The Fear in Fear of Harm

The Types and Range of Fears in Fear of Harm

THE FEAR

Everyone knows what it is to be afraid of something. But the type of fear that affects a person characterized by Fear of Harm (FOH) is better thought of as an extreme perception of threat.

Over the course of human development, our brains have become hard-wired to pick out threat. After all, the primary, most ancient drive in human beings is to survive. So we developed patterns of vigilance and response which would help us with that survival.

In its most basic form threat is thought of as predators, enemies, pain, hunger, violence, and exposure to toxins, germs, and weather extremes. But it becomes much more complicated than that. It also includes things that are unfamiliar, depleting and unpredictable. It extends to the protection of property, territory and status. It is everywhere. Threat plays out at all levels of intensity from small events that would threaten ones status-quo to urgent and serious events which could result in death. When the threat is high enough, it triggers the instinct of” fight or flight”.

In the animal world, it is easy see responses to threat.  Some examples include playing/fighting for dominance within the group, protecting territory, food, and the young, using vocal warnings and defensive posturing, avoiding or fleeing from predators, and even using camouflage.

While the threat of violence, deprivation, extreme weather and illness occur in our modern society, there are many other subtle things that we run up against in our daily lives that we might not even consciously think of as threats. These can include a brother taking the first helping of mashed potatoes, a person with a quizzical look, a bunch of kids standing on the playground ignoring, or alternatively, staring, at the child, the requirement to go to school when concentration or anxiety issues make it uncomfortably “boring”, blame for something (regardless of whether it is deserved), and of course, the very threatening “no” by a parent.  While that “no” may seem appropriate and benign enough, think of it instead as a refusal of perceived need by the person who is the most important gatekeeper to that child’s survival. (This may be why “mom” usually gets the brunt of it!)

Typically, people deal with many of these minor threats quite effectively. From a very early age, experience informs our brains that we don’t need to pay attention to many of them. For the minor threats that we do need to pay attention to, we learn to channel the fear into productive or negotiated solutions…or even just to bear it. The threats that exceed those levels result in what we commonly think of as fearful responses; usually they are appropriate and commensurate to the threat.

However, for children with FOH, the circuitry which modulates the perception seems to be stuck on high. This means that the same threat that others may ignore, those with FOH may perceive as very threatening or even a matter of life or death. This explains the 0-to-100 description that is often applied to their reactive behavior. When a pitched threat to survival is perceived, there is no time to measure and modify; instinct kicks and trigger the well-known fight-or-flight response.

THE REACTION

While one of the options of the fight-or-flight response to threat is to flee, children with FOH are primarily tilted toward the fight reaction.  The pairing of a heightened perception of threat with a defensively aggressive response is what investigators have called the fear-of-harm trait. They have determined that it the trait is genetically based. (click here for more) As with any genetically based trait, its effect will be expressed along a spectrum. Reactions will vary from child to child and from circumstance to circumstance.

That said, by understanding that their perception of threat is poorly modulated, it easier to understand why the reaction of a child with FOH can be so large: a lot of adrenalin gets pumping in matters of survival. When the genetic trait is strong, or when the child is particularly symptomatic, he or she can attack others and destroy property.  The extreme outbursts that can erupt often make these children difficult to manage in home and school.

But it is very important to remember that these responses are not premeditated or offensive; they are defensive in origin. A common response of authority figures is to restrain (or in some other way punish) them which only escalates the reaction as the child’s sense of threat increases.

RAGE IS NOT REQUIRED

The response to threat is not always aggressive. Just as an animal may growl rather than pounce, children with FOH do not always respond with rage. In fact, some children never rage nor do they behave aggressively. There are many more subtle and pervasive ways that the trait can express itself. Deflection of blame, non-compliance/refusal, and behavior which is considered bossy, argumentative, selfish, irritable and irrational are all ways of avoiding subordination and protecting the self.

Additionally, like everyone, children with the trait try to adjust as well as they can to the society in which they live. In addition to just wanting to have a happier, more balanced and productive life, the very loss of control in public and being “different” presents its own sort of threat. So as children grow and become more socialized, and as different parts of their brains mature, they work VERY hard at, and are often able to become better at, directing and/or managing their behavior.  Investigators have documented that as the children grow, they more often turn their aggression inward upon themselves in terms of injury and suicide.

TOO OFTEN THE FEAR ACTUALLY DOES INCLUDE MONSTERS

As if it weren’t enough that these children perceive so much threat from the real things they encounter every day, but they also confront “monsters”. They are frequently plagued with terrible nightmares of blood, gore, death and pursuit. Unlike most of us who don’t actually feel the pain, or get caught and killed: they do. Just as it is difficult for anyone to shake off a bad dream, these nightmares overflow onto an already difficult day.

Further, many of the children suffer from psychotic fears and paranoia which make them feel as if life-threatening situations are around every corner; snakes in trees, snipers in windows, monsters in bedrooms. But remember…this is their “normal”. Why would they not believe what they see, hear, smell and sense. Why would they not think that this is how the world is and that people who tell them otherwise are wrong?

FEAR’S COMPANION: ANXIETY

Imagine what it would feel like to live in their world. When highly symptomatic, everything can be a threat to safety; bridges may fall, something might happen to their parents, they may forget to do something, an evil creature may be hovering behind them, or they may get sick from going outside…and on and on. Even when in a more stable phase, there is a lot going on.

Anxiety is a natural partner to fear. It helps us stay away from threatening situations. But under these conditions, it can become all consuming. As life experiences accumulate the anxiety can become as profound as to be paralyzing…or at least highly impairing. Avoidance behaviors become well-honed and the worlds of these children become smaller and smaller while conflicts with school, friends and family may become larger and larger. Self-esteem plummets.

Further, when our brains are busy responding to or controlling threat and anxiety (either consciously or unconsciously), our brain’s ability to perform other things is diminished. On our brain’s priority list, thoughts and resources for survival trump thoughts which can produce committed concentration and creativity.  Rapid or distracted thoughts get in the way. Sometimes the manifestation is an actual absence of thoughts; something that would be hard for most of us to imagine and certainly uncomfortable. This secondary level of effect exacts a huge toll on the child’s ability to navigate forward in life and adds to the snow-balling experience of demoralization, isolation and pain.

IS THE TRAIT AN EXCUSE FOR BAD BEHAVIOR?

To the outsider, a child with FOH may appear to be the same as all the other children on the playground. What they see is behavior that is confusing, different, undesirable and often unacceptable. But in the world of these children, their responses are logical and adaptive.

Many people may consider the description we give here as an over-analysis or defense of what is just plain-and-simply socially unacceptable behavior. It is true that nothing is an explanation for everything.  Like all children, those with FOH test boundaries in order to inform themselves of what is and isn’t acceptable. The problem is that for children with FOH, the ability to adjust behavior based on that experience is not always possible because there may be so much more behind that experience.  The difficulty to differentiate which child is which is, in large part, why it is so controversial and difficult to talk about children and disorders.

NO, IT’S NOT AN EXCUSE

At this point, investigators are confident that that evidence in support of the trait will be gathered in a reasonably short period of time. We hope that the Clinical Intranasal Ketamine Study, started in February 2013 will provide the next step in that process.

Already, children with the trait can be identified with 96% accuracy.  This is important because it will allow for the replication of results –another requisite in science. The symptoms and behaviors associated with the trait include some measurable physiological conditions that are not open to observational interpretation.  These include, primarily, the symptoms related to thermoregulation.  It is conceivable that further knowledge of these symptoms may ultimately provide a diagnostic test for the condition.

 

 

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