What to Know About Fear of Harm (FOH) in Bipolar Disorder

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Fear of harm, or FOH, is a syndrome sometimes seen in children with bipolar disorder.This syndrome can cause separation anxiety, obsessions, trouble sleeping, overheating at night, and poorer response to treatment.FOH is also related to more severe mania and depression, and a more severe and lengthy course of illness in general. Children with bipolar disorder may be especially susceptible to FOH duringmanic episodes.Symptoms of Fear of Harm (FOH) in Bipolar DisorderFear of harm is not currently listed as a distinct diagnosis in theDSM-5-TR. Instead, it is considered through research to be a “syndrome” related to bipolar disorder, which means that it is a way to describe a certain manifestation of the disorder. In addition, the Juvenile Bipolar Research Foundation has outlined proposed diagnostic criteria for fear of harm in pediatric bipolar disorder.Below are some of the symptoms of fear of harm in bipolar disorder in children:Separation anxiety:A child with FOH may experience significant anxiety when separated from a parent or caregiver. They may cry, have trouble sleeping, and refuse to go to school or participate in activities away from home.Intrusive thoughts:A child with FOH may have intrusive, unwanted thoughts about harm coming to him or her. These thoughts may be so severe that they interfere with the child’s ability to function.Obsessions:A child with FOH may become fixated on certain objects or ideas and experience significant distress related to these obsessions.Trouble sleeping:A child with FOH may have difficulty falling asleep or staying asleep due to anxiety. They may also wake up frequently during the night and have nightmares.Trouble waking up:A child with FOH may have difficulty waking up in the morning and may seem “foggy” or disoriented when they do wake up.Overheating at night:A child with FOH may perspire excessively at night and have difficulty regulating their body temperature. This can lead to disturbed sleep and fatigue during the day.Poorer response totreatment:Children with FOH may be less responsive to treatments for bipolar disorder, such as medication and therapy. This may be due to the fact that FOH is associated with more severe illness.Feeling threatened:A child with FOH may feel like he or she is in danger, even when there is no apparent threat. As a result, the child may react with anger or fear to seemingly innocuous situations.Self-harm:A child with FOH may engage in self-harming behaviors or make suicide attempts. If your child is experiencing suicidal thoughts or behaviors, it is important to seek immediate medical attention. Call 911 or take your child to the nearest emergency room.Causes of Fear of Harm (FOH) in Bipolar DisorderThe causes of fear of harm in pediatric bipolar disorder are not fully understood. However, FOH is thought to be related togenetic factorsand alterations in brain development and function.Neural pathways that are responsible forfear and anxietymay also be overactive in children with FOH.Treatment for Fear of Harm (FOH) in Bipolar DisorderIf your child is experiencing symptoms of fear of harm, it is important to seek professional help. There is no specific treatment for fear of harm in bipolar disorder. However, treatment for bipolar disorder, in general, may help to reduce symptoms of FOH. Medication and psychotherapy are the two main treatment options for bipolar disorder.Medication:Medications that may be used to treat fear of harm include antidepressants, anti-anxiety medications, and mood stabilizers.These medications can help to relieve symptoms of anxiety and depression, which may be contributing to FOH.Cognitive behavioral therapy (CBT):Cognitive behavioral therapy (CBT) is a type of therapy that has been shown to be particularly helpful in treating anxiety disorders.CBT can help people to identify and change negative thoughts and beliefs that are contributing to their anxiety. It can also teach people skills for managing anxiety and improving coping.In addition, new research indicates thatketaminemay be a promising new treatment for fear of harm in children.In a study conducted in 2018 and published in the Journal of Affective Disorders, children with bipolar disorder who were treated with ketamine showed a decrease in symptoms of anxiety and depression, as well as a decrease in fear of harm.However, more research is needed to confirm these findings.Coping with Fear of Harm (FOH) in Bipolar DisorderThere are a number of things you can do to help your child with bipolar disorder cope with FOH.Encourage your child toexpress his or her feelings:It is important to encourage your child to express his or her feelings, both positive and negative. This will help your child to feel supported and understood.Encourage your child to be active and social:Staying active and social can help your child to combat symptoms of anxiety and depression. Participating in activities that he or she enjoys can also help to boostself-esteem, which is important for those with bipolar disorder.Make sure your child is getting enough sleep:Gettingenough sleepis crucial for managing symptoms of bipolar disorder. Try to establish a regular sleep schedule for your child and make sure that he or she is getting enough rest.Teach your child relaxation techniques:There are a number ofrelaxation techniquesthat can help to reduce symptoms of anxiety. Some examples include deep breathing, progressive muscle relaxation, and visualization.If you are struggling to cope with your child’s FOH, it is important to seek professional help. A mental health professional can provide you with support and guidance.A Word From VerywellIt can be difficult coping if your child is experiencing fear of harm as part of bipolar disorder. However, there are treatments and coping strategies that can help. If you are struggling to cope, it is important to seek professional help. A mental health professional can provide you with support and guidance.

