Hero

Videos

Slideshows

Articles

Podcasts

Poll

The fallout from the COVID-19 pandemic, a lethal presidential transition, the ongoing reckoning with policing in America, and a gaping racial wound that has been present since well-before the nation’s inception have traumatized an untold number of Americans. Like most institutions associated with mental health services, graduate medical education in psychiatry will need to evolve in tangible ways to meet the demands of this moment. Here are 3 proposals that would help residency programs produce trainees that are adept at both treating and advocating for a traumatized populace.

Residency programs will need to continue their efforts to keep psychotherapy as a mainstay of psychiatric practice. Psychotherapy continues to be a 

cornerstone in the treatment psychological trauma

 Unfortunately, the role of psychotherapy training in residencies has dwindled considerably over the 

, though not necessarily because of a lack of interest or enthusiasm among residents.

A multi-site survey of psychiatry residents conducted between 2006 and 2007 showed that 

 considered being psychotherapists central to their identity as clinicians.

 Owing to its small sample size, one can hardly draw sweeping conclusions. That said, anecdotal evidence suggests that psychiatrists recognize psychotherapy as having an important place in practice and are concerned about its diminishing role. External pressure from the health care system increasingly confines them to the role of prescriber while outsourcing psychotherapy to therapists. While this is ultimately driven by perceived economic costs, it is a grossly short-sighted approach. Psychotherapeutic skills are critical even for psychiatrists who choose to practice from a predominately biological orientation. 

A possible solution could be to offer psychotherapy 

 Unfortunately, this could have the effect of disincentivizing residency programs from going beyond simply meeting the requirements of the Accreditation Council for Graduate Medical Education (ACGME). Since gaining competency in psychotherapy is a time intensive endeavor, perhaps the answer lies in expanded tracks within training programs that allow residents to pursue their interests in psychotherapy within the confines of a 4-year training program.

2. Formalized Education in Historical Trauma

 is defined as “complex and collective trauma experienced over time and across generations by a group of people who share an identity, affiliation, or circumstance.”

 In order to offer more than just an empathetic ear, psychiatrists should develop a subtle understanding of how patients experience the sequelae of historical trauma at an individual level. One way for programs to accomplish this would be to adopt a more formal education in historical trauma. Furthermore, hiring a trauma-informed workforce is among the key organizational changes proposed by the Center for Health Care Strategies in their 

 on the implementation of trauma-informed care.

Adopting this framework contextualizes trauma from historical injustices as a collective experience for members of a community. Moreover, it frames trauma as an ongoing process, as opposed to a singular historical event with a definitive bookend. Placing contemporary injustices in a historical context will bolster cultural competency, and in turn yield a stronger therapeutic alliance with patients.

This moment demands that psychiatrists accept our mutually reinforcing roles of healer and advocates for public mental health. Therefore, residency programs must incorporate seminars and/or workshops on advocacy into didactics, and the ACGME should consider instituting this as a requirement. As a specialty, psychiatry must be attuned to an individual’s socioeconomic status, as well as their sociopolitical circumstances—these are central to mental well-being. Improving a community’s mental health needs to simultaneously address the conditions that either predispose individuals to poor mental health or exacerbate current conditions. This requires engagement that goes beyond the clinic, hospital, or an electronic screen. The key challenge here will be to strike a precarious balance between respecting individual autonomy and paternalism.

Advocacy through meaningful community engagement can assume many different modalities, including but not limited to social media, coalition building, developing relationships with local stakeholders, or lobbying local legislators, etc. Programs may consider developing a formal curriculum that equips trainees with effective strategies for exploring these avenues. This should go hand in hand with developing networks of local advocates who can help trainees gain in-field experience.

The good news is that psychiatry already recognizes the indispensable role of social determinants to an individual’s overall well-being. This is why it is the specialty that tends to champion the various causes of social justice, whether they be racial, economic, environmental, reproductive, etc. Moving forward, it would be a boon to our patients if this became an occupational objective, rather than an occupational hazard. 

Acknowledgments: I am grateful to Dr James Knoll for his edits to this piece.

is a PGY1 in psychiatry at Upstate Medical University. The views expressed in this article do not necessarily represent the views of his institution.

