Psychogenic fever: how psychological stress affects body temperature in the clinical population (Oka 2015)

Woolie

Woolie

Senior Member
Not brand new, but I just came across it and had to share!!

https://www.tandfonline.com/doi/full/10.1080/23328940.2015.1056907

There was an idea banging about in the 1930s that fever can be "psychogenic" - in women of course - and it seems there are still advocates of this idea today. The author of this 2015 paper laments the fact that some physicians seem to be resistant to the idea:
Moreover, there are still physicians who do not recognize the fact that psychological stress can cause high (core body temperatures).
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He notes in this article that virtually all reported cases are females, particularly young females (the author is a Japanese male). And here is some of the evidence he presents. This is a temperature graph of one "obedient and good" schoolgirl (his words). You can see how her temperature goes up when she is at school:

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What was the terrible stressor at school that brought on these attacks? We get the idea that they did a lot of questioning to uncover this, and what they came up with was "some classmates teased and bullied a friend who had a physical handicap".

This case report will also make you smile - or cry:
... a 56-year-old head rheumatology nurse. She suffered from NSAIDs- and adrenocorticosteroid-resistant, low-grade (37–38°C) high Tc for more than 3 months. Her doctor, a rheumatologist, conducted thorough medical tests but could not discern any findings to account for her fever. For diagnostic purposes, the doctor asked her to take NSAIDs and corticosteroids, but they were ineffective in reducing her fever...Through a diagnostic interview, I realized that she was in a physically and psychologically demanding situation because of cumulative stressful life events at the time she noticed the low-grade high Tc in April. She had been working as a nurse for more than 30 years while at home taking care of her father with dementia in recent years. In January, she was shocked to hear that her younger sister was diagnosed with breast cancer. In March, one hospital nurse suddenly quit and the patient had to substitute for her and had to work an overnight duty as well.
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And what account of "psychogenic fever" would be complete without a mention of low grade fever in CFS?
a 24-year-old woman having both CFS and FMS... her Tc and fatigue scores were higher during working days compared to days off. As she was a telephone operator, ... the higher Tc may not be due to increased activity during the working day, but due to psychological strain.
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The article goes on to show that the woman's temperature also went up when she was asked to discuss her stressful life. Here is a graph showing how her temp was higher at work, and correlated dwell with her ratings of fatigue:

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And the cherry on top: we've got to think of a more palatable name for the poor dears:
Why not "Functional Hyperthermia"?
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I'm not completely sure what to think about this paper (apart from knowing for sure that I would not want to spend any time chatting to the author). I'm very doubtful about claims of stress directly causing illness. But I can see that stress might possibly raise temperature in humans. After all, we do have the phrase 'hot and bothered' for when someone is a bit stressed.

First, repeated exposure to uncontrollable stressors such as daily confrontation with a dominant rat at fixed time intervals induces anticipatory or learned hyperthermia, i.e., Tc becomes higher during the hour preceding the scheduled time of stress application or during the hour when animals have been exposed to dominant rats even if they are kept in their home cages without stress exposure.
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It looks as though animal experiments have shown that temperature does increase with stress and with anticipated stress. These should be easy experiments to do, without a lot of room for error or bias. Of course, a determined researcher could still skew the results though.

I can see that a raised temperature in response to stress could be useful - maybe making chemical reactions and nerve transmission faster so the animal is better prepared for fight or flight. Also perhaps a higher temperature might make the body better able to fight off infections resulting from proximity with unknown animals or from injuries.

As in laboratory animals, psychological stress increases the Tc in healthy humans. Previous studies have demonstrated that Tc just before emotional events is higher than Tc after these events or at the same hour of the day under non-stressful conditions. For example, the mean oral temperature before boxing contests (37.55°C) in 12 school boys (12–14 years old) was 0.8°C higher than that taken at home at the same hour of the day (36.75°C). The mean oral temperature on movie-watching days in separate groups of females in their teens and twenties (37.55°C and 37.46°C) was 0.53°C and 0.27°C higher than that of the same hour on preceding or following days (37.03°C and 37.19°C), respectively.

