Children and adults experience fear and anxiety. When the stressor ortrigger has passed, these feelings usually resolve. Fear can be excessive for some children and can have a significant effect on their life.

“Fear of harm is a collection of symptoms that are thought to be a part of a child’s mental illness. A person or health condition is referred to as a pheotype.”

FOH is a fear of hurting oneself or others. It can include sleep problems and overheating at night.

FOH is still being studied. It is not a formal diagnosis and is not listed in the Diagnostic and Statistical Manual of Mental Disorders, 5th edition (DSM-5). FOH and diagnosing bipolar disorder in children remain controversial topics.

We know a lot about FOH in children with bipolar disorder, but what symptoms define this phenotype, and what treatment options are being studied, are not yet known.

Pediatric bipolar disorder is a mental health condition thought to affect between 1.8 to 3.9 percent of children and teens. Similar to bipolar disorder in adults, the condition is characterized by periods of depression and mania or hypomania with periods of stable mood in between.

According to the National Institute of Mental Health (NIMH), children with bipolar disorder may have more difficulties in school and their relationships than their peers. They’re also at an increased risk of self-harm and suicide.

Demitri Papolos, a psychiatrist and lead researcher on FOH, told NPR that thousands of children might experience fear of harm as a part of their bipolar disorder.

The use of the drug ketamine as a possible treatment is being studied by Papolos. He directs the juvenile bi-polar research foundation which lays out the proposed diagnostic criteria and treatment options for FOH.

2013 research found that FOH is common among children with bipolar disorder. This research revealed that approximately one-third of children with bipolar disorder have high levels of FOH symptoms. Another third have low levels, and a final third do not have symptoms of fear of harm.

The research concluded that children with fear of harm are more likely to experience severe cases of mania and depression.

The symptoms of FOH are many and can be experienced. Some children have many symptoms, while others have fewer.

According to 2014 research, the most commonly observed symptoms associated with fear of harm include:

  • Fears of terrible things happening to oneself or others are intrusive.
  • often feeling threatened and reacting to perceived threats with angry outbursts
  • thoughts of self-injury or suicide
  • elevated levels of anxiety, including separation anxiety
  • insomnia, not wanting to go to bed, and racing thoughts at night
  • night terrors or nightmares that may be violent
  • waking up fatigued or being difficult to wake up
  • an inability to regulate your body temperature, especially at night

It’s important to understand that children who have these symptoms are not like this all the time, and these symptoms do not define who they are. As Papolos tells NPR, once an instance or episode of acute symptoms is over, children are often endearing and amicable.

FOH is still controversial as a proposed subcategory of symptoms in children with a mental illness. There is no way to diagnose children with FOH beyond treating individual symptoms. FOH is not currently listed in the DSM-5.

The DSM criteria for fear of harm have been proposed by the JBRF. Papolos and others have observed some symptoms in their research and clinical practice.

If you believe your child may have FOH symptoms as part of their bipolar disorder diagnosis or has not been diagnosed with bipolar disorder but is showing signs of FOH, contact a pediatrician or child psychologist.

“Children experience moods as a natural part of growing up and learning to process their emotions, but some symptoms need professional evaluation. School and home life can be disrupted by signs of FOH. It may cause risks to your child’s mental health.”

“If you want to understand your child’s behavior and get them the help they need, you should look for licensed mental health professionals.”

FOH is not an official diagnosis by the FDA, so there are no treatments for children who experience it.

Papolos found that general treatments for the disorder were not effective at fully addressing FOH symptoms. He claims that treating FOH with ketamine has immense promise, as he has studied it in children.

In 2018, Papolos and his colleagues published a small study about the promising treatment. They surveyed 45 children who received intranasal ketamine over a period of 3 months and up to 6.5 years.

Children showed reductions in symptoms. The improvement in social skills and school performance was significant.

Before surgeries, it is often used as an anesthetic, but it has been used to treat mental health conditions before.

A nasal form of ketamine called esketamine (Spravato) has previously been FDA-approved to treat depression. However, some experts argue the drug’s risks outweigh its benefits for this use.

“There is limited research on the treatment of mental health conditions. It is best to have a professional evaluate your child’s symptoms and come up with a plan of care.”

Treatments for bipolar disorder in children

There are several standard treatments for the disorder.

According to the NIMH, for children with bipolar disorder, management and treatment may consist of:

Medication

There are many different types of medication used to treat the disorder. Many people have to try more than one drug before finding one that works for them. It is important to have your child take medication as directed by your doctor and report any side effects they may experience. Doctors try to give the lowest possible dose of medication to children.

Common medications used to treat bipolar disorder in children include:

Psychosocial therapy

Different therapies help children develop cope mechanisms, practice social skills and emotional regulation, and provide a safe space for them to express their thoughts and feelings.

This can include some things.

FOH is still in its infancy and is being considered a phenomenon in children with a disorder. Some of the symptoms associated with FOH may be mistaken for other mental health conditions.

According to the JBRF, these include:

If you notice your child is acting crazy or is worrying a lot, you should reach out to a doctor.

The symptoms observed in FOH can be upsetting to witness and affect your child and family’s quality of life. While FOH is not an official diagnosis, you can work with a mental health professional to address and treat symptoms. This may include medication, lifestyle changes, or Talk therapy..

A leading voice on FOH, Demitri Papolos, has proposed that ketamine be used as a treatment. This treatment has not been approved by the FDA, but has been used to treat mental health conditions before.

If you suspect that your child is displaying signs of FOH, please reach out to a mental health professional. There are many people who experience excess fear, worry, or extreme shifts in mood associated with bipolar disorder. You and your child deserve the best for them.