What is Fear of Harm or FOH?

Question: What is Fear of Harm, and how did they discover it?


Answer: Fear of Harm (of FOH for short) is the name given to a specific set of symptoms that appear in about ⅓ of all people with bipolar disorder. That’s about 250,000 children and nearly 2 million adults who are estimated to have FOH. Its symptoms can be debilitating and devastating to live with. One thing that makes it unique in the world of mental health is that it has a physical symptom that actually makes it much easier to identify that you might realize. 


FOH was first identified by researchers at the Juvenile Bipolar Research Foundation who were looking at the symptoms of about 6,000 kids who had been diagnosed with bipolar disorder. What they saw was that in addition to the classic depressive and manic symptoms of bipolar disorder, the kids with this new set of symptoms also showed elevated anxiety and fearfulness which seemed to mimic a trauma response and included hypervigilance and believing they were in danger when they weren’t.


These kids also had incredible trouble with all aspects of sleeping, including falling asleep, staying asleep, waking up in the morning, and they often had horrible nightmares that would continue to traumatize them during the day with recurring images from the dreams. 


Most interestingly, these kids also had difficulty keeping their body temperature regulated and they spent a lot of time overheated and angry. Further examination of these symptoms made the researchers realize that they were actually looking at a symptom cluster that showed a new diagnosis

Because one of the hallmark symptoms of this disorder is the incredibly high levels of fear the researchers started calling the new type of bipolar disorder “Fear of Harm” for short. 


After 15 years of research into the causes and treatments for Fear of Harm it’s undergone more than one name change, and who knows what the DSM committee will decide what to call it once it makes its way to their collective desk. But one thing that has stayed the same is that it can be identified based on the symptoms that appear in addition to the classic bipolar symptoms of mania and depression. 


Those additional symptoms are what became the identifying diagnostic criteria and are listed in a list, like this:

  1. Erratic and abrupt changes in mood throughout the day;
  2. Fear of harm, either being harmed or harming someone else;
  3. Disrupted body temperature regulation;
  4. Aggression and anger;
  5. Sleep disturbances. 


Of course, while every child is slightly different, and each child with FOH can experience each symptom in a wide range of intensities and frequencies, there are certain strong through-lines in the presentation. Clinicians who are seasoned and familiar with how to diagnose and treat Fear of Harm can usually help to identify it accurately based on the presence (or lack thereof) of the objective, physical, and physiological symptom of temperature dysregulation. 

Coming up soon we’re going to go over all of those symptoms in detail so you know what to look for, so don’t miss the rest of the series!

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