The mean oral temperature of 108 medical students (18 – 27 years old) immediately before examination (37.4°C) was 0.18°C higher than what was taken at the same hour of the day 3 days after the exam (37.22°C). The mean oral temperature of medical students (17 – 19 years old) 5 – 7 days before examination (36.91°C) was 0.17°C higher than that at the same time 5 – 7 days after the examination (36.74°C). In contrast, one study demonstrated that exposing healthy subjects to a standardized laboratory stress task (the Trier Social Stress Test) did not change temporal artery temperature and also decreased intestinal temperature, both of which are assumed to reflect Tc.
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The evidence for a temperature increase in response to stress in humans wasn't so convincing. It's likely that the boys were bouncing around practicing before their boxing contest, so they were probably quite hot from physical activity (it's called a warm-up after all). Movie-watching must be a competitive sport in young women in Japan, if movie-watching is an example of stress. More likely the physical activity of getting ready to go out and getting to the movie theatre is a bigger contribution. And exams, which you would think would be, on average, more stressful than going to the movies, don't seem to have much impact on temperature.

The thing is, if stress can cause a temperature increase in healthy mammals, then perhaps it isn't a big leap to think that stress might sometimes be a cause of 'functional fevers'?

I look forward to learning more from your comments.
 
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It is a well recognised phenomenon that women's temperature rises by about 1 degree in the second half of the menstrual cycle from ovulation onwards when there is a different balance of female hormones from the first half of the cycle. Sports people also get very hot after activity (I have seared on my brain the image of Andy Murray sitting in an ice bath holding up the Wimbledon Trophy). And of course infection triggers fever. It doesn't seem particularly odd to me that other factors such as an increase in stress hormones might raise temperature too.
 
Hutan said:
The thing is, if stress can cause a temperature increase in healthy mammals, then perhaps it isn't a big leap to think that stress might sometimes be a cause of 'functional fevers'?
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I think there are two problems. The first, and largest, is co-opting the literature to promote a strongly personally held view (the author is a specialist in "psychosomatic medicine"). The effect has been a cobbling together of studies, some that have clear alternative explanations (e.g., high activity levels), and others which are foregone conclusions because if you look hard enough, you will always find some "stress" in a person's life which can appear to account for their presenting symptoms.

I can't speak for whether the animal literature is solid or not, but I don't think a single human observation or study cited here provides any evidence to support the author's view. So I'm not holding out a lot of hope for the animal stuff.

The second more specific problem is confusing causation with modulation. The symptoms of lots of diseases can be influenced by emotions, especially ones that dramatically alter the autonomic nervous system (e.g., fear or anxiety). It doesn't mean that the illness was caused by psychological factors and that therapy can cure it. How's that going to go down anyway? Create a stress-free life - or assume the person is kind of messed up about their emotions and needs some sort of correction.
 
Trish said:
It is a well recognised phenomenon that women's temperature rises by about 1 degree in the second half of the menstrual cycle from ovulation onwards when there is a different balance of female hormones from the first half of the cycle. Sports people also get very hot after activity (I have seared on my brain the image of Andy Murray sitting in an ice bath holding up the Wimbledon Trophy). And of course infection triggers fever. It doesn't seem particularly odd to me that other factors such as an increase in stress hormones might raise temperature too.
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The people in the paper do seem to have something wrong with them. The high temperatures are pretty high and are periodic.
 
Woolie said:
I think there are two problems. The first, and largest, is co-opting the literature to promote a strongly personally held view (the author is a specialist in "psychosomatic medicine"). The effect has been a cobbling together of studies, some that have clear alternative explanations (e.g., high activity levels), and others which are foregone conclusions because if you look hard enough, you will always find some "stress" in a person's life which can appear to account for their presenting symptoms.
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Is there an experiment that can reliably induce fever through what can be reasonably called psychological stress?
 
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Trish said:
Just looking at those graphs again that @Woolie copied. The first one of the schoolgirl shows a very dramatic rise in temperature when she is at school. I can't help wondering whether there is some chemical in the classroom environment that is setting off an allergic reaction that triggers this in that particular child.
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If I was looking at the data the first thing I would want to do is collect additional data and look for correlations. For example activity measures, temperature in the room, I wonder if there are proxy measures that could be used for stress as well. Then look for correlation (including leading and lagging correlation).

