Fear of Harm FOH and Aggression

Question: Can you explain FOH’s fourth symptom, aggression? What makes it different from regular aggression?


Answer: In this series we’re going to cover the first 5, which are all observable. In this installment we’ll look at the 4th symptom, simply called “Aggression”, which includes:

    • Excessively aggressive or controlling speech,
    • Excessive anger and oppositional/aggressive reactions,
    • Self-directed aggression
    • Temper tantrums,
    • Often threatens or breaks objects, slams doors, smashes walls.


The behaviors that go along with the criteria of aggression can be difficult to differentiate from either regular frustration, anger and aggression, or from normal childhood behaviors, or from other diagnoses that have already made their way into the DSM. 


Generally speaking people are pretty familiar with the idea that a toddler might have a tantrum over either rational or irrational things. We’ve all seen memes with a photo of a screaming toddler holding a blue sippy-cup, captioned by the parents, “he wanted the blue sippy-cup”. Those tantrums are considered to be developmentally normal and usually only last a few minutes. A few may run as long as an hour, but in kids who don’t have a psychiatric diagnosis longer tantrums are rare.


But, in a child (or adult) with Fear of Harm these tantrums can, and will, last much longer nearly every time. These tantrums can easily last 30, 60, or 90 minutes at a time and they are often (not always) accompanied by physical and verbal aggression. Screaming, throwing things, slamming doors, putting holes in walls, kicking, hitting, biting, and scratching are all a part of the tantrums and these behaviors escalate with the child’s age to include cursing and verbal threats. 


Parents know when their child’s tantrums are unusual and are different from the developmentally normal outbursts that occur in early childhood. 


Additionally, aggression in Fear of Harm is shown in other non-tantrum related ways such as:

    • Defiant and oppositional behavior,
    • Refusals to follow simple instructions,
    • Refusal to complete expected tasks, and
    • Inability to engage in basic chores such as teeth brushing, showering, completing homework, and getting dressed.


Requests to do chores, transition from one activity to the next, or mild redirection can result in verbally abusive responses which can then quickly escalate into tantrums, verbal or physical fights. This leaves parents, siblings, and caregivers feeling as though they are walking on eggshells, never certain what interactions will be fraught with aggression and the potential for violence.


These outbursts also leave the person with Fear of Harm confused and afraid because they don’t want to behave this way and don’t know why they did. They are often filled with regret, remorse, and shame afterwards and they berate themselves for being unable to control this overwhelming and involuntary symptom.  


In the end this aggression leaves those with Fear of Harm and their families feeling exhausted, burned out, and hopeless.

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