Fear of Harm FOH and Moodiness

Question: Can you explain FOH’s first symptom, erratic mood states? What does that mean?


Answer: There are 7 criteria that are used to help diagnose Fear of Harm. In this series we’re going to cover the first 5, which are all observable. In this installment we’ll look at the 1st symptom, called “Episodic and Abrupt Transitions in Mood States”, which includes:

    • Rapid alterations in level of arousal
    • Emotional excitability
    • Sensory sensitivity
    • Manic/hypomanic or mixed episode required for diagnosis


So, this first symptom really includes a lot of the classic bipolar disorder symptoms that most people can already identify. The difference for kids is often in how they show up, or in how quickly they resolve. But, either way, they include rapid and unexpected changes in mood, with emotional excitability, sensory sensitivities, and symptoms of depression and mania, or hypomania. 


One of the things can can make it difficult to understanding childhood onset bipolar disorder (versus adult onset bipolar disorder) is how fast depressive and manic episodes cycle in kids as opposed to adults. In adults, it’s not uncommon for depressive or manic episodes to last for weeks or months at a time. In fact, the diagnostic criteria in the DSM that doctors and therapists use states that manic episodes must be “present most of the day, nearly every day, lasting at least 4 consecutive days,” or in the case of depressive episodes that they “have been present during the same 2- week period… most of the day, nearly every day”. 


However, with children these manic and depressive episodes don’t usually present this way. Kids with bipolar disorder experience these episodes so quickly that it’s actually called “rapid cycling”. This means that the moods are quickly cycling between manic and depressive with symptom breakthroughs multiple times during a single day


In adults the depressive episodes of bipolar disorder include sad or empty feelings, with a lack of interest in activities they used to enjoy. But it’s important to remember that in children, symptoms of depression and mania most often present as:

    • Irritability,
    • Crankiness, 
    • General rigidity, and
    • Refusals to try new things.

When kids exhibit these symptomatic behaviors they are most often misinterpreted and experienced by parents and caregivers as oppositional and/or defiant behavior.


Mania and hypomania in children can appear as:

    • Excessive excitability,
    • Silliness,
    • Restlessness, and
    • Distractibility.

Again, these symptoms often get misinterpreted by the adults around them as evidence of ADHD. But in both cases these are more likely symptoms of a mood disorder, bipolar disorder, and/or Fear of Harm. 

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