Hot Temperatures Equal Hot Tempers?

Recently, a fellow trauma mama made a connection for me between the temperature outside and my child's behaviors. With more research, I realized that internal temperatures and emotional temperatures (did you know anxiety and anger can raise the body's internal temperature?) can have just as strong an affect on people's behaviors. 

I live in the South where outside temperatures can be over 100 degrees for months. I knew that certain medications can cause heat intolerance which can ruin a day of fun in the sun and have dangerous physical side effects (like heat exhaustion or heat strokes). 

What I did not realize was that higher temperatures can affect behaviors. Elevated behaviors like feeling irritable, depressed/aggressive (in children, depression often shows as anger), and miserable. 

Heat and Mental Health Issues

There's a reason we say we are "hot under the collar," "steamed," "boiling mad," when we are extremely angry and "don't sweat it" when we're trying to stay cool, calm, and collected. Temperature affects our feelings and behaviors, and even how we sleep.

"Extreme heat has significant impacts on mental health alongside serious physical health impacts. Some groups, including people with pre-existing mental health conditions, are especially vulnerable.

Extreme heat has been associated with a range of mental health impacts in research over many years, including increases in irritability and symptoms of depression and with an increase in suicide. It can also affect behavior, contributing to increased aggression, incidence of domestic violence, and increased use of alcohol or other substances to cope with stress.

Research has also linked high temperatures to problems with memory, attention and reaction time. Sleep difficulties associated with extreme heat can contribute to and further exacerbate mental health symptoms."

Several factors contribute to people with mental illness being especially vulnerable. People with schizophrenia can experience difficulties with body temperature regulation and changes in temperature can change symptoms of mood disorders. Some psychiatric medications, including some antidepressants and antipsychotics, can affect the way the body regulates temperