Obsessive fears about harm to self or others and overt aggressive behaviors in youth diagnosed with juvenile-onset bipolar disorder.

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).

Limitations: 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.