title: Obsessive fears about harm to self or others and overt aggressive behaviors in youth diagnosed with juvenile-onset bipolar disorder.
abstract: BACKGROUND
  Obsessive fear-of-harm, either fear of doing harm or fear of harm coming to self, may be closely associated with aggressive behaviors in juvenile-onset bipolar disorder.
  
  
  METHODS
  We analyzed parent-report data on the Yale-Brown Obsessive Compulsive Scale (YBOCS) and Overt Aggression Scale (OAS) for 1601 children/adolescents with a clinician-assigned diagnosis of bipolar disorder. The summing of 6 YBOCS items rated "often" or "very often or almost constant" yielded a biphasic distribution of scores. Median-split was used to define meaningful subgroups contrasting high vs. low "fear-of-harm", which were then compared on parent-reported severe injury to self and others and on parent-reported suicide threats.
  
  
  RESULTS
  High fear-of-harm was strongly associated with parent-reported severe injury to self and others. For self-injury, the estimated risk ratio for high vs. low fear-of-harm subgroups was 2.68 (95% confidence interval 1.87-3.86), indicating greater than doubling of risk associated with high fear-of-harm. For severe injury to others, the estimated risk ratio was 7.97 (95% confidence interval 4.19-15.2), suggesting a nearly eight-fold increased risk associated with high fear-of-harm. High fear-of-harm subjects were reported to make serious suicide threats much more frequently than low fear-of-harm subjects (odds ratio, estimated by ordinal logistic regression modeling methods, was 2.42 (95% CI 2.00 to 2.92; z=9.12, p<0.001).
  
  
  CONCLUSIONS
  Child report data was not obtained; clinician diagnosis was not validated via research interview.
  
  
  CONCLUSIONS
  Obsessive fears about harm to self or others in a sample of children with a clinician-assigned diagnosis of bipolar disorder were found to be positively related to increased behavioral aggression towards self and others, as well as to frequent suicide threats.
authors.affiliation: Juvenile Bipolar Research Foundation, 550 Ridgewood Rd., Maplewood, NJ 07040, United States. dpapolos@jbrf.org
authors.forename: Demitri
authors.initials: D
authors.lastname: Papolos
authors.forename: John
authors.initials: J
authors.lastname: Hennen
authors.forename: Melissa
authors.initials: M
authors.lastname: Cockerham
mesh_terms: D000293:Adolescent; D000328:Adult; D000374:Aggression / Q000523:psychology*; D001714:Bipolar Disorder / Q000175:diagnosis* / Q000523:psychology; D002648:Child; D002675:Child, Preschool; D003625:Data Collection / Q000706:statistics & numerical data; D003937:Diagnosis, Differential; D005239:Fear; D005260:Female; D006801:Humans; D020407:Internet; D008297:Male; D009770:Obsessive Behavior / Q000175:diagnosis / Q000523:psychology*; D010552:Personality Assessment / Q000706:statistics & numerical data; D016728:Self-Injurious Behavior / Q000523:psychology*