A 40-year-old man reports intense, recurrent sexual urges and fantasies involving fire-setting and watching fires burn. He has set multiple fires 'for sexual gratification.' He denies political motives, financial gain, or delusional beliefs. This pattern, causing significant legal and social impairment, is most accurately diagnosed as:

• A Pyromania
• B Pyrophilia (a paraphilic disorder) ✓
• C Antisocial personality disorder with fire-setting
• D Conduct disorder

Explanation

When fire-setting is associated specifically with sexual arousal and gratification, the DSM-5 classification is pyrophilia — a paraphilic disorder — rather than pyromania (which is an impulse-control disorder driven by tension/release without sexual motivation). Pyromania involves deliberate fire-setting accompanied by tension beforehand and pleasure or relief when watching, but without sexual arousal as the primary driver. The distinction is clinically and forensically important. Antisocial personality disorder requires a pervasive pattern of rights violation; conduct disorder is diagnosed in minors. The explicit sexual arousal component makes pyrophilia (paraphilic disorder) the accurate diagnosis.

Reference: Kaplan & Sadock's Synopsis of Psychiatry, 11th ed.

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Written and medically reviewed by the StethoPrep medical team.