Fear of Harm FOH and Temperature

Question: Can you explain FOH’s third symptom, temperature dysregulation? How can you tell if someone has this?


Answer: There are 7 criteria that are used to help diagnose Fear of Harm. In this series we’re going to cover the first 5, which are all observable. In this installment we’ll look at the 3rd symptom, called “Thermoregulatory Disturbance”, which includes:

    • Experiences thermal discomfort (e.g., feeling hot, excessive sweating) in neutral ambient temperature environments
    • Little or no discomfort during exposure to moderate or extreme cold 
    • Alternates noticeably between being excessively hot in the evening and cold in the morning


Honestly, this may be the most important symptom on the criteria list because it’s a physical symptom that is objectively measurable. But, you’ve probably never been told that it could be related to a mental health condition. This symptom relates to the body’s inability to correctly regulate its temperature. It’s what’s called a “biological marker” and Fear of Harm is basically the only psychiatric disorder that has one.


The amazing thing about having a biological marker is that it means that you can target and treat a biological symptom. When that happens it helps to control the other, behavioral symptoms, and helps the person stabilize and manage their mood and behavior. 


So, what do thermoregulatory disturbances look like? Well the most noticeable might be that kids (and adults) with Fear of Harm often feel hot, and sweat, when the climate around them doesn’t call for it, like in normal room temperatures. These neutral ambient temperature environments don’t feel so neutral to those with Fear of Harm. Normally body temperatures dip at bedtime, to help induce sleep, and rise in the morning to facilitate waking. But with Fear of Harm people may go from feeling excessively hot in the evening to cold in the morning, disrupting not only body temperature, but sleep patterns as well.


Some other tell-tale signs of temperature dysregulation are:

    • Bright red ears, that are often warm or hot to the touch, as the body tries to get rid of excess heat that builds up in the core.
    • A refusal to wear weather appropriate clothes, for example wearing shorts in the winter, or refusing to wear a coat in freezing temperatures.
    • Experiencing little to no discomfort when exposed to the cold.

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