Hero

Videos

Slideshows

Articles

Podcasts

Poll

Nightmare disorder can produce emotional manifestations of fear, anger, and sadness. Here are 7 reasons parasomnias can challenge even the most astute diagnostician.

7 Things to Know About Parasomnias

Sandra L. Curtis, PhD, MTA, MT-BC, talks violence against women, which has increased during the COVID-19 pandemic. She suggests music therapy as a potential treatment to overcoming trauma. 

is a music therapy practitioner, educator, and researcher with over 30 years of experience working in Canada and the United States. Find more at her website: 

Violence against women isn't new, but it's heightened right now. 

Locked Down With an Abusive Partner

Our series features new insights on mentorship, antiracist habits for 2021, why Black History Month is important to psychiatry, prominent Black physicians who paved the way, strategies to eradicate structural racism in training, and Civil War systemic racism. Stand by during the month for links to the collection!


Mentorship: Salute to a Windy City Educator

Balkozar Adam, MD, Rameshwari V. Tumuluru, MD, and Sarah H. Arshad, MD

Why Psychiatry Training Must Include Discussions on Structural Racism

Black Americans’ Distrust of the COVID-19 Vaccine

Why Is Black History Month Important to Psychiatry?

Race and Opioids: Lessons From the Civil War-Era Opioid Addiction Crisis

H. Steven Moffic, MD, and Rahn Bailey, MD: 

If I Had a Hammer: Advancing the Conversation in Psychiatry and Racism

Purcell Pearson: A Young Black Man Who Dreamt of Becoming a Psychiatrist

7 Black Physicians That Made History in the Mental Health Field

During the month of February, we will publish important stories commemorating Black History Month.

Psychiatric Times Honors Black History Month

 in terms of the harm caused to individuals, the damage caused to property, and the financial implications for individuals and society. Between 2010-2014, an estimated 261,330 intentional fires were reported to US municipal fire departments each year, resulting in 440 deaths, and 1310 injuries, and the economic cost of fire setting was estimated to be as high as $328.5 billion per year.

 In the United States, 1 in 100 adults self-reported a lifetime history of deliberate fire setting; 38% of these fire settings persisted beyond the age of 15 years.

 Although estimations of the number of people who set fires within a population are almost certainly imprecise due to methodological limitations such as variations in study design, definition of fire setting used, data analysis techniques, ungeneralizable samples, and response bias, they do provide insight into the scale of the problem.

Various terminology, with somewhat different meanings, has been used within the literature to describe offending behavior that involves fire (

 are terms used to describe intentional fires set within specific contexts (eg, legal or psychiatric), 

 is the current preferred term in the literature to describe acts of deliberately started fires regardless of their legal or diagnostic status.

Comorbidity is common among adults who set fires. Common diagnoses include personality disorder, psychosis, substance dependence, and mood disorders.

 Reported prevalence rates of pyromania are relatively low, ranging between 0 to 10% of adults who set fires.

 Lower cognitive functioning, intellectual disabilities, and other developmental disorders (eg, autism) are also common, although exact prevalence varies widely depending upon the population sampled (ie, inpatient, community, prison samples).

Despite the development of reliable and valid assessment tools in other areas of offending behavior (eg, sexual offending), the systematic development of tools specific to fire setting has been slower to progress. Nevertheless, several tools have been developed to support the process of systematically collecting and collating clinical information from a range of sources (eg, self and informant reports, behavioral observations, file reviews and clinical assessments) in order to formulate risk and identify treatment needs and intervention plans for individuals who set fires (eg, the Tranah Firesetting Inventory,

 St Andrew’s Fire and Arson Risk Instrument,

 Northgate Firesetter Risk Assessment-2.0,

). These tools do not represent validated risk assessments for fire setting, however, a few fire-specific psychometric measures have been developed to assess fire-related factors (although they lack sufficient evaluation) (

Most recently, the properties of the Fire Interest Rating Scale, Fire Attitudes Scale and the Identification with Fire Questionnaire were analyzed using factor analysis and 4 clinically relevant constructs identified across the 3 scales (ie, the Four Factor Fire Scales): 

However, data collected to validate these measures was limited (eg, ungeneralizable/small samples). Nevertheless, despite fire specific measures not having undergone rigorous reliability and validity evaluations, they can still be used by experienced clinicians as part of a comprehensive assessment.