Fear of harm, or FOH, is a syndrome sometimes seen in children with bipolar disorder.This syndrome can cause separation anxiety, obsessions, trouble sleeping, overheating at night, and poorer response to treatment.

FOH is also related to more severe mania and depression, and a more severe and lengthy course of illness in general. Children with bipolar disorder may be especially susceptible to FOH duringmanic episodes.

Symptoms of Fear of Harm (FOH) in Bipolar Disorder

Fear of harm is not currently listed as a distinct diagnosis in theDSM-5-TR. Instead, it is considered through research to be a “syndrome” related to bipolar disorder, which means that it is a way to describe a certain manifestation of the disorder. In addition, the Juvenile Bipolar Research Foundation has outlined proposed diagnostic criteria for fear of harm in pediatric bipolar disorder.

Below are some of the symptoms of fear of harm in bipolar disorder in children:

Causes of Fear of Harm (FOH) in Bipolar Disorder

The causes of fear of harm in pediatric bipolar disorder are not fully understood. However, FOH is thought to be related togenetic factorsand alterations in brain development and function.Neural pathways that are responsible forfear and anxietymay also be overactive in children with FOH.

Treatment for Fear of Harm (FOH) in Bipolar Disorder

If your child is experiencing symptoms of fear of harm, it is important to seek professional help. There is no specific treatment for fear of harm in bipolar disorder. However, treatment for bipolar disorder, in general, may help to reduce symptoms of FOH. Medication and psychotherapy are the two main treatment options for bipolar disorder.

In addition, new research indicates thatketaminemay be a promising new treatment for fear of harm in children.

In a study conducted in 2018 and published in the Journal of Affective Disorders, children with bipolar disorder who were treated with ketamine showed a decrease in symptoms of anxiety and depression, as well as a decrease in fear of harm.However, more research is needed to confirm these findings.

Coping with Fear of Harm (FOH) in Bipolar Disorder

There are a number of things you can do to help your child with bipolar disorder cope with FOH.

If you are struggling to cope with your child’s FOH, it is important to seek professional help. A mental health professional can provide you with support and guidance.

A Word From Verywell

It can be difficult coping if your child is experiencing fear of harm as part of bipolar disorder. However, there are treatments and coping strategies that can help. If you are struggling to cope, it is important to seek professional help. A mental health professional can provide you with support and guidance.

10 SourcesVerywell Mind uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.Papolos D, Mattis S, Golshan S, Molay F.Fear of harm, a possible phenotype of pediatric bipolar disorder: a dimensional approach to diagnosis for genotyping psychiatric syndromes.J Affect Disord. 2009;118(1-3):28-38. doi:10.1016/j.jad.2009.06.016Juvenile Bipolar Research Foundation.Treatment Protocol for Fear of Harm.The Bipolar Child.Fear of Harm: Novel syndrome, novel treatment.Yee CS, Hawken ER, Baldessarini RJ, Vázquez GH.Maintenance Pharmacological Treatment of Juvenile Bipolar Disorder: Review and Meta-Analyses.Int J Neuropsychopharmacol. 2019;22(8):531-540. doi:10.1093/ijnp/pyz034Miklowitz DJ, Efthimiou O, Furukawa TA, et al.Adjunctive Psychotherapy for Bipolar Disorder: A Systematic Review and Component Network Meta-analysis.JAMA Psychiatry. 2021;78(2):141-150. doi:10.1001/jamapsychiatry.2020.2993Papolos D, Frei M, Rossignol D, Mattis S, Hernandez-Garcia LC, Teicher MH.Clinical experience using intranasal ketamine in the longitudinal treatment of juvenile bipolar disorder with fear of harm phenotype.J Affect Disord. 2018;225:545-551. doi:10.1016/j.jad.2017.08.081Sohal M, Singh P, Dhillon BS, Gill HS.Efficacy of journaling in the management of mental illness: a systematic review and meta-analysis.Fam Med Community Health. 2022;10(1):e001154. doi:10.1136/fmch-2021-001154Ironside ML, Johnson SL, Carver CS.Identity in bipolar disorder: Self-worth and achievement.J Pers. 2020;88(1):45-58. doi:10.1111/jopy.12461Kaplan KA.Sleep and sleep treatments in bipolar disorder.Curr Opin Psychol. 2020;34:117-122. doi:10.1016/j.copsyc.2020.02.001Tarsha MS, Park S, Tortora S.Body-Centered Interventions for Psychopathological Conditions: A Review.Front Psychol. 2020;10:2907. Published 2020 Jan 24. doi:10.3389/fpsyg.2019.02907

10 Sources

Verywell Mind uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.Papolos D, Mattis S, Golshan S, Molay F.Fear of harm, a possible phenotype of pediatric bipolar disorder: a dimensional approach to diagnosis for genotyping psychiatric syndromes.J Affect Disord. 2009;118(1-3):28-38. doi:10.1016/j.jad.2009.06.016Juvenile Bipolar Research Foundation.Treatment Protocol for Fear of Harm.The Bipolar Child.Fear of Harm: Novel syndrome, novel treatment.Yee CS, Hawken ER, Baldessarini RJ, Vázquez GH.Maintenance Pharmacological Treatment of Juvenile Bipolar Disorder: Review and Meta-Analyses.Int J Neuropsychopharmacol. 2019;22(8):531-540. doi:10.1093/ijnp/pyz034Miklowitz DJ, Efthimiou O, Furukawa TA, et al.Adjunctive Psychotherapy for Bipolar Disorder: A Systematic Review and Component Network Meta-analysis.JAMA Psychiatry. 2021;78(2):141-150. doi:10.1001/jamapsychiatry.2020.2993Papolos D, Frei M, Rossignol D, Mattis S, Hernandez-Garcia LC, Teicher MH.Clinical experience using intranasal ketamine in the longitudinal treatment of juvenile bipolar disorder with fear of harm phenotype.J Affect Disord. 2018;225:545-551. doi:10.1016/j.jad.2017.08.081Sohal M, Singh P, Dhillon BS, Gill HS.Efficacy of journaling in the management of mental illness: a systematic review and meta-analysis.Fam Med Community Health. 2022;10(1):e001154. doi:10.1136/fmch-2021-001154Ironside ML, Johnson SL, Carver CS.Identity in bipolar disorder: Self-worth and achievement.J Pers. 2020;88(1):45-58. doi:10.1111/jopy.12461Kaplan KA.Sleep and sleep treatments in bipolar disorder.Curr Opin Psychol. 2020;34:117-122. doi:10.1016/j.copsyc.2020.02.001Tarsha MS, Park S, Tortora S.Body-Centered Interventions for Psychopathological Conditions: A Review.Front Psychol. 2020;10:2907. Published 2020 Jan 24. doi:10.3389/fpsyg.2019.02907

Verywell Mind uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.

