.33%, 4 out of 12) were currently attending school. Among adults (66.67%, 8 out of 12 cases), six had completed high school, and 2 had dropped out; none pursued post-secondary education. All adults were single and unemployed. These demographic characteristics are summarized in Table 2 and illustrated in Figure 1.

Table 2.

Socio-demographic Characteristics of 12 Cases with a Lifetime History of Pyromania.

Socio-demographic Variable		Estimate (n; Out of 12 Cases)	Estimate (%; n/12×100)
Age
▒Age range		09–59 years
▒Mean age ± SD		28.58 ± 16.21 years
▒Age groups	0–12 years (children)	3	25.00
	13–17 years (adolescents)	1	8.33
	18–45 years	5	41.67
	45–60 years	3	25.00
Gender
▒Male		9	75.00
▒Female		2	16.67
▒Transgender		1	8.33
Ethnicity
▒Caucasian		0	0.00
▒African American		8	66.67
▒Hispanic		4	33.33
Nationality
▒US born		10	83.33
▒Non-US born		2	16.67
Educational level
▒Current student		4	33.33
▒High school dropout		2	16.67
▒High school graduate		6	50.00
▒Higher education		0	0.00
Employment
▒Current student (children and adolescents)		4	33.33
▒Unemployed (all adults)		8	66.67
▒Employed		0	0.00
Relationship status
▒Single (all adults)		8	100.00
▒Married		0	0.00

Figure 1. Demographic Characteristics of 12 Cases with Lifetime History of Pyromania.

A relatively even distribution of lifetime pyromania cases was observed across age groups. However, when considering only the cases with newly presenting pyromania symptoms, a downward trend with advancing age was noted, as shown in Figure 2.

Figure 2. Age Distribution in 12 Cases of Pyromania.

Psychiatric comorbidities were highly prevalent (Table 3). Psychotic disorders were present in 58.33% (7/12), bipolar disorder in 50% (6/12), and neurodevelopmental disorders in 41.67% (5/12). PTSD occurred in 33.33% (4/12), anxiety disorders in 25% (3/12), and depressive disorders in 25% (3/12). No personality disorders were documented. Among child and adolescent cases (ages 9–14), ADHD was present in 75% (3/4), oppositional defiant/conduct disorder in 75% (3/4), and disruptive mood dysregulation disorder in 50% (2/4). These findings are shown in Figure 3.

Table 3.

Psychiatric Comorbidities in 12 Cases with a Lifetime History of Pyromania.

1. Psychiatric Comorbidity	Estimate (N; Out of 12 Cases)	Estimate (%; N/12×100)
Neurodevelopmental disorders	5	41.67
Intellectual disability	1	8.33
Autism spectrum disorder	1	8.33
Attention-deficit/hyperactivity disorder	4	33.33
Schizophrenia spectrum and other psychotic disorders	7	58.33
Acute psychosis	1	8.33
Schizophrenia	4	33.33
Schizoaffective disorder	2	16.67
Bipolar disorder	6	50.00
Major depressive disorder	1	8.33
Anxiety disorder	3	25.00
Posttraumatic stress disorder	4	33.33
Personality disorders	0	0.00
2. Psychiatric comorbidity in children and adolescents	Estimate (N; out of four cases)	Estimate (%; N/4×100)
Attention-deficit/hyperactivity disorder	3	75.00
Disruptive mood dysregulation	2	50.00
Oppositional defiant disorder/conduct disorder	3	75.00

Some cases had multiple co-occurring psychiatric comorbidities.

Figure 3. Psychiatric Comorbidities in 12 Cases with Lifetime History of Pyromania.

Some cases had multiple co-occurring psychiatric comorbidities.

Substance use disorders were identified in 58.33% (7/12) of all patients, affecting 87.5% (7/8) of adults and none of the children or adolescents (Table 4). The most commonly reported substances were tobacco (41.67%), cannabis (33.33%), alcohol (25%), cocaine (25%), and opioids (16.67%). Multiple substances were reported in all seven cases. Patterns of use are presented in Figure 4.

Table 4.

Substance Use in 12 Cases with a Lifetime History of Pyromania.

Substance Use	Estimate (N; Out of 12 Cases)	Estimate (%; N/12×100)
Substance use disorder	7	58.33
Tobacco use disorder	5	41.67
Cannabis use disorder	4	33.33
Cocaine use disorder	3	25.00
Alcohol use disorder	3	25.00
Opioid use disorder	2	16.67
No substance use mentioned	5	41.67

Some cases used multiple substances.

Figure 4. Breakdown of Substance Use in the 12 Cases with a Lifetime History of Pyromania.

Some cases exhibited polysubstance abuse.

Discussion

Our findings highlight the importance of understanding pyromania within a broader social, developmental, environmental, and psychiatric context. Although pyromania is rare, the disorder in our urban sample appeared prominently among individuals facing substantial socioeconomic and psychosocial adversity. These factors, including poverty, low educational attainment, unemployment, and limited access to consistent mental health care, may exacerbate impulsivity, emotional dysregulation, and maladaptive coping behaviors, contributing to the manifestation of fire-setting behavior. ²⁵

Although prior studies identify pyromania most often in late adolescence, fire curiosity and fire-related behaviors may begin much earlier.^15,26 The apparent decline in active pyromania with advancing age likely reflects underreporting due to legal fears or social stigma. Interpretation of age-related patterns must be cautious. Although fewer older adults presented with active pyromania symptoms in our study, this likely reflects underreporting rather than an actual decline in the prevalence. Legal consequences, stigma, and limited collateral history in older, chronically ill psychiatric patients could all contribute to the concealment of past fire-setting behaviors. Additionally, the study’s retrospective design limited our ability to assess onset or progression.

