This is the second of a three-part series to inform you about research on juvenile bipolar disorder sponsored by the Juvenile Bipolar Research Foundation.  We hope you will be encouraged by the progress and inspired to believe that the end of this journey is attainable.

What do the following have in common?

  • deflects blame
  • suffers horrendous nightmares
  • antagonizes siblings
  • excessively craves sweets and carbohydrates
  • functions in mission mode
  • wets the bed
  • sleeps hot
  • takes excessive risks
  • hoards food
  • has many ideas at once
  • interrupts or intrudes on others
  • experiences periods of self-doubt and poor self-esteem

Independently, each of these traits is a symptom of a myriad of different psychiatric disorders. Considered together, they are all symptoms of Pediatric Bipolar Disorder (PBD).

But wait a minute! Isn’t bipolar disorder all about mania and depression? How can these unrelated symptoms be part of that same profile?

This more complete list of symptoms is reflective of the research progress JBRF has made by adopting the dimensional approach of defining psychiatric disorders: symptoms overlap between psychiatric conditions and one condition is differentiated from the other by how those clusters of overlapping symptoms come together.

Proceeding down this path, researchers have arrived at a novel perspective of the illness. While traits like mania and depression remain important, this analysis finds that they are not the central behavioral dimensions of PBD. Other dimensions such as aggression, anxiety, sensory sensitivity, sleep/wake disturbance, attention/executive function deficit, and oppositional behavior also figure prominently. Of paramount interest is a dimension that establishes a link between obsessive fears and aggressive behavior. JBRF investigators have termed this correlation “Fear-of-Harm” (FOH). This new characterization of PBD has been labeled the “Core phenotype“.

The Core phenotype is a more complete and accurate description of what these children experience than what is offered by the Diagnostic and Statistical Manual for Mental Disorders (DSM). Investigators suggest that in the DSM, bits and pieces of this single disorder have been parceled out into numerous other diagnoses. It is likely that this fragmented perspective of the disorder has obscured a clear view of its actual presentation in children and stalled efforts to get at the underlying biology.

Concentrated exploration of the FOH trait has lead investigators to define a clinically homogeneous subgroup of children who are the most severely impacted by this disorder. This subgroup is called the FOH phenotype. These children are characterized by extreme anxiety and the hyper-perception of threat which causes them to respond in a defensively retaliatory manner. They are often hospitalized and face great challenges socially and academically.

Not only have research investigators been able to describe the symptom profile of this FOHphenotype, but under this new paradigm, they have also pieced together the likely underlying biology involved in the disorder. Certain brain areas, activities and development that had not previously been considered became obvious foci for their attention. The specific neural pathway that ties these activities together in a manner consistent with the profile has been identified. Investigation of this complex system is ongoing. The more the details fall into place, the greater its explanatory value grows.

The FOH phenotype moves us further in our quest to uncover the genetic variations associated with PBD. The high heritability of the FOH trait, refinement of the dimensionally derived symptoms that associate with it, and the fact that the CBQ can identify with 96% accuracy children whose profiles fit the phenotype make us optimistic that we are on the right path for a meaningful genetic analysis.

JBRF actively supports the collection DNA from children whose CBQ scores indicate that they fit the FOH Phenotype.

This novel understanding of the dimensions of bipolar disorder in childhood puts us on much firmer footing as we move towards the identification of biological markers. The identification of new biological markers opens the door for new treatments.

We are hopeful that this compelling work will facilitate the much needed consensus amongst researchers that will unite their creative minds into a common direction and thus enable us to move ahead more quickly on this journey towards relief.

Alissa Bronsteen and Demitri Papolos, M.D.

1 Comment

  1. My son will be 23 in July. He was diagnosed with BP1 almost 2 1/2 years ago. He has a FOH. I find that this occurs more during the depression than in the mania. His FOH causes him to stay in and not socialize. If he needs to leave the house he wants to have a weapon to protect himself because he is afraid someone will try to hard him. Although he is going to be 23 I find your list of symptoms apply to my son now. Looking back at when he was young the only symptom he had was severe separation anxiety during kindergarten. My middle child who has not been diagnosed BP had issues with his shoes and socks and has a limited diet. My niece and nephew however have quite a few of the symptoms on the list. My nephew only eats chicken nuggets, french fries, bread, bakes potatoes pancakes and bacon, candy, soda, cake. He is over weight and doesn’t socialize with other children as much as he should. He is smart and does well in school, so does my niece. Thank you for all information. It’s very helpful and I have told my sister in law to keep an eye on them.

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