Fear of Harm FOH and Sleep Problems

Question: Can you explain FOH’s fifth symptom, sleep disruptions? How is that a symptom of mental illness?


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

    • Excessively restless sleep
    • Alterations in circadian phase
    • Night-terrors or nightmares – often containing images of gore and mutilation
    • Fear of going to sleep because of disturbing dreams
    • Sleepwalking
    • Bedwetting
    • Bruxism – teeth grinding


Again, we have a symptom that most people don’t think of as having anything to do with mental illness, but the truth is that sleep problems are often an early indicator of mental health struggles and kids with FOH usually begin displaying sleep difficulties in infancy. Many parents report that their children never slept properly, even as babies. Some kids may not develop the ability to truly sleep through the night until after they start treatment, which, in some cases, isn’t until the children are in their teens or are adults. 


We are able to identify these sleep/wake disturbances in three different ways:

    1. Issues such as sleepwalking, sleep talking, night sweats, bedwetting, and teeth grinding, which demonstrate problems with the proper execution of sleep cycles.
    2. Frequent and recurrent nightmares and night terrors themed with pursuit and/or abandonment with violent and often gory imagery involving scenarios where they or someone they love is being hurt, maimed, or killed. These images may linger with the patient long after they awaken and may plague them throughout the day as repetitive intrusive thoughts.
    3. Alterations in circadian rhythms, including difficulty falling asleep, difficulty staying asleep, and difficulty waking.
      1. Falling asleep: it’s very difficult for the child to “wind down” in the evenings and prepare for bed as they experience rising energy levels, anticipatory dread about being unable to fall asleep, and anticipatory fear of nightmares.
      2. Staying asleep: restlessness includes frequent middle of the night awakenings, trips to the bathroom, and bedsheets, pillows, and pajamas in wild disarray.
      3. Waking: they often do not appear to have the energy to move in the morning when awakened.


Something to remember about nightmares and night terrors is that while nightmares are consciously remembered after waking, night terrors on the other hand most often aren’t. But night terrors are just as traumatic because during a night terror the body and brain are reacting to the frightening dream events and images as though they were really happening, creating trauma in the brain. Night terrors are also traumatic for parents and family members who observe them. Often with night terrors the patient appears to be awake, walking, talking, screaming, and crying, trying to get away from the threat they are dreaming about. Children will often cry out for their parents, begging for help, while simultaneously pushing their parents away, recoiling in fear. While the child will most likely not remember the night terror in the morning, as a parent, if you’ve been awake with your child through the night terror, you most certainly will remember.


These sleep disruptions combine to make sleep and bedtime incredibly difficult for families. Kids have an incredibly difficult time “winding down” in the evenings and preparing for bed. When most people are starting to feel tired out from their day, those with Fear of Harm are having their energy ramp up, and find themselves wide awake and unable to settle down just as sleep should be setting in. This makes bedtime a mess, as the child experiences the combination of rising energy levels, anticipatory dread about being unable to fall asleep, and anticipatory fear of the nightmares they know are coming. 

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