Arson and fire-setting — structured clinical viva

Triad. Firesetting (behaviour) ≠ arson (crime) ≠ pyromania (rare diagnosis with exclusions).[1]

Epidemiology. Community fire-setting ~1% order with comorbidity (NESARC); pyromania rare in recidivist series (Lindberg); arson strongly associated with psychosis among crime types (Anwar) without implying high absolute risk for every patient.[2][3][4]

Pathways. Instrumental, revenge, thrill/interest, psychosis-driven, substance-facilitated, developmental/ID/youth — multi-trajectory not single type.[1][6]

Assessment/treatment. Multi-source reconstruction; fire-specific needs; specialist programmes show effects on fire-related factors (Gannon FIPP-style; FIP-MO for mentally disordered offenders); treat underlying illness/substances; means restriction.[5][6]

Legal. Responsibility then / fitness now / fire risk future; diagnosis ≠ defence; no invented sections.[7]

Youth. Long-term offending trajectories; public-health response (Lambie).[8]

1. Salience and stereotype; clinical response is the triad + exclusions + pathway formulation. Most arson is not pyromania.[1][3]
2. Motive may be primarily criminogenic; still screen for illness/substances, but pyromania is excluded and mental-condition defences are less likely if planning for gain is clear — write to the actual referral question.[1][7]
3. SPJ tools inform future general violence/antisocial risk at group level with modest accuracy; they do not replace fire-specific formulation and do not answer past responsibility.[6][7]
4. Immediate means restriction and search; observation for further ignition and suicide; treat mental state; multi-source review of motive; incident learning; do not rely on "he promised not to" alone.[1][6]