Psychogenic fever: how psychological stress affects body temperature in the clinical population

Abstract

Psychogenic fever is a stress-related, psychosomatic disease especially seen in young women. Some patients develop extremely high core body temperature (Tc) (up to 41°C) when they are exposed to emotional events, whereas others show persistent low-grade high Tc (37–38°C) during situations of chronic stress. The mechanism for psychogenic fever is not yet fully understood. However, clinical case reports demonstrate that psychogenic fever is not attenuated by antipyretic drugs, but by psychotropic drugs that display anxiolytic and sedative properties, or by resolving patients' difficulties via natural means or psychotherapy. Animal studies have demonstrated that psychological stress increases Tc via mechanisms distinct from infectious fever (which requires proinflammatory mediators) and that the sympathetic nervous system, particularly β3-adrenoceptor-mediated non-shivering thermogenesis in brown adipose tissue, plays an important role in the development of psychological stress-induced hyperthermia. Acute psychological stress induces a transient, monophasic increase in Tc. In contrast, repeated stress induces anticipatory hyperthermia, reduces diurnal changes in Tc, or slightly increases Tc throughout the day. Chronically stressed animals also display an enhanced hyperthermic response to a novel stress, while past fearful experiences induce conditioned hyperthermia to the fear context. The high Tc that psychogenic fever patients develop may be a complex of these diverse kinds of hyperthermic responses.

Keywords:

• emotional fever
• fever of unknown origin
• psychogenic fever
• stress-induced hyperthermia
• stress
• human

Disclosure of Potential Conflicts of Interest

No potential conflicts of interest were disclosed.

Funding

This study was supported in part by a Grant-in-Aid for Scientific Research from the Japan Society for the Promotion of Science (number 23390189 to TO).

About the Author

Takakazu Oka is a physician specializing in psychosomatic medicine. He exclusively treats patients with psychosomatic diseases, i.e., physical diseases and conditions affected by psychosocial factors. One such disease is psychogenic fever. When he was a resident in psychosomatic medicine and internal medicine, he met some patients with fever of unknown causes that developed during highly stressful situations. In spite of repeated and thorough medical tests, abnormal findings were not detected and antipyretic drugs failed to attenuate their high body temperature. However, their high temperature was normalized after psychotherapy sessions. Since then, he has been conducting basic research on the mechanisms of psychogenic fever as well as seeing patients as a clinician.