Those who engage in fire setting are often complex individuals with a diverse set of treatment or intervention needs warranting a specialist approach that reduces their risk of further offending. Most specialist treatment programs are underpinned by a 

approach, targeting a range of criminogenic needs and factors associated with fire setting, including cognitive distortions, poor problem solving, communication difficulties, self-regulation deficits, and relapse prevention. Treatment often includes a component on fire safety education and the consequences of fire setting, while also address­ing a range of associated interpersonal problems (eg, low self-esteem, social competence difficulties, and poor goal setting). 

 summarizes empirically evaluated treatment programs.

Existing interventions that target fire setting behavior in adults include an adapted version of the Fire Awareness Child Education UP (FACE-UP).

 More recently, a cognitive-behavioral group-based intervention for individuals with developmental disabilities called the Northgate Firesetters Treatment program was developed.

 Investigators reported follow-up data for 24 participants (16 men, 8 women) who completed the Northgate Firesetters Treatment Programme, between 4 years and 12 years, 9 months posttreatment. The majority of participants (n = 17) were living in community settings and only 1 female participant was reported to have set a further fire, although suspicions were raised concerning another 2 participants.

 Despite these positive findings, both of these treatment programs are grounded in theoretical perspectives that predate more recent advancements in the field (ie, Functional Analysis Theory,

). Furthermore, their effectiveness are limited in their comparability to other generic interventions, small sample sizes, and lack of robust evidence in terms of their effectiveness in reducing reoffending.

The Firesetting Intervention Programme for Prisoners (FIPP)

 and the Firesetting Intervention Programme for Mentally Disordered Offenders (FIP-MO)

 are based on the latest comprehensive theory of fire setting: the Multi-Trajectory Theory of Adult Firesetting (M-TTAF).

 The M-TTAF integrates parts of existing psychological theory that are supported by empirical evidence including psychological vulnerabilities, developmental factors, cultural factors, social learning factors, biological factors, and contextual factors related to fire setting into a detailed multifactorial theory.

Following a pilot evaluation of the FIPP, positive findings were reported posttreatment on measures related to fire interest/problematic associations with fire, offence supportive attitudes (ie, fire specific, violent, antisocial), locus of control, and anger regulation, which were stable at 3 month follow-up.

 However, the evaluation of the FIPP was conducted solely with adult males in a prison environment; thus, its effectiveness for women and adults with 

intellectual and developmental disabilities

 has yet to be established. Consequently, the FIP-MO was developed to address fire setting and fire-related risk behaviors for both men and women across secure forensic psychiatric hospitals in the United Kingdom. Significant improvements on self-reported interests, beliefs and attitudes about fire, as well as improvement in anger expression.

It is important to note that due to the paucity of research on fire setting by adults with intellectual and developmental disabilities, the generalizability of the M-TTAF to such groups, and the interventions underpinned by it, has yet to be established. Further, despite evidence suggesting that between 0.4% to 43.6% of adults who set fires have intellectual and developmental disabilities,

 no treatment program to date has been rigorously evaluated for this population. Yet, there is evidence to suggest this small but important group have different characteristics and offence specific treatment needs requiring a 

 Nevertheless, the FIPP and FIP-MO represent the first standardized specialist interventions for individuals who deliberately set fires and have been subject to a multisite research evaluation, with results showing that they are effective in reducing some of the fire setters’ key deficits.

Evidence suggests general recidivism is as high as 60% among adults who set fires; reoffending with fire is much lwer with estimates between 4% and 16%.

 However, the operational definition of recidivism, study methodology, setting and sample populations vary widely. Nevertheless, recidivism has been largely associated with younger age, single relationship status, a diagnosis of personality disorder, a history of criminal offending, an interest in fire, and a number of attributes suggestive of childhood disturbance.

 Furthermore, reported length of stay in hospital for adults with intellectual and other developmental 

 and history of fire setting vary from 950 days to 1725 days.

 However, very few studies have included details pertaining to length of stay, which is inevitably effected by many confounding variables, such as mental health, engagement in treatment, previous offending history that are not accounted for within the data.

