Also known as Thermoregulatory Sleep Dysregulation Disorder
A companion to CMHRC’s Bipolar-FOH book, this packet includes published research papers on this unique disorder. 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.
Free access can also be found through the National Library of Medicine website, PubMed, Hapres academic publishing, and/or other publicly accessible websites.
Thermoregulatory Sleep Dysregulation Disorder (which is most often referred to as “Fear of Harm” or “FOH”) is a newly recognized 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 TSDD/FOH 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
A Newly Identified Mental Illness: How Understanding “Fear of Harm” May Help Save Your Child
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 were developed by Dr. Demitri Papolos and his research team at JBRF during the decade long investigation that first identified TSDD-FOH.
This chart below was developed by Dr. Papolos and his team to show the symptoms that were identified as the basis for 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.
