Question: Why is Temperature So Important in the “FOH” Diagnosis?

 

Answer: The “Fear of Harm” (FOH) phenotype of bipolar disorder, currently referred to by researchers as Thermoregulatory Sleep Dysregulation Disorder, is revolutionary because it’s the first mental illness to have a biological symptom that can be used to identify and confirm the diagnosis. This biomarker is seen as a disruption in the body’s thermoregulation system. This means that the body can’t regulate its temperature properly, which leads to a bunch of different physical and psychiatric symptoms that are often mistaken for willful behaviors.  Some of these symptoms include sleep problems and intense and exaggerated fear and aggression.

 

The part of the brain that is supposed to control body temperature is related to the part of the brain that controls the triggering of the fight-flight-freeze response. “FOH’s” thermoregulatory disturbance confuses the fight-flight-freeze instinct, triggering it, and making the person feel like they are being threatened with danger even when there isn’t actually any danger in the environment. This results in those physical and emotional symptoms we mentioned earlier.

 

When the body’s can’t properly control its temperature it impacts sleep, resulting in a whole host of sleep disturbances including trouble falling asleep, staying asleep, and getting up in the morning.

 

Thermodysregulation also disrupts the transition between REM and non-REM sleep and results in what are called parasomnias such as nightmares, night terrors, sleep-walking, sleep-talking, and bedwetting. All of these parasomnias, especially the violent and gory nightmares cause significant ongoing trauma.

Researchers at the Juvenile Bipolar Research Foundation (JBRF) first identified this biomarker and have also uncovered ways to manage this temperature dysregulation to help reduce symptoms.

 

The most effective way to manage thermodysregulation is to keep environmental temperatures steady throughout the day. This is best done by avoiding significant temperature fluctuations in the environment which confuse the body’s already malfunctioning system. Some examples of problematic environmental temperature fluctuations include temperature high/low differentials of greater than 25 degrees F in a single day, average daily temperature differential greater than 25 degrees F from one day to the next, and temperature differentials between indoor and outdoor temperatures of 25 degrees F or more.

 

Essential treatment recommendations include staying indoors in that temperature controlled environment during extreme weather conditions such as temperatures above 90 degrees F and below 30 degrees F. They also include staying indoors in a temperature controlled environment during seasonal changes when outdoor temperatures can change dramatically from day-to-day or within the same day.

Additional techniques used to maintain a stable and body temperature include submerging the whole body in tepid water between 78-85 degrees F, using ceiling and standing fans, wearing cooling clothing, as well as regularly eating ice cold food and drinks.

For more information on:

• “FOH”, please visit our website’s “FOH” information page
• Cooling strategies, please view our educational video, “Mood Disorder First Aid: Managing Temperature Disruptions”
• Cooling tools recommended by CMHRC community families, please visit our website’s Recommended Products page*