1. Guideline Development Panel for the Treatment of PTSD in Adults, American Psychological Association. Summary of the clinical practice guideline for the treatment of posttraumatic stress disorder (PTSD) in adults. 

2. Mojtabai R, Olfson M. National trends in psychotherapy by office-based psychiatrists. 

3. Lanouette NM, Calabrese C, Sciolla AF, et al. Do psychiatry residents identify as psychotherapists? A multisite survey. 

4. Moran M. Should psychotherapy be a psychiatric subspecialty? 

https://psychnews.psychiatryonline.org/doi/10.1176/appi.pn.2020.3b6

5. Mohatt NV, Thompson AB, Thai ND, Tebes JK. Historical trauma as public narrative: A conceptual review of how history impacts present-day health. Soc Sci Med. 2014;106:128-136.

6. Menschner C, Maul A. Key ingredients for successful trauma-informed care implementation. April 2016. 

https://www.samhsa.gov/sites/default/files/programs_campaigns/childrens_mental_health/atc-whitepaper-040616.pdf

What should residency programs be doing to address current traumas? 

Three Proposals for Trauma-Sensitive Residency Programs 

H. Steven Moffic talks about trauma and posttraumatic stress disorder (PTSD) awareness month. 

is an award-winning psychiatrist who has specialized in the cultural and ethical aspects of psychiatry. A prolific writer and speaker, he received the one-time designation of being a Hero of Public Psychiatry from the Assembly of the American Psychiatric Association in 2002. He has recently been leading Tikkun Olam advocacy movements on climate instability, burnout, Islamophobia, and anti-Semitism for a better world. He serves on the Editorial Board of

Are We a Traumatized Nation?

In a chilling scene of the television series, 

 set in rural North Carolina, an unnamed elderly white woman tauntingly sings these lyrics with a wide grin as she trespasses on the Black female protagonist Lucky’s property. This serenade foreshadows the racist violence that ensues after. This song, “Old Black Joe,” written by the “Father of American music,” 

 Foster also wrote many minstrel songs, a form of entertainment for white audiences in which white performers donned 

, a facial costume in which white individuals smeared their faces with burnt cork and drew on larger, red lips, with the intent of looking like Black/African-American individuals.

“Old Black Joe” represents an entire culture of songs, written by white composers, that were dehumanizing to Black individuals. These cringeworthy songs were enmeshed in American society to the detriment of the psychological wellbeing of Black individuals, and their songwriters are still memorialized even to this day. A statue of the renowned Stephen Foster, with an African slave sitting at his feet strumming a banjo, was only recently removed.

 is a horror/thriller series recently released on Amazon Prime. The series joins a growing collection of movies and television shows, like 

 that graphically illustrate 1 key point: the violence of white individuals towards Black individuals, simply due to the color of their skin, is scarier than any horror movie monster.

 expertly combines elements of reality and the supernatural to illustrate the horrors of racism and white supremacy to its audience. The series centers on a Black family who moves from the south to California in the 1950s, during a time in history known as the 

, in which Black families moved north to flee the racial violence of the South.

In fact, my mother’s family was one of them, having left the brutal environment of Mississippi for Ohio, hoping for a better life. I have cousins who were murdered by white individuals for attempting to register Black voters. My father’s family, from Macon, Georgia, remained in the South. My uncle, alive and well today, remembers seeing a Black man who had been lynched, swinging from a tree. He was just a child. His father, my grandfather, took pictures of the lynching and published it in a Black-owned Macon newspaper he led. White individuals in the area were furious—not because a Black man had been murdered, but because it had been publicized in the newspaper.

Black children have never had the luxury of being shielded from racism, and 

 highlights this. Ruby, the adolescent protagonist, is sent to the principal’s office for disrupting her class (the disruption being when she raises her hand to answer a question, her white classmates begin making sounds like a monkey). Gracie, the youngest in the family, is forced to see a myriad of Black dolls hanging from ropes in front of her house as she leaves for school. The dolls were placed there by her white neighbors to intimidate Gracie’s family into leaving the neighborhood.

 does not just give the audience a window into the lives of Black Americans, but it also gives a powerful account of the silenced truths of American history, the facts that are largely erased from history books in favor of a narrative that places white Americans in a more positive, nonviolent, light. The series illustrates the harassment and violence that Black Americans endured across the United States upon moving into predominantly white neighborhoods.

