The Fear

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

It is easy to understand that over the course of human development, our brains became hard-wired to pick up on a wide range of threats. After all, the primary, most ancient drive in human beings is to survive. So we are vigilant to anything that would disturb or diminish that.

It could be said that threat comes in two main categories: tangible and intangible.

  • Tangible threats would be all those things that might physically hurt or deprive us of a direct need. In addition to things that might cause bodily injury, this would also include things that would threaten our possessions, food and shelter.
  • Intangible threats are harder to understand. They are basically things that threaten our status in the community. Our ability to survive and perpetuate is often largely effected by how well we fair within the structure and provisions of the community. The well placed person gets the food and possessions he or she needs to do well, whereas the rejected person may not be able to access those resources.

While some of the ways this plays out in our modern society may seem vague, irrelevant or plain old ridiculous, millennia of evolution have hardwired us with patterns of vigilance against those threats.

Many types of threats are easy to identify and accept as such: germs, weather, violence, hunger. But others are more subtle; these are more likely to be the intangible ones. Threat can include: a brother taking the first helping of the mashed potatoes, a person with a quizzical expression, kids staring at or ignoring him/her, the requirement to go to school when concentration issues make it difficult, or receiving blame for something. At the top of the list might be 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.

But There Are Monsters Too

In addition to facing perceived threat from actual real-life interactions and possibilities, children with FOH also confront much more terrifying things.

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, or kill someone else: 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, hallucinations and paranoia which make them feel as if life-threatening situations are around every corner; snakes in trees, snipers in windows, monsters in bedrooms.

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 that these things are not real are wrong?

The Reaction

Typically, we learn to deal with the more benign threats in our lives effectively. From a very early age we figure out how to channel the fear from the perceived threat into productive lessons or negotiated solutions. Or we just manage to keep a lid on it. However, for children with Fear of Harm, they have inherited a trait which makes the perception of that threat extremely large; the vigilance dial is turned way up. Without proper modulation, the brain interprets most things as higher up on the matter-of-life-or-death spectrum than they deserve: It triggers the survival instinct.

That instinct, the well-known “fight or flight response”, causes the person either to fend off that threat or to run away from it. It is easy to think about this type of behavior-pattern in the animal world where growling, protecting territory, defending the young, fighting for (or giving up) dominance, running from predators, using camouflage and other survival tactics are easy to see.

In children with FOH, the response is most often tilted toward the fight option. Investigators found a strong association or link between the fear-of-harm trait and an aggressive response. In social interactions, the “fight” can be expressed as bossiness, defensiveness, provocation, belligerence, and non-compliance. But for many of these children, it can quickly escalate into physical attacks and rage. It can manifest in aggression-oriented preparations such as hiding knives and even going so far as to making plans to kill people who might hurt them.  It is important to remember that, at its core, this aggressive behavior is defensively oriented. This differentiates it from other forms of aggressive behavior.

To underscore how primal this aggressive reaction can be, even though the animal reference was used to help you think about survival behavior, in fact, parents often report a feral look come over their children when they are in the throes of this reaction; the eyes just change and their child is replaced by something they don’t recognize. One parent has even described that her son would crawl under tables, glaring murderously and growling at the person who challenged him.

When put in the context of survival, it is easier to understand why an extreme and rapid escalation can happen: We get a lot of adrenalin pumping in matters of survival.  Unfortunately, the common response of authority figures is to become more rigid, restrain, or in some other way punish the child. This only escalates the defensive reaction.

Siblings are a common target of aggression. Not only do siblings intrude on the child’s possessions and space, but they also represent a challenge to the pecking order within the family. As the child gets older the aggression more often turns inward. Tragically, and far too often, the serious injury they inflict upon themselves can escalate to suicide.

The rapid and extreme aggression, and the damage and injury it can cause, make it difficult to manage the child at home and school. There is frequent interaction with the juvenile justice system. Everyone, including the child, needs to be safer. So often the children are moved to hospitals and residential treatment centers…or even correctional youth facilities. Certainly this is a heartbreaking situation exacerbated by the fact that, when not caught up in these negative behaviors, the children are typically loving and kind. They work hard at controlling their behavior and are often full of remorse for the damage or injury they cause when they are not able to do so.

Nature and Nurture

Of course the degree of aggression varies from child to child (and circumstance to circumstance). The fear-of-harm trait is inherited. If the genetic loading for the trait is strong, then the degree of vigilance is too –and so would be the reactive aggressive behavior linked to the trait.

That said, 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 more controlled, happy and productive life, the very loss of control in public and being “different” is even its own sort of threat. That is why, for many children, the “meltdowns” and aggressive responses most often occur in a safe environment: the home. In fact, it is not uncommon for people outside the family to have little or no idea of the extremes that can go on in the home.

As they age and become increasingly socialized, and as their brains mature and develop a higher capacity to control impulses, the children learn how to redirect and re-interpret as much as they can. But understandably, most will not be able to reach the same place as a person who is not affected by the trait.

Fear’s Companion: Anxiety

Imagine what it would feel like to live in their world. There is no inner peace or calm. When highly symptomatic, everything undermines a sense of safety and security. Even when in a more stable phase, there is a lot going on.  So anxiety is ever-present. It is a natural partner to fear in that it helps us identify and stay away from threat.

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.

Further, when our brains are busy responding to or controlling threat (either consciously or unconsciously) our brain’s ability to perform other things is diminished. In 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. Or sometimes the manifestation is an actual absence of thoughts; something that would be hard for most of us to imagine and certainly uncomfortable and anxiety provoking.

The anxiety can exert a profound burden on the child’s ability to navigate forward in his or her life. It creates a snow-balling experience of demoralization, isolation and pain. As life experiences accumulate, the limitations imposed by anxiety can become so profound as to be paralyzing.

Is the Fear in Fear of Harm Just a Handy Excuse?

Clinical data, observations, and anecdotes collected over 10 years substantiate the pervasive and extreme kinds of fears and reactions described above and experienced by children with the FOH syndrome.

Children with the trait can be identified with 96% accuracy.  This is important because it will allow for the replication of results. 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.

At this point, investigators are confident that that scientifically recognized evidence in support of the fear-of-harm trait will be gathered in a reasonably short period of time. We are hopeful that the Clinical Intranasal Ketamine Study, started in February 2013, a genetic study started in 2001 and another planned study which will gather sensitive thermoregulatory information will provide important data towards that goal.