Once the fear-of-harm trait was established and its importance confirmed, investigators wanted to learn more about it and the impact it has on children who are characterized by it.

The Children

An exploration of data from over 3,000 children diagnosed with, or at risk for a bipolar disorder determined that one third of them had no evidence of fear-of-harm, one third had low fear-of-harm and the other third had high fear-of-harm. All groups were found to be challenged with significant impairments that affected their ability to successfully navigate through the school system and away from the juvenile justice system.  Additionally, all groups were found to have early presentation of psychiatric symptoms, early evaluations by mental health professionals and assignment of diagnoses, as well as early psychiatric hospitalization.  This common profile underscores the urgent necessity to find better treatment for any child with a bipolar disorder.

Children with the fear-of-harm trait fared worse than the children without the trait and children with high fear-of-harm fared worst of all. Children with fear-of-harm experienced more severe mania and depression, more frequent hospitalizations and suffered greater school failure in terms of being held back or suspended.

A child who fits the FOH phenotype is easily traumatized, emotionally over-sensitive to criticism, rejection, disappointment and loss, and often misperceives others as threatening.  They have an over-reactive and rapid retaliatory response to real or imagined threats (however this is typically defensive to limit setting or perceived threat/deprivation which distinguishes it from other forms of aggressive behaviors).   Given their overly-sensitive interpretation of threat, the retaliatory behavior is a frequent and problematic issue.

Poor modulation of appetitive and acquisitive impulses result in excessive cravings for sweets with periodic binges, as well as hoarding of food and possessions.  When stressed, children with this behavioral phenotype also have a tendency to drift off readily into daydreaming states that may progress to mild hallucinations.  During regular sleeping hours, the child may have difficulty getting to sleep, staying asleep and rousing to wakefulness.  Dysregulation of their sleep architecture causes parasomnias (arousal disorders of sleep) such as night terrors, bed-wetting and teeth grinding.

Other behavioral attributes include anxiety, fear of germs, fear of others, fear of intruders, nightmares of pursuit, and fascination as well as fear of gore and horrific imagery.


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