White families did not want to live next to Black families due to a host of fears, such as Black men raping white women, a common racist idea that was used to support the 

 This becomes especially ironic, given that rape of Black women by white men was a widely used 

 The series follows a group of housewives in the area who will stop at nothing to remove the Black family from their neighborhood. The series also delves deeper to show how realtors denied home loans or intentionally offered predatory loans to Black families with the goal of disadvantaging them. Viewers get the opportunity to watch how the color grading system, known as 

, developed by the Home Owners’ Loan Corporation to place value on property values in a given area, plays out in the lives of 

 The series follows a female realtor who participates in this heinous system, and partners with a policeman, who only protects Black families from being murdered by white neighbors in return for a profit gained from the predatory home loan given to the Black family.

Although redlining is no longer technically legal today, homeowner racism is still very real, with Black homeowners still given 

 for the same property as their white peers.

, while no longer legal, is also still very much in effect.

Psychiatrists Need to Learn About White Supremacy

When some hear the words “white supremacy,” they think of extremist groups on the fringe of society. Indeed, this terminology was used to describe such groups in the past. But today, white supremacy is often used to describe a political and socioeconomic system in which those racialized as “white” enjoy structural advantages and rights that other racial groups do not. In this way, white supremacy is woven throughout American society. Psychiatrists must learn about the effects of white supremacy on Black Americans if they are to even begin to understand the plight of Black Americans and help them navigate it. Although a horror/thriller show with its share of supernatural monsters, 

 highlights the very real thoughts and behaviors of white Americans in a white supremacist system, many of which persist today. 

Racism and white supremacy incorporate many behaviors that one might deem antisocial, being executed seemingly without compassion or empathy for the lives of Black Americans. 

 shows us how white Americans murdered Black Americans with smiles on their faces, and as one character reports, “lynch Black people just for shade.” Thousands of Black Americans were 

, but these widespread, racially terrorizing behaviors of white Americans are largely left out of history accounts.

 Yet, one can easily turn to the internet to read about the 

 of white Americans having picnics with their families while they watched Black Americans be lynched.

 The ease with which white Americans justified their hateful behaviors towards Black individuals is upsetting, and disturbing to say the least.

Although Black Americans are no longer (openly) hung from trees (although, activists in the Black community still continue to be mysteriously lynched, 

), the continued murder of unarmed Black men by the police and the mass incarceration of a 

 for nonviolent crimes is but a manifestation of the same story.

 The murder of George Floyd has come to be known by many as a modernized lynching, and he the modern 

 Those who engage in racist acts are often everyday citizens rather than extremists, and this series shows this with gut-wrenching clarity.

Psychiatrists need to understand how damaging racism and white supremacy have been, and continue to be, for Black Americans. How can psychiatrists help Black Americans heal from the generational trauma of racism if they themselves do not even know what that trauma entailed? How can psychiatrists help Black Americans to navigate the white supremacy of today if they themselves have not learned about it?

Movies and television can be a powerful, visual way of learning about the plight of Black Americans. The media can be a gateway for psychiatrists to do further research, leading them to the mounting empirical evidence documenting the 

 of racism on the mental and physical health of Black Americans today.

 It is imperative that psychiatrists learn about white supremacy and racism if they are to rectify its traumatic and violent effects on Black Americans. Start by watching 

is a second year psychiatry resident at Yale School of Medicine/Yale Child Study Center in the Adult/Child Albert J. Solnit integrated program. Dr Calhoun’s research centers on the improvement of mental and physical health outcomes in Black Americans by targeting the trauma of racism. Dr Calhoun calls herself an “activist trainee” and through public speaking and writing, exposes current and historical racism in the medical system. She firmly believes that all doctors should be activists and promotes the integration of social justice teaching with medical education.

