Prevalence and Correlates of Fire-Setting in the United States: Results From the National Epidemiologic Survey on Alcohol and Related Conditions (NESARC)

Objective: To estimate the prevalence, sociodemographic correlates, comorbidity, and rates of mental health service utilization of fire-setters in the general population.

Method: A face-to-face survey of more than 43,000 adults aged 18 years and older residing in households was conducted during the 2001-2002 period. Diagnoses of mood, anxiety, substance use disorders, and personality disorders were based
on the Alcohol Use Disorder and Associated
Disabilities Interview Schedule-DSM-IV Version (AUDADIS-IV).

Results: The prevalence of lifetime fire-setting in the US population was 1.13 (95% CI, 1.0-1.3). Being male, never married, and US-born and having a yearly income over $70,000 were risk factors for lifetime fire-setting, while being Asian or Hispanic and older than 30 years were protective factors for lifetime fire-setting. The strongest associations with fire-setting were with disorders often associated with deficits in impulse control, such as antisocial personality disorder (ASPD) (odds ratio [OR]’ ‰=’ ‰21.8; CI, 6.6-28.5), drug dependence (OR’ ‰=’ ‰7.6; 95% CI, 5.2-10.9), bipolar disorder (OR’ ‰=’ ‰5.6; 95% CI, 4.0-7.9), and pathological gambling (OR’ ‰=’ ‰4.8; 95% CI, 2.4-9.5). Associations between fire-setting and all antisocial behaviors were positive and significant. A lifetime history of fire-setting, even in the absence of an ASPD diagnosis, was strongly associated with substantial rates of Axis I comorbidity, a history of antisocial behavior, a family history of other antisocial behaviors, decreased functioning, and higher treatment-seeking rates.

Conclusions: Our findings suggest that fire-setting may be better understood as a behavioral manifestation of a broader impaired control syndrome and part of the externalizing spectrum. Fire-setting and other antisocial behaviors tend to be strongly associated with each other and increase the risk of lifetime and current psychiatric disorders, even in the absence of a DSM-IV diagnosis
of ASPD.

J Clin Psychiatry

Submitted: October 20, 2008; accepted April 21, 2009.

Online ahead of print: February 23, 2010
(doi:10.4088/JCP.08m04812gry).

Corresponding author: Carlos Blanco, MD, PhD, New York State Psychiatric Institute, 1051 Riverside Drive, Box 69, New York, NY 10032 ([email protected]).