Papolos D, Mattis S, Golshan S, Molay F.Fear of harm, a possible phenotype of pediatric bipolar disorder: a dimensional approach to diagnosis for genotyping psychiatric syndromes.J Affect Disord. 2009;118(1-3):28-38. doi:10.1016/j.jad.2009.06.016Juvenile Bipolar Research Foundation.Treatment Protocol for Fear of Harm.The Bipolar Child.Fear of Harm: Novel syndrome, novel treatment.Yee CS, Hawken ER, Baldessarini RJ, Vázquez GH.Maintenance Pharmacological Treatment of Juvenile Bipolar Disorder: Review and Meta-Analyses.Int J Neuropsychopharmacol. 2019;22(8):531-540. doi:10.1093/ijnp/pyz034Miklowitz DJ, Efthimiou O, Furukawa TA, et al.Adjunctive Psychotherapy for Bipolar Disorder: A Systematic Review and Component Network Meta-analysis.JAMA Psychiatry. 2021;78(2):141-150. doi:10.1001/jamapsychiatry.2020.2993Papolos D, Frei M, Rossignol D, Mattis S, Hernandez-Garcia LC, Teicher MH.Clinical experience using intranasal ketamine in the longitudinal treatment of juvenile bipolar disorder with fear of harm phenotype.J Affect Disord. 2018;225:545-551. doi:10.1016/j.jad.2017.08.081Sohal M, Singh P, Dhillon BS, Gill HS.Efficacy of journaling in the management of mental illness: a systematic review and meta-analysis.Fam Med Community Health. 2022;10(1):e001154. doi:10.1136/fmch-2021-001154Ironside ML, Johnson SL, Carver CS.Identity in bipolar disorder: Self-worth and achievement.J Pers. 2020;88(1):45-58. doi:10.1111/jopy.12461Kaplan KA.Sleep and sleep treatments in bipolar disorder.Curr Opin Psychol. 2020;34:117-122. doi:10.1016/j.copsyc.2020.02.001Tarsha MS, Park S, Tortora S.Body-Centered Interventions for Psychopathological Conditions: A Review.Front Psychol. 2020;10:2907. Published 2020 Jan 24. doi:10.3389/fpsyg.2019.02907

Papolos D, Mattis S, Golshan S, Molay F.Fear of harm, a possible phenotype of pediatric bipolar disorder: a dimensional approach to diagnosis for genotyping psychiatric syndromes.J Affect Disord. 2009;118(1-3):28-38. doi:10.1016/j.jad.2009.06.016

Juvenile Bipolar Research Foundation.Treatment Protocol for Fear of Harm.

The Bipolar Child.Fear of Harm: Novel syndrome, novel treatment.

Yee CS, Hawken ER, Baldessarini RJ, Vázquez GH.Maintenance Pharmacological Treatment of Juvenile Bipolar Disorder: Review and Meta-Analyses.Int J Neuropsychopharmacol. 2019;22(8):531-540. doi:10.1093/ijnp/pyz034

Miklowitz DJ, Efthimiou O, Furukawa TA, et al.Adjunctive Psychotherapy for Bipolar Disorder: A Systematic Review and Component Network Meta-analysis.JAMA Psychiatry. 2021;78(2):141-150. doi:10.1001/jamapsychiatry.2020.2993

Papolos D, Frei M, Rossignol D, Mattis S, Hernandez-Garcia LC, Teicher MH.Clinical experience using intranasal ketamine in the longitudinal treatment of juvenile bipolar disorder with fear of harm phenotype.J Affect Disord. 2018;225:545-551. doi:10.1016/j.jad.2017.08.081

Sohal M, Singh P, Dhillon BS, Gill HS.Efficacy of journaling in the management of mental illness: a systematic review and meta-analysis.Fam Med Community Health. 2022;10(1):e001154. doi:10.1136/fmch-2021-001154

Ironside ML, Johnson SL, Carver CS.Identity in bipolar disorder: Self-worth and achievement.J Pers. 2020;88(1):45-58. doi:10.1111/jopy.12461

Kaplan KA.Sleep and sleep treatments in bipolar disorder.Curr Opin Psychol. 2020;34:117-122. doi:10.1016/j.copsyc.2020.02.001

Tarsha MS, Park S, Tortora S.Body-Centered Interventions for Psychopathological Conditions: A Review.Front Psychol. 2020;10:2907. Published 2020 Jan 24. doi:10.3389/fpsyg.2019.02907

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