Consistent with prior literature, most individuals diagnosed with pyromania in our study were male and within younger age groups.^8,13 However, the racial distribution differed from national trends in fire-setting. While previous population-based studies reported higher rates of fire-setting among non-Hispanic White individuals,^6,27 the majority of our sample identified as African American or Hispanic. An important consideration is the demographic composition of the sample, drawn from the Bronx, New York: 81% of participants were non-white, including 39% African Americans and 68% Hispanics. ²⁸ This pattern reflects the demographics of the surrounding community and underscores how sociocultural context influences clinical presentation.

Additionally, the socioeconomic profile of the surrounding area, including high poverty levels, limited educational opportunities, and elevated unemployment, likely contributed to shaping this cohort’s demographic characteristics. Our sample showed markedly lower socioeconomic and educational attainment than the cohort described by Grant et al. Most individuals in our study were unemployed, and none had achieved a college-level education, with many having difficulty completing high school. In contrast, the Grant et al. sample included individuals with higher educational achievement and substantially greater workforce participation. ² These differences suggest that socioeconomic disadvantage may be more pronounced in our clinical population and could play an essential role in shaping vulnerability to fire-setting behavior, access to treatment, and overall functional outcomes. ²⁴ The service area of our hospital is one of the most underserved boroughs in New York City, with as high as 40% of the population with less than a high school degree, 34% of the population living in poverty, 42% of the households having income less than $25,000, and a rate of unemployment at 27.4%. ²⁴

Grant and Kim reported pyromania cases marked by high rates of mood disorders and other impulse-control conditions. ² In our sample, we observed a similar pattern, with affective disorders including bipolar and depressive disorders. Among children and adolescents, the prominent presence of ADHD, oppositional defiant disorder (ODD), conduct disorder, and DMDD aligns with known associations between externalizing behaviors and fire-setting tendencies. Furthermore, our study cases demonstrated a more complex and heterogeneous clinical profile. Many individuals presented with psychotic disorders, most commonly schizophrenia, and a substantial portion had underlying neurodevelopmental conditions such as intellectual disability, autism spectrum disorder, or ADHD. Although antisocial personality disorder has been linked to fire-setting behavior in prior literature, ¹² no cases were identified in our sample. This absence may reflect the diagnostic priorities of acute psychiatric settings, where clinicians emphasize stabilization of acute symptoms rather than detailed assessment of longstanding personality traits.

Substance use disorders were highly prevalent among adults but absent in children and adolescents, reflecting developmental exposure and access. Psychoactive substances such as cannabis, alcohol, cocaine, and tobacco may worsen impulsivity and disinhibition, potentially intensifying fire-setting risk among susceptible individuals.

Treatment of pyromania remains challenging due to the interplay of psychological, social, and contextual factors. ²⁹ Cognitive-behavioral therapy (CBT) remains the most supported intervention for reducing fire-setting behaviors, particularly when focused on impulse regulation, coping skills, and cognitive restructuring.^3,12 Pharmacologic treatments, including SSRIs, mood stabilizers, and atypical antipsychotics, may be beneficial for managing co-morbid psychiatric conditions. Still, evidence for direct effects on fire-setting behavior is limited and derived primarily from case reports.^3,12,30 Impulse-control underlies the pathology of pyromania, and environmental and social factors, such as access to education and employment opportunities, play a crucial role in this. Access to academic and structured employment settings provides constructive outlets and redirects impulses into positive behaviors through routine and responsibility.^3,12,29

Because fire-setting carries serious medical and legal consequences, including injuries, fatalities, and substantial property damage, comprehensive preventive strategies are essential.^31–33 While individuals diagnosed with pyromania are different from arsonists, they usually impulsively set fire in controlled situations. ² But it is necessary to include fire safety training, cooperation with the fire department, and caregiver/parental involvement at the community level to prevent unintentional mishaps, in addition to the existing psychotherapeutic approaches. Clinical teams should maintain a high index of suspicion for fire-setting behavior in individuals presenting with impulsivity, trauma histories, externalizing disorders, or unexplained burn incidents.

Limitations

The small sample size and retrospective design restrict generalizability. Documentation of pyromania symptoms was often incomplete, as many patients presented for other psychiatric concerns, and fire-setting behaviors were not consistently detailed. Although the PSYCKES database improved diagnostic verification, missing narrative information limited clinical interpretation. The socio-demographic characteristics of the Bronx population limit the broader applicability of racial and socioeconomic findings. Additionally, information regarding family psychiatric history and genetic predispositions, which have been emphasized in prior research, was largely unavailable.

Conclusions

Strengthening screening for pyromania during routine psychiatric evaluations is crucial for improving the detection of this rare condition. Our findings help address gaps in the literature by highlighting the role of social determinants, particularly education and employment, in shaping clinical presentation and outcomes. Increasing access to educational and vocational support may aid recovery and improve long-term functioning. Given the complex presentations observed in our study, a multimodal approach addressing psychiatric comorbidities, environmental stressors, and behavioral patterns is necessary. Improved screening practices, including structured interviews and targeted assessment of impulsivity and fire-setting behaviors, may help identify cases that are otherwise masked by co-occurring psychiatric symptoms. Future studies should include larger, more diverse populations and use both retrospective and prospective methods to clarify the onset, risk factors, and treatment responsiveness. As the first study to describe cases of pyromania in the Bronx, our findings offer insight into patterns observed in urban, underserved communities. Enhanced screening that incorporates assessment of impulsivity, trauma exposure, and fire-setting behaviors may also improve early identification.