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The 6 Dimensions of the Fear Of Harm Phenotype

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The 10 Dimensions of the Core Phenotype

Hidden Symptoms of Childhood Bipolar Disorder

Common Symptoms of Childhood Bipolar Disorder

Criteria for Bipolar Disorder Diagnosis

The Fear of Harm Phenotype (Observable Traits) of Childhood Bipolar Disorder

The Juvenile Bipolar Research Foundation (JBRF) Research Consortium and Dr. Demitri Papolos (author of “The Bipolar Child” and director of JBRF) developed a dimensional approach which uses phenotypes (observable traits) that are described by ranges of behavior that exist on a continuum to define the Core Phenotype of childhood bipolar disorder. The ten dimensions of the Core Phenotype included a group of symptoms labeled “Fear of Harm” which was looked at in greater detail. The same approach used to define the Core Phenotype was also used to define the Fear of Harm (FOH) phenotype. The difference this time was that instead of looking at the symptoms of all children who were at risk for, or had a diagnosis of bipolar disorder, only the symptoms of children who had a high degree of the fear of harm trait were looked at.

The fear of harm trait was defined by using two questionnaires – the Yale-Brown Obsessive Compulsive Scale (Y-BOCS) and the Overt Aggression Scale (OAS). The Y-BOCS reports were used to learn more about the presence of six aggressive obsessions in children with bipolar disorder:

  • Fear might harm self
  • Fear might harm others
  • Fear harm might come to self
  • Fear harm might come to others (may be because of something the child did or did not do)
  • Fear will act on unwanted impulses
  • Fear will be responsible for something else terrible happening (i.e., fire, burglary)

Based upon the answers to the six questions above, children were divided into two groups – low fear of harm or high fear of harm. This group of symptoms was then compared to the aggressive behaviors in the OAS questionnaire. A strong positive correlation was found to exist between the obsessions and the symptoms. It was also discovered that the higher the fear of harm score was, the association with the most severe aggressive symptoms in the OAS was more likely. The most severe aggressive symptoms include:

  • Mutilates self, causing deep cuts, bites that bleed, internal injury, loss of consciousness, loss of teeth
  • Attacks others, causing severe physical injury – broken bones, deep lacerations, internal injuries

The association between fear of harm and severe aggressive symptoms showed that children with a high fear of harm were 2.7 times more likely to inflict severe harm on themselves and 8 times more likely to inflict it on others. It should also be noted that as children age, there is a strong shift from the direction of harming others towards self with a high relationship to threats of suicide. This establishes a relationship between fearful obsessions and aggressive behavior, but in no way means that all children with a high fear of harm will cause severe injury either to self or others.

It should be noted that the fear of harm trait is genetically expressed and has a high degree of hereditary. Researchers also noticed that children with a high level of fear of harm were also characterized by disturbances in appetite and sleep/arousal systems. Researchers believe the Fear of Harm Phenotype is neuroanatomical (related to the brain and nervous system) and are currently investigating possible treatments to correct the dysregulations.

 

The 6 Dimensions of the Fear Of Harm (FOH) Phenotype

  • TERRITORIAL AGGRESSION
    • Has irritable mood states
    • Is intolerant of delays
    • Relentlessly pursues own needs and is demanding of others
    • Is willful and refuses to be subordinated by others
    • Argues with adults
    • Is bossy towards others
    • Defies or refuses to comply with rules
    • Blames others for his/her mistakes
    • Is easily angered in response to limit setting
    • Lies to avoid consequences of his/her actions
    • Has protracted, explosive temper tantrums
    • Has difficulty maintaining friendships
    • Displays aggressive behavior towards others
  • HARM TO SELF AND OTHERS
    • Has destroyed property intentionally
    • Curses viciously, uses foul language in anger
    • Makes moderate threats to others or self
    • Makes clear threats of violence to others or self
    • Has made clear threats of suicide
    • Is fascinated with gore, blood, or violent imagery
  • ANXIETY
    • Displays excessive distress when separated from family
    • Exhibits excessive anxiety or worry
  • SELF-ESTEEM
    • Complains of being bored
    • Experiences periods of self-doubt and poor self-esteem
    • Feels easily criticized and/or rejected
    • Feels easily humiliated or shamed
  • PSYCHOSIS/PARASOMNIAS/SWEET CRAVINGS/OBSESSIONS (PPSO)
    • Has acknowledged experiencing auditory and/or visual hallucinations
    • Has night terrors and/or nightmares
    • Wets bed
    • Craves sweet-tasting foods
    • Hoards or avidly seeks to collect objects or food
    • Has concerns with dirt, germs, or contamination
  • SLEEP/AROUSAL/THERMOREGULATION
    • Has difficulty arising in the AM
    • Has difficulty settling at night
    • Has difficulty getting to sleep
    • Sleeps fitfully and/or awakens in the middle of the night

 

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