1. Friedman M. Can’t escape Stephen Foster. 

https://www.newyorker.com/culture/culture-desk/cant-escape-stephen-foster

https://www.washingtonpost.com/archive/entertainment/books/1997/05/11/in-tune-with-america/58e48ba7-361b-49a2-a98a-4b187e864ce2/

3. History.com editors. The Great Migration. 

https://www.history.com/topics/black-history/great-migration

4. Hamblin J. Why we took cocaine out of soda. 

https://www.theatlantic.com/health/archive/2013/01/why-we-took-cocaine-out-of-soda/272694/

5. Hale C, Matt M. The intersection of race and rape viewed through the prism of a modern-day Emmett Till. The American Bar Association. 

https://www.americanbar.org/groups/litigation/committees/diversity-inclusion/articles/2019/summer2019-intersection-of-race-and-rape/

6. Mitchell B. HOLC “redlining” maps: the persistent structure of segregation and economic inequality. National Community Reinvestment Coalition. March 20, 2018. 

7. Richardson B. Redlining’s legacy of inequality: low homeownership rates, less equity for black households. 

https://www.forbes.com/sites/brendarichardson/2020/06/11/redlinings-legacy-of-inequality-low-homeownership-rates-less-equity-for-black-households/?sh=2dfec9402a7c

8. Olick D. A troubling tale of a Black man trying to refinance his mortgage. 

https://www.cnbc.com/2020/08/19/lenders-deny-mortgages-for-blacks-at-a-rate-80percent-higher-than-whites.html

9. Williams JP. Segregation’s legacy. April 20, 2018. 

https://www.usnews.com/news/the-report/articles/2018-04-20/us-is-still-segregated-even-after-fair-housing-act

10. Lartey J, Morris S. How white Americans used lynchings to terrorize and control black people. 

https://www.theguardian.com/us-news/2018/apr/26/lynchings-memorial-us-south-montgomery-alabama

11. Gross T. As new lynching memorial opens, a look back on America’s history of racial terrorism. 

https://www.npr.org/2018/05/04/608477810/as-new-lynching-memorial-opens-a-look-back-on-americas-history-of-racial-terrori

12. Farzan AN. Police are investigating the death of a Ferguson protester’s son as a suicide. His mother insists he was lynched. 

https://www.washingtonpost.com/nation/2018/11/01/police-believe-ferguson-protesters-son-killed-himself-his-mother-insists-he-was-lynched/

13. Stevenson B. Slavery gave America a fear of black people and a taste for violent punishment. Both still define our criminal-justice system. 

https://www.nytimes.com/interactive/2019/08/14/magazine/prison-industrial-complex-slavery-racism.html

https://www.history.com/topics/black-history/emmett-till-1

15. Williams DR. How racism makes us sick. 

https://www.ted.com/talks/david_r_williams_how_racism_makes_us_sick?language=en

Psychiatrists who want to understand white supremacy should watch this series… 

Them: Must-See TV for Psychiatrists 

Tony Thrasher, DO, DFAPA, talks about 4 crucial misunderstandings about mass shootings. 

is the president of the American Association for Emergency Psychiatry (AAEP) and the medical director of crisis services in Milwaukee county, Wisconsin.

As the recent waves of violence show, a conversation needs to be had on mass shootings and gun violence...

Debunking 4 Myths Around Mass Shootings

Molly Ansari, PhD, LCPC, ATR-BC, talks about the problem with blaming yourself for your trauma in the second part of her 2-video series.

You can watch the first video, Trauma: The Narrative That Takes Control, 

, a licensed clinical professional counselor, and board certified registered art therapist at

Everything happens for a reason... or does it?

Pointing Fingers: The Problem of Victim Blaming

Molly Ansari, PhD, LCPC, ATR-BC, talks about the narrative that can take over victim's perception of a traumatic event in the first part of her 2-video series.

, a licensed clinical professional counselor, and board certified registered art therapist at 

Victims can get caught up in blaming themselves for their traumatic event...

Trauma: The Narrative That Takes Control 

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). 

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

Trauma And Violence