Whilst there have been significant advancements in our understanding of deliberate fire setting in recent years, further research is urgently needed to understand the etiology of fire setting and to further develop specialist assessment and treatment protocols. In particular, little is known about the relationship between cultural factors and fire misuse, gender-specific factors, or the needs of individuals with intellectual and/or other developmental disabilities. In addition, research on fac­tors that influence the maintenance and desistance process for fire setting will aid the construction of valid and reliable risk assessment tools and ensure individualized treat­ment approaches are taken and practice is evidence based. Focusing on these areas will also ensure that treatment efforts evolve to meet the needs of individuals who have set fires regardless of the treatment setting.

is a postgraduate researcher at the Tizard Centre, School of Social Policy, Sociology and Social Research, University of Kent, UK. 

 is a lecturer in forensic psychology at theSchool of Psychology, Victoria University of Wellington, New Zealand, and Honorary Lecturer in Forensic Psychology at the University of Kent, UK. 

is a chartered psychologist and lecturer in forensic psychology and intellectual and developmental disabilityat the Tizard Centre, School of Social Policy, Sociology and Social Research, University of Kent. Ms Collins and Dr Barnoux have nothing to disclose regarding this article. Dr Tyler is involved in providing training and evaluating the FIPP and FIP-MO programs and has received funding from Fire and Emergency New Zealand to conduct research on their Fire Awareness Intervention Programme (FAIP) for youth.

1. Home Office. Fire statistics data tables. May 14, 2020. Accessed July 23, 2020. 

https://www.gov.uk/government/statistical-data-sets/fire-statistics-data-tables

2. Campbell R. Intentional fires. National Fire Protection Association. July 2017. Accessed July 23, 2020. https://www.nfpa.org/News-and-Research/Data-research-and-tools/US-Fire-Problem/Intentional-fires

Accessed July 23, 2020. http://www.stoparsonuk.org/arson/documents/Arson-Prevention-Forum-Booklet.pdf

4. Zhuang J, Payyappalli VM, Behrendt A, Lukasiewicz K. 

. National Fire Protection Association. October 2017. Accessed July 23, 2020. https://www.nfpa.org/News-and-Research/Data-research-and-tools/US-Fire-Problem/Total-cost-of-fire-in-the-United-States

5. Blanco C, Alegria AA, Petry NM et al. Prevalence and correlates of fire setting in the United States: results from the National Epidemiologic Survey on Alcohol and Related Conditions (NESARC). 

6. Vaughn M, Fu Q, DeLisi M, et al. Prevalence and correlates of fire setting in the United States: results from the National Epidemiological Survey on Alcohol and Related Conditions. 

Diagnostic and Statistical Manual of Mental Disorders, DSM-V. 

8. Bell R, Doley R, Dawson D. Developmental characteristics of adults who set fires: are recidivist offenders distinctive? 

9. Geller JL, Bertsch G. (1985). Fire-setting behavior in the histories of a state hospital population. 

10. Lindberg N, Holi MM, Tani P, Virkkunen M (2005). Looking for pyromania: characteristics of a consecutive sample of Finnish male criminals with histories of recidivist fire-setting between 1973 and 1993. 

11. Lees-Warley G, Rose J. What does the evidence tell us about adults with low intellectual functioning who deliberately set fires? a systematic review

. International Journal of Developmental Disabilities

12. Tranah T, Nicholas J. Interventions for young people with intellectual disabilities who commit arson. 

13. Taylor JL, Thorne I, Slavkin ML. Treatment of fire-setting behaviour. In: Lindsay WR, Taylor JL,Sturmey , eds.

 Offenders with Developmental Disabilities

14. Long CG, Banyard E, Fulton B, Hollin CR. (2014). Developing an assessment of fire-setting to guide treatment in secure settings: The St Andrew's fire and arson risk instrument (SAFARI). 

15. Taylor JL, Thorne I. Northgate firesetter risk assessment. Unpublished manual. Northgate and Prudhoe NHS Trust; 2005.

16. Taylor JL, Thorne I, Robertson A, Avery G. (2002). Evaluation of a group intervention for convicted arsonists with mild and borderline intellectual disabilities. 

17. Murphy G, Clare I. Analysis of motivation in people with mild learning disabilities (mental handicap) who set fires. 

Firesetting: Addressing Offending Behavior.

 Redcar and Cleveland Psychological Service; 1997.

19. Gannon TA, Ó Ciardha C, Barnoux MFL. The Identification with Fire Questionnaire. CORE-FP, School of Psychology, University of Kent; 2011.

20. Gannon TA, Barrowcliffe E. Firesetting in the general population: The development and validation of the Fire Setting and Fire Proclivity Scales. 

21. Ó Ciardha C, Tyler N, Gannon TA. (2015). A practical guide to assessing adult fire setters’ fire-specific treatment needs using the Four Factor Fire Scales. 

22. Hayes A. Climbing the ladder of reform. 

23. Taylor JL, Robertson A, Thorne I, Belshaw T, Watson A. Responses of female fire‐setters with mild and borderline intellectual disabilities to a group intervention. 

Journal of Applied Research in Intellectual Disabilities. 

