Intermittent explosive disorder, kleptomania and pyromania

Disorder

Three disorders of failing to resist an impulse: sudden outbursts of rage, stealing things not needed, and setting fires for the fire itself.

Updated Nov 13, 2026

Key points

IED: outbursts are out of proportion to the stressor or provocation and are not better explained by another mental disorder.
DSM-5 IED criteria use two patterns: non-destructive verbal or physical aggression at least twice a week for 3 months, or at least three destructive outbursts within a year.
Kleptomania: the stolen items are not needed; it is usually kept secret out of embarrassment, and in one series about 5 in 8 patients were women.
Fire setting is not the same as pyromania: high rates of conduct disorder are found among young arsonists, and pyromania excludes fires set for money, revenge or political aims.
Most people with IED also have another mental disorder (about 82 in 100 over their lifetime), so look for it before and after diagnosing IED.
CBT has proved a valid treatment for aggressive patients, and fluoxetine reduced irritability and aggression in a controlled IED trial; kleptomania is treated with CBT techniques, SSRIs and naltrexone.

What it is

These three are traditional impulse-control disorders. In intermittent explosive disorder (IED), a person has recurrent episodes of aggressive behavior far out of proportion to the stressor or provocation, not better explained by another mental disorder. In kleptomania, a person repeatedly steals objects that are not needed, although they have the money to pay or no use for the goods, driven by an anxious urge for an act that is pleasurable in the moment but causes distress. In pyromania, a person repeatedly and deliberately sets fires on impulse, without an external reward such as money, revenge or a political aim.

Key facts

IED is an early-onset disorder, with a median onset at 17 years, and is more common among males, the young and the socially disadvantaged.
Major depression is by far the most common condition alongside kleptomania; symptoms start before age 11 in about a third, and most patients have never been treated for it.
Fire setting by young people is more common in boys, peaks between ages 12 and 14 and often goes with conduct disorder.
People with antisocial personality disorder often also have an impulse-control disorder; the diagnosis requires conduct disorder before age 15.

Aggression, stealing or fire setting: what else it could be

Condition	Pattern	Distinguishing point
Intermittent explosive disorder	Aggression far out of proportion to the trigger	Not better explained by another mental disorder
Conduct disorder	Persistent aggression, destruction, theft and rule-breaking in youth	Pervasive pattern of violating social norms and laws
Antisocial personality disorder	Deceit, exploitation, aggression in adults	Conduct disorder before 15; no remorse
Ordinary theft or shoplifting	Stealing for use or money	The items are needed or valued
Arson for gain or revenge	Deliberate fire setting with a motive	Money, revenge or a political aim

Clinical notes

Assess the risk to others and to the patient first, and ask about legal problems.
Screen for coexisting disorders: most people with IED have at least one other mental disorder, and antisocial personality often comes with substance use, impulse-control and gambling disorders.
For IED, CBT is a valid treatment for aggression; in a controlled trial fluoxetine reduced irritability and aggression, and lithium and divalproex have also been used.
Kleptomania treatment uses CBT techniques that encourage resisting the impulse, covert sensitization, SSRIs and naltrexone, which is avoided in significant liver disease.
For people who set fires, non-drug treatment including CBT has shown some efficacy; no controlled drug trial has been done in pyromania.

Test yourself

Think of the answer, then tap the question to see it.

What distinguishes kleptomania from ordinary shoplifting?

In kleptomania the person has the money to pay or does not need the items, and the theft follows an anxious urge and is pleasurable in the moment; ordinary theft is for use or money.

Which two patterns of aggression meet the DSM-5 criteria for intermittent explosive disorder?

Non-destructive verbal or physical aggression at least twice a week for 3 months, or at least three destructive outbursts within a year.

Most people who set fires do not have pyromania. Which disorder is common among young arsonists?

Conduct disorder; pyromania also excludes fires set for money, revenge or political aims.

Which medicine has some evidence for reducing urges in kleptomania?

Naltrexone, an opioid antagonist: most participants responded in an open-label study; it is used alongside cognitive behavioral techniques.

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Educational content on behavior and the clinical relationship; not a diagnostic or treatment guide and no substitute for assessment by a health professional. If you or someone near you is at risk, seek help now from an emergency service or a mental-health helpline.

Sources: Antisocial Personality Disorder (ASPD) (MSD Manual Professional Edition, 2026); The cross-national epidemiology of DSM-IV intermittent explosive disorder (Psychological Medicine (PubMed Central), 2016); Epidemiologic and clinical updates on impulse control disorders: a critical review (European Archives of Psychiatry and Clinical Neuroscience (PubMed Central), 2006); Overview of Kleptomania and Phenomenological Description of 40 Patients (Primary Care Companion to the Journal of Clinical Psychiatry (PubMed Central), 2004).

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