Otherwise it is just an observation that can be speculated about,
 
Woolie said:
The people in the paper do seem to have something wrong with them. The high temperatures are pretty high and are periodic.
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My daughters temperature used to fluctuate quite quickly so when she felt worse it went up.

It does occur to me that if someone is getting an abnormal temperature rise when stressed then although it may look like stress causing it it isn't normal. So it suggest that a part of the body's control system is failing to respond properly and failing to keep temperature under control. This would bring us to a control system issue which exhibits itself when a stressor or shock is applied.
 
From the Annals of Psychological Medicine:

I must write of a most compelling case, brought to my doorstep by my good friend Arbuthnot just this month past. The patient presented with a strange lassitude, malaise and some manner of fever. A thorough investigation with sphygmomanometer and stethoscope, and a letting of blood for the purpose of regarding its colour, revealed no physical dysfunction whatever. Arbuthnot and I were perplexed. But then, possessed of a sudden inspiration, I bade the patient disrobe, whereupon the nature of the disease became clear. “Arbuthnot!" I cried. "I know what ails this creature. It is a female!” The mystery solved, I prescribed a period of confinement, some light housework (to be increased to its proper amount by degrees), and an absolute proscription against engaging in discussion of politics or matters of finance, which I understood the patient to have been lately attempting (quite overwhelming its small female brain). Further, I recommended the patient keep company with gentle ladies for an hour or two each week, and be encouraged to smile more and wear vestments more appropriate to her sex. Arbuthnot reports that the patient has scarcely complained since, and when glimpsed at an attic window was looking “most decorative”.

- Annals of Psychological Medicine, May 2018
 
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Woolie said:
The symptoms of lots of diseases can be influenced by emotions, especially ones that dramatically alter the autonomic nervous system (e.g., fear or anxiety). It doesn't mean that the illness was caused by psychological factors and that therapy can cure it. How's that going to go down anyway? Create a stress-free life - or assume the person is kind of messed up about their emotions and needs some sort of correction.
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My mother's CFS doc in the 1990s (who was firmly in the bio camp) told her to reduce all levels of stress in her life. "So shoot your husband and give up your kids," he added, and they both laughed themselves sick (pun totally intended).
 
FreeSarah said:
From the Annals of Psychological Medicine:

I must write of a most compelling case, brought to my doorstep by my good friend Arbuthnot just this month past. The patient presented with a strange lassitude, malaise and some manner of fever. A thorough investigation with sphygmomanometer and stethoscope, and a letting of blood for the purpose of regarding its colour, revealed no physical dysfunction whatever. Arbuthnot and I were perplexed. But then, possessed of a sudden inspiration, I bade the patient disrobe, whereupon the nature of the disease became clear. “Arbuthnot! I cried. I know what ails this creature. It is a female!” The mystery solved, I prescribed a period of confinement, some light housework (to be increased to its proper amount by degrees), and an absolute proscription against engaging in discussion of politics or matters of finance, which I understood the patient to have been lately attempting (quite overwhelming its small female brain). Further, I recommended the patient keep company with gentle ladies for an hour or two each week, and be encouraged to smile more and wear vestments more appropriate to her sex. Arbuthnot reports that the patient has scarcely complained since, and when glimpsed at an attic window was looking “most decorative”.

- Annals of Psychological Medicine, May 2018
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PUBLISH. IT.
 
Adrian said:
It does occur to me that if someone is getting an abnormal temperature rise when stressed then although it may look like stress causing it it isn't normal. So it suggest that a part of the body's control system is failing to respond properly and failing to keep temperature under control. This would bring us to a control system issue which exhibits itself when a stressor or shock is applied.
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Thanks @Adrian, yes, I think that's the answer to this paper.

It may well be that it's normal for there to be a small increase in temperature in response to some emotional stresses, just as there is to physical activity. It looks as though stress hormones can cause vasoconstriction, which reduces heat loss from the skin so body temperature rises.

But, if any stress (mental or physical) causes a big and abnormal increase in temperature and other symptoms as well, then it's not really the stress that's the problem (although perhaps reducing stress may be part of the answer). The key problem is some dysfunction of the body that prevents it from operating normally. And that is where the focus should be for investigations and treatment.

Waving away medical issues with a 'oh, she can't cope with stress, poor dear', is a cop out, an exhibition of prejudice and a lack of professional curiosity.
 
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