Living with Pyromania - Introduction to Human Physiology - Lecture Slides, Slides of Human Physiology

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Living with Pyromania & Autism

Aims

• Background
• Case report
• Evidence base
• Issues for clinicians & service providers

Autism 1

• Disorders of psychological development: Pervasive developmental disorders
• Abnormal/ impaired development manifest before age 3 years
• ICD10 F84 “childhood autism” but can be diagnosed in all age groups

Autism 2: Triad of Impairments

Qualitative impairments in reciprocal social interaction

Qualitative communication impairments

Narrow/ repetitive Repertoire Stereotyped patterns of behaviour

Links with Offending Behaviour

• Features of ASD predispose to antisocial and offending behaviour. These include frustration at social limitations and at disruption to routines, misinterpretation of intentions of others, poor comprehension of social rules, compulsive fantasies or interests, and co- morbid psychiatric disorder (Crocombe, 2007)

Pyromania 1

ICD-10 Classification:

• F60 DISORDERS OF ADULT PERSONALITY & BEHAVIOUR.
• F63 HABIT & IMPULSE DISORDERS
• F63.1 PATHOLOGICAL FIRE SETTING

Pyromania 3

• Differential diagnosis: dissocial personality disorder, mood disorders, conduct disorders, temporal lobe epilepsy, substance abuse, learning disability and psychosis.
• Co-morbidity: substance abuse disorders, obsessive- compulsive disorder, anxiety disorders, and mood disorders
• Incidence <1%, M>F

Pyromania 4

• Associated with depression, suicidal ideation, relationship difficulties, and difficulty coping with stress.
• Freudian psychoanalysis: regression to a primitive desire to demonstrate power over nature, fire has a special symbolic relationship to the male sexual urge.
• "ego triad" of fire-setting, enuresis & cruelty to animals (Hellman’s triad)

Background 1

• Demographic details: 36yrs, single, unemployed, residing in ‘low secure’ LD home on guardianship order
• Family History: eldest son of 5, has 3 sisters and 1 brother. Turbulent relationship with parents, particularly father. No family history of LD, ASD or mental illness

Background 2

• Developmental History: normal birth, normal motor development, delayed speech, had Speech Therapy
• Attended special needs school, was bullied – pins, ?aggression from father, violence & absconding at school, expelled at age 19.
• interest in fire from age 16, would cook fried food late at night, no concept of safety

Placements

• Has lived in 5 residential homes over the last 8 years, as well as 3 extended hospital stays and his parents home. Repeated moving has been a result of verbal and physical aggression, repeated absconding, behavioural incontinence of urine and fire setting.

Aggressive incidents

• First reports of verbal and physical aggression towards parents at age 15yrs. From this time they began to receive respite care.
• Father- boiling water 2x, stitches to eye, threats with hot pan & knife; Mother- slap
• Carers - pushed home proprietor down the stairs, kicked staff, tried to pull down fire extinguisher, smashed windscreen

Psychology sessions 2

• Photos of sequence of setting a fire in a home: very enthusiastic; only glanced at watch once (rare in sessions) asked psychologist’s name
• Near end of session, went to face the corner of the room, proceeded to unbuckle belt and attempt to remove his trousers, after being told several times went to toilet, returned looking slightly disorientated but this dissipated quickly

Psychology sessions 3

• Good understanding of events that lead to a fire starting, progressing and being extinguished. Limited understanding of consequences of fires
• Fires and the procedures (e.g. fire brigade) are stimulating to him and may be sexually stimulating.
• Fire may be used to express feelings of unrequited love, both incidents were linked to women he had strong attachments to.