24. Taylor JL. Roots, referrals, risks and remedies for offenders with intellectual disabilities. Paper presented at: A Risky Business, BPS conference. October 2014. University of Manchester, UK.

25. Jackson H, Glass C, Hope S. (1987). A functional analysis of recidivistic arson. 

26. Fineman KR. Firesetting in childhood and adolescence. 

27. Fineman KR. A model for the qualitative analysis of child and adult deviant behavior. 

The Firesetting Intervention Programme for Prisoners (FIPP). 

Firesetting Intervention Programme for Mentally Disordered Offenders (FIP-MO) Version 2.0.

 CORE-FP. University of Kent and Kent Forensic Psychiatry Services, NHS; 2014.

30. Gannon TA, Ó Ciardha C, Doley RM, Alleyne E. The Multi-Trajectory Theory of Adult Firesetting (M-TTAF). 

31. Gannon TA, Alleyne E, Butler H, et al. Specialist group therapy for psychological factors associated with fire setting: Evidence of a treatment effect from a non-randomized trial with male prisoners. 

32. Tyler N, Gannon TA, Lockerbie L, Ó Ciardha C. An evaluation of a specialist fire setting treatment programmed for male and female mentally disordered offenders (the FIP-MO). 

33. Ritchie EC, Huff TG. Psychiatric aspects of arsonists. 

34. Dickens G, Sugarman P, Ahmad F, Edgar S, Hofberg, K, Tewari S. Characteristics of low IQ arsonists at psychiatric assessment. 

35. Alexander RT, Chester V, Green FN, Gunaratna I, Hoare S. Arson or fire setting in offenders with intellectual disability: clinical characteristics, forensic histories, and treatment outcomes. 

Journal of Intellectual and Developmental Disability

36. Rice ME, Harris GT. Firesetters admitted to a maximum security psychiatric institution: Offenders and offenses. 

37. Ducat L, McEwan TE, Ogloff JR. An investigation of fire setting recidivism: factors related to repeat offending. 

The development of an actuarial model for arson recidivism

39. Dickens G, Sugarman P, Edgar S, Hofberg K, Tewari S, Ahmad F. Recidivism and dangerousness in arsonists. 

The Journal of Forensic Psychiatry & Psychology

Gunaratna I, Hoare S. Arson or fire setting in offenders with intellectual disability: clinical characteristics, forensic histories, and treatment outcomes

Journal of Intellectual and Developmental Disability.

41. Edwards MJ, Grace RC. The development of an actuarial model for arson recidivism. 

42. Dickens G, Sugarman P, Edgar S, et al. Recidivism and dangerousness in arsonists. 

The Journal of Forensic psychiatry & Psychology

43. Alexander RT, Chester V, Green FN, et al. Arson or fire setting in offenders with intellectual disability: clinical characteristics, forensic histories, and treatment out-comes. 

44. Taylor JL, Thorne I, Robertson A, Avery G. Evaluation of a group intervention for convicted arsonists with mild and borderline intellectual disabilities. 

Fire setting is the current preferred term in the literature to describe acts of deliberately started fires regardless of their legal or diagnostic status.

Understanding Adult Fire Setting, Pyromania, and Arson

There is a common saying that if the care we provide our clients is not culturally sensitive, then it is not trauma-informed.

I am a big believer in meeting our clients’ cultural needs, and in respecting and celebrating the beauty of their traditions. However, we need more than superficially pleasant interactions with individuals from diverse backgrounds, individuals who we label as “different than us” because of the way they look, talk, or practice their culture or religion.

Trauma sensitivity alone, I believe, is not enough. We need culturally responsive and effective care. I will give an example here, then expand on how to put this concept into action.

I recently walked into the inpatient unit where I work to find that my staff had called security and were about to inject or seclude a large, agitated black man. I asked if I could try to talk to him. As I listened, he asked that he only work with staff of color, asked for a menu fit for a Muslim man who only consumes halal/kosher meat, and asked if he could talk to an imam to learn how to pray again. We ended up not needing restraints or antipsychotics after all; all he needed that morning was human connection. I happen to share aspects of his cultural background, and that made him feel safe enough to open up to me.

It is not going to be possible to have non-white staff assigned to him all the time, but on this particular day that plan worked best.

There are 4 things to remember when bearing witness to individuals in distress:

1. Authenticity. Our clients will quickly discover if we genuinely care.

2. Curiosity. Show interest in them as humans, not only the labels assigned to them.

3. Flexibility. We must be ready to adjust our way of thinking, and in doing so, we can better meet their needs.

4. Humility. Maintain the attitude of a student, keen to learn from each encounter.

Psychiatry is not only a field of suffering or an industry of pain; there is also a lot of joy that we should get out of caregiving. If you are not looking for beauty in every interpersonal encounter you have with those you serve, then you have not yet touched the soul of medicine. By listening to and meeting patients’ cultural needs, we all win.

is a practicing psychiatrist in Providence Healthcare System, Portland, OR.

Sometimes the best medicine is understanding. 

Rx: Meeting Cultural Needs 

Abusive behaviors are likely excacerbated right now, due to feelings of depression, frustration, anxiety, and maybe even rage. Mannette Morgan talks about 3 important steps to helping survivors.

1. Getting help. Survivors need assistance making plans, reaching out to meet needs, and finding space for the healing process. Deciding to get help is the first move towards liberation. 

2. Getting out. Their physical safety can only be secured if they are out of the toxic situation/household. They will need emotional support to make this transition.

3. Stop the cycle. Once out of their abusive situation, they need to begin the healing process. You as mental health professionals can guide them through this, ensuring they are strong enough not to reenter the cycle of abuse. 

 is an inspirational speaker, life coach, and the author of 

Survivors of abuse need help now more than ever. 

Facing the Reality of Their Own Truth

Question and consider how people adapt, how families/communities cope, and how physicians should engage with trauma. 

Trauma Informed Care

The field of psychiatry needs to pay close attention to the long-term psychosocial impacts of trauma, not only on trauma survivors as individuals, but also on their families and communities.

Trauma that affects 1 member of a family system has the potential to fundamentally change the whole family structure. It threatens to erode the very foundation of the family unit, and family members may start to see each other as enemies. 

 has the power to make or break a family.

, out of cultural taboos and stigma, is seen as a source of shame and kept a secret, it can manifest in different ways, especially relationally, leading to a dysfunctional environment of toxic stress and silent suffering, a deadly web many families find themselves tangled in.

Early prevention is always better than late intervention because trauma can span generations. Trauma survivors can repeat the cycle and become part of the problem, or they can become part of the solution by investing in their families, normalizing the process by speaking up, and expressing emotions. To continue to choose the narrative is to choose to continue the vicious cycle and feed the fires that eventually destroy everything in their way.

Trauma that happens to children can shatter and confuse core beliefs they hold about themselves and the world. Children need to believe that the world is a safe place and that adults can be trusted to care for them. When these foundational basic needs are violated, these young beautiful creatures lose hope and start to wrestle with existential issues, doubting their own self-worth and beauty.

Psychiatrists working with traumatized populations need to establish safe spaces that serve as platforms where people can regain their voice and reclaim their narrative. Through encouraging and supporting open channels of communication and building bridges of trust, they help break the cycle for their clients, and that in turn helps bring hope in healing.

Interpersonal trauma that casts dark shadows on our beliefs about our innate goodness and shared humanity is arguably more harmful to the psyche than a largescale destruction caused by natural disasters. But the trauma story, if viewed as a learning tool, can help us become more resourceful and resilient.

We owe it to our loved ones to break the cycle. Not everything we inherit is worth passing to our children, especially not our trauma story.

Post Traumatic Slave Syndrome: America's Legacy of Enduring Injury and Healing

From Generation to Generation: Healing Intergenerational Trauma Through Storytelling

Trans-generational Trauma and the Other: Dialogues across history and difference

Patients want to pass on many things to their children; trauma is not one of them. 

The Unforgiving “Gift” of Generational Trauma

Partners may be recognizing traits in their significant others, that while once cute, are now irritating. Knowing who your partner is, or rather who they have evolved to become, is one of the first measures to resolving domestic disharmony. 

Additionally, since kids were cooped up all summer, unable to go to summer camps or typical activities, they may be restless. Spending meaningful time may help bridge any gaps forming in your relationship. 

is Professor and Regional Chair, Texas Tech University Health Sciences Center at the Permian Basin, Department of Psychiatry, in Midland, TX.

There is an increase in reports of domestic violence. How can you resolve domestic disharmony with your significant other and your family unit as a whole? 

Reinventing Relationships 

Problematic behviors emerge after a traumatic brain injury as a result of basic needs or wants not being met accurately or appropriately. Establishing replacement behaviors, or evening the scales, is a way to reacclimate patients to their new normal. 

 is a certified behavior analyst in Bakersfield, California. 

A behavior analyst shares his stories and information on establishing appropriate replacement behaviors for patients with traumatic brain injuries and problematic behavior. 

Trauma And Violence