Clinical Reviews

A Case of Pyrophilia

Larry C Litman, PhD, CPsych

Forensic Psychologist, Forensic Services, St Thomas Psychiatric Hospital, St Thomas, Ontario, Canada.



A case involving a paraphilic erotic focus on fire, coined pyrophilia, in a 25-year-old married white male is described. This case met the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) criteria for paraphilia. Comorbid sexual masochistic features and a personality that revolved around hysteric, obsessive– compulsive, and masochistic dynamics were also observed. The psychoanalytic concept of “repressed oedipal drives” could be applied to the dynamics of this case, suggesting long-term psychoanalytic treatment as one of the interventions of choice. However, the subject appeared to be a poor candidate for any form of treatment intervention, given that he denied having any significant problems and, except when under stress (and when symptoms of anxiety and dysthymia appeared), he would typically present as overtly psychologically normal.

Laws and O’Donohue’s recent monumental volume on sexual deviance is reported as “the most comprehensive book published on this topic to date” and a “definitive resource providing comprehensive information about the full range of paraphilias in one clearly organized volume” (1). While it provides the most comprehensive coverage of this topic to date, reviewing the literature on scores of both common and very rare paraphilias, there is no mention of sexual deviance in which the erotic focus is fire. This article describes a clear-cut case of such a paraphilic disorder, which I had the opportunity to examine within the forensic unit of a mental health centre in southwestern Ontario. In line with the current nomenclature in labelling such disorders (for example, “misophilia” to refer to an erotic focus on “filth” and “olfactophilia” to refer to an erotic focus on “odours”), the term “pyrophilia” was coined to describe the current case involving an erotic focus on fire. As described below, this case clearly met the DSM-IV “essential features” criteria of a paraphilia—that is, “recurrent, intense sexually arousing fantasies, sexual urges, or behaviours generally involving 1) nonhuman objects, 2) the suffering or humiliation of oneself or one’s partner, or 3) children or other nonconsenting persons, that occur over a period of at least 6 months (Criterion A). The behaviour, sexual urges, or fantasies cause clinically significant distress or impairment in social, occupational, or other important areas of functioning (Criterion B).”

While the erotic focus immediately raises the diagnostic issue of pyromania, the DSM-IV classifies this disorder as an impulse-control disorder, with nothing to indicate or suggest an overlap between this disorder and the paraphilias. Other than the purposeful act of fire-setting itself (Criterion A), there is no mention of the possibility that the tension or affective arousal experienced before the act (Criterion B); the fascination with, interest in, or attraction to fire and its situational contexts (for example, paraphernalia, uses, consequences) (Criterion C); or the pleasure, gratification, or relief when setting, witnessing, or participating in the aftermath of fires (Criterion D) might be sexual in nature or even contain a sexual arousal component. In addition, there was no evidence uncovered in the following index case to indicate that the patient ever displayed any of the behaviours commonly associated with pyromania, such as being a regular “watcher” at fires in his neighbourhood; setting off false alarms; deriving pleasure from institutions, equipment, and personnel associated with fire, spending time at the local fire department, setting fires to be affiliated with the fire department; and either showing indifference to the consequences to life and property caused by the fire or deriving satisfaction from the resulting destruction of property.

This 25-year-old married white male nursing assistant was referred for a psychological examination to determine his status regarding his sexually motivated fire-setting activities and associated psychopathology. He had voluntarily admitted himself to the unit for assessment and treatment of his disorder, prompted by the concern of both the police and the patient’s wife about the dangerous consequences of his fire-setting activities (for example, he had recently caused irreparable damage to his car by setting the dashboard on fire).

The patient reported being aroused by fire and having irresistible compulsions to set fires for as long as he could remember. He recalled an incident at the age of 19 years when he sat on a pot on the stove and asked his mother to turn it on (she complied with his request) and that this occurred “during the day when his father wasn’t home” (psychoanalytically oriented practitioners may invoke the concept of “repressed oedipal drives” in relating this to his pyrophilic activities). He also recalled helping his mother shovel coal as a young child and his mother showing him how hot the stove was by touching his hand to it. In addition, he recalled receiving physical abuse from his father as a child, which resulted in his becoming “used to pain.” He would set fire to anything (for example, pieces of paper, articles of clothing). At times he burnt himself by accident. He used heat to give himself sexual excitement, and he reached a point where he could be sexually aroused by just talking about fires or having his wife talk about burning things (she reportedly resented having to do this). Clomipramine hydrochloride taken orally, 3 times daily, which he initially took for depression and obsessiveness, reportedly helped reduce the time spent ruminating about fire by about 75%. However, this was discontinued when he began to experience severe anticholinergic side effects. In any case, there was no evidence of major depression during his stay on the unit, and all aspects of his mental status were unremarkable.

The patient acknowledged that his marriage and his job as a nursing assistant in a senior citizens’ residence would be at stake if he continued with his fire-setting activities but felt that he was unable to control these behaviours, even with the aid of psychotropic drugs. However, he did not feel that he had a major problem.

The patient was examined over a period of 1 week with psychometric instruments (Minnesota Multiphasic Personality Index [MMPI] and Millon Clinical Multiaxial Inventory [MCMI]) and again 3 months later with phallometry. During this period he displayed periods of intense agitation that required suicide precautions. The results indicated anxiety and dysthymia in association with a tendency to express psychological difficulties through somatic channels. The use of hysteroid defence mechanisms (that is, denial and repression) was indicated. He attempted to present himself in a positive light but did so in a naive and unsophisticated way (that is, by denying that he had any fault, frailty, or weakness, no matter how trivial or common). His profile was as follows: makes initial positive impressions on clinicians but is constricted and overcontrolled, lacks insight into own and others’ behaviour, denies any psychological problems, prefers being alone to interacting with others, has no interests that are traditionally masculine in nature, is sensitive to the reactions of others, tends to worry constantly, becomes easily hurt and upset, and looks for simplistic, concrete solutions not requiring self-examination to his problems.

The patient’s penile tumescence in response to audiotaped scenarios based on his self-reported sexually arousing fantasies of heat and fire (which I asked him to transcribe) was physiologically assessed via phallometry. Despite his self-reported attempts to not become sexually aroused by the scenarios (as a result of being anxious about the procedure), substantial psychophysiological sexual arousal in response to masochistic sexual scenarios of being forcibly and painfully set on fire by a heterosexual partner or by a mob of sadistic people and subsequent combined intense feelings of love, peace, warmth, pain, and sexual excitement was observed.

The sexual masochistic elements in the patient’s self-reported pyrophilic fantasies were interesting in light of the many studies asserting that paraphilic individuals typically have more than 1 paraphilia (1). The DSM-IV criteria specify that the presence of sexual masochism can be inferred solely on the basis of observed “recurrent, intense, sexually arousing fantasies” of being made to suffer in some way (Criterion A), and this element was explicitly delineated in the patient’s self-reported pyrophilic fantasies. However, the patient’s history included actually engaging in behaviours designed to induce pain with fire for sexual stimulation (that is, sitting on a hot stove, wrapping a pair of pants around his arm and setting fire to them, and otherwise using heat to achieve sexual excitement).

The patient’s wife reportedly left him during this period, and he discharged himself, virtually unchanged from his mental and psychosexual status upon admission, despite intensive medical and psychotherapeutic intervention (that is, antidepressant medication, sodium amytol interview, group psychotherapy, and marathon group therapy with sleep deprivation).

In summary, the patient appeared to be suffering from a longstanding pyrophilic disorder with sexual masochistic features in a personality that revolved around hysteric, obsessive–compulsive, and masochistic dynamics. Dynamically, he appeared to have concatenated feelings of sexual excitement, pain, peace, warmth, and love. Except when under stress, when symptoms of anxiety and dysthymia were displayed, he would present as overtly psychologically normal.

References

1. Laws DR, O’Donohue W, editors. Sexual deviance: theory, assessment, and treatment. New York: Guilford Press; 1997.

2. American Psychiatric Association. Diagnostic and statistical manual of mental disorders. 4th edition. Washington (DC): American Psychiatric Press; 1994.

Résumé : Un cas de pyrophilie

On décrit ici le cas d’un homme de race blanche, âgé de 25 ans, marié, souffrant d’une perversité sexuelle, caractérisée par une fixation érotique sur le feu, qui porte le nom de pyrophilie. Ce cas répond aux critères de perversité sexuelle du DSM-IV, comportant des pulsions masochistes et une personnalité de type hystérique, obsessionnel–compulsif et masochiste. On dit qu’on pourrait expliquer la dynamique de ce trouble, dans ce cas particulier, par la notion psychanalytique de « pulsions œdipiennes réprimées », ce qui laisse entendre qu’une psychanalyse de longue durée pourrait être ici une intervention de choix. Toutefois, le patient semble être un mauvais candidat pour quelque forme d’intervention thérapeutique qu’il soit du fait qu’il prétend ne souffrir d’aucun trouble important, sauf s’il est stressé. Dans ce cas-là, les seuls symptômes qu’il reconnaît manifester sont l’anxiété et la dysthymie. Il se perçoit autrement comme étant une personne normale sur le plan psychologique.