Impulse Control Disorder Not Elsewhere ClassifiedPyromania
The diagnosis of pyromania requires the following: deliberate and purposeful fire setting behavior, tension or arousal before the act, fascination with fire, and relief or gratification when witnessing the aftermath of their behavior. There is no monetary gain, desire to hide another crime, expression of anger, or a desire to improve one’s living circumstances. The fire setting behavior is not in response to hallucinations or delusions nor is there seriously impaired judgment due to dementia, intoxication, or mental retardation. This behavior is not better accounted for by conduct disorder, manic episode, or anti-social personality. Pyromania is a controversial diagnosis. Because most arsonists deny guilt and reasons for their fire setting behavior, they can easily be confused with someone who might be diagnosed with pyromania.
Psychoanalytic and Behavioral therapy are often used in the treatment of Pyromania. However, these individuals tend to refuse responsibility for their behavior, use denial excessively, have little insight or desire for insight, and are often alcoholic.
Crisis or excessive stress may trigger fire-setting behavior. If the patient can verbalize and work through their frustrations, he can better deal with stressors. In any case, these patients are difficult to treat.
Pathological Gambling
Pathological Gambling is often considered an addiction and has many features consistent with substance abuse. Criteria for the diagnosis include at least five of the following: preoccupation with gambling or planning to gamble; increasing monetary investment to achieve similar levels of excitement; unsuccessful efforts to control gambling; uses gambling to escape problems; often chases losses with more gambling; lies to others about the behavior; has committed illegal acts to fund the gambling; has risked a relationship, a job, or career or educational opportunity; relies on others to relieve desperate financial situations caused by gambling.Treatment may be psychodynamic and behavioral therapy. Further, medication has been used to treat the disorder. However, as with many addictions, relapse is high.
Aversive behavior therapy has been used with little efficacy in treatment of Pathological Gambling. Treatment has been found more effective when a multimodal approach is used. One somewhat effective approach includes the use of imaginal desensitization. Gamblers anonymous and group therapy may be the most effective means of psychosocial treatment. Group members can discuss their gambling behavior with others who have similar issues and members can confront denial and self-destructive behavior. Mood stabilizers have some efficacy in treating the disorder. Some patients have co-morbid major depression. Treatment of the depression may make the patient more accessible to other treatment for the gambling.
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