Information on Fear of Harm (FOH)
Also known as Thermoregulatory Sleep Dysregulation Disorder
Purchase Our “FOH” Information Book
To support families and providers looking for more information about TSDD/FOH we’ve compiled a book that supports accurate diagnosis and effective treatment. This book, contains details about TSDD/FOH, how to identify its symptoms, and research backed treatment recommendations.
This book also contains checklists and questionnaires, based on nearly 20 years of published research into TSDD/FOH, and years of community sourced reports of common symptom presentation in children and teens.
Parents, patients, and providers can use these checklists, medication histories, family histories, and behavior charts to help identify symptoms of TSDD/FOH and to facilitate access to effective treatment.
The Bipolar – Fear of Harm book can be purchased in paper form (allow 2 weeks for delivery) for $99 and includes a digital copy of the book which is delivered to you immediately. Or, families can opt to purchase only the digital form for $59.
Download Our Free Research Packet on FOH
This packet is a companion to CMHRC’s materials outlining the diagnosis of Thermoregulatory Sleep Dysregulation Disorder (TSDD), which is also commonly referred to as FOH.
The research papers that follow have all been cited in CMHRC’s review of current literature on bipolar disorder and TSDD/FOH. Each paper can be found online and accessed for free by the general public. The copyrights belong wholly to the authors and the publications in which they were originally published. CMHRC makes no claim of ownership or authorship.
CMHRC does not charge any fee for access to these research papers. They are collected here only as a convenience.
Free access to these papers can also be found through the National Library of Medicine website, PubMed (which is made available through National Institutes of Health), Hapres academic publishing, and/or other publicly accessible websites.
Fear of Harm (FOH)
Sleep Dysregulation Disorder (which is most often referred to as “Fear of Harm” or “FOH”) is a newly identified phenotype of Bipolar Disorder. Research sponsored by the Juvenile Bipolar Research Foundation (JBRF), and headed by Dr. Demitri Papolos, lead to the publication of the first paper on this new phenotype in 2009: Fear of Harm, a Possible Phenotype of Pediatric Bipolar Disorder: A Dimensional Approach to Diagnosis for Genotyping Psychiatric Syndromes (Journal of Affective Disorders). This article outlined the new phenotype and their findings on it, which indicated that there were possibly more than 250,000 children and nearly 2 million adults in the US alone with this new disorder.
Since 2005 Dr. Papolos and his team of researchers, sponsored by JBRF, have published a dozen articles on childhood onset Bipolar Disorder, Fear of Harm, and its groundbreaking biological marker – temperature dysregulation. This includes the publication in 2025 of the paper Treatment of Early-Onset Specified and Unspecified Bipolar Disorders: A Systematic Review and Strategies for Identifying and Managing a Thermally Dysregulated Subtype in Children , published in Acta Psychiatrica Scandinavica. These papers explain the symptoms and treatments that have been uncovered.
CMHRC’s founder and executive director, Elizabeth Errico, worked closely with JBRF researchers for more than three years as they honed the proposed diagnostic criteria and investigated both medicinal and non-medication based treatments for this unique disorder. CMHRC’s education, outreach, advocacy, and support programs on Fear of Harm incorporate these cutting edge published journal articles. Our expert staff are able to provide parents with information about this disorder, as well as symptom management strategies, in clear, easy to understand, layman’s language.
Proposed Diagnostic Criteria for Fear of Harm*
*”Fear of Harm” is the commonly used term to describe a newly identified phenotype of bipolar disorder. Its official name is likely to change if/when it is included in the DSM, but it remains known within the community as “Fear of Harm” or FOH for short.
The video below, “Mood Disorder First Aid: Managing Temperature Disruptions”, explains tools and strategies that can be used immediately, at home, with no prescription, in order to combat the impact of temperature dysregulation on mood stability and the temperature driven symptoms of FOH.
The 6 Dimension of the Fear of Harm (FOH) Phenotype (below) were developed by Dr. Demitri Papolos and his research team (sponsored by the Juvenile Bipolar Research Foundation) during the decade long investigation that first identified Fear of Harm.
This chart below was developed by Dr. Papolos and his team to shows the symptoms that emerged, and which assisted in the identification of the new diagnosis of Fear of Harm. These dimensions were outlined further in their 2009 published paper: Fear of Harm, a Possible Phenotype of Pediatric Bipolar Disorder: A Dimensional Approach to Diagnosis for Genotyping Psychiatric Syndromes (Journal of Affective Disorders), and were used to develop FOH’s proposed diagnostic criteria.
Below are videos from a JBRF event in 2019. They show Dr. Demitri Papolos and Dr. Steven Mattis, discussing Fear of Harm, its identification, and the field changing implications of this transformational diagnosis. These videos can be found on the JBRF YouTube channel. You can watch them below or click “Watch on YouTube” to be taken to the JBRF channel.
CMHRC ‘s is led by and for families living with mental illness. from our dedicated board, to our expert staff, to our enthusiastic volunteers we represent this lives experience. With many decades of combined experience as mental health professionals treating mental illness and as families surviving and thriving with mental illness, we bring a unique and essential perspective to the world of mental health services.
Our programs and services have been developed specifically to support both families and the professionals who treat them. From community building support and educational programs like our monthly Book Club, to our free monthly webinars and clinical seminars, to high-touch expert Wayfinder Service, to our unique Palliative Parenting classes and professional discussion groups, to our invaluable CMHRC Toolkit web-app for tracking symptoms, moods, and medications, we’re here to help families and providers grow, learn, and enjoy the best possible quality of life.
Of course, all of this incredible offerings are made possible by the incredible support of our CMHRC members. The CMHRC membership program brings together visionaries who truly understand the reality of the lived experiences of children, adolescents, and families navigating the challenges of mental illness. Our members, through their charitable support, reshape the landscape of children’s mental health for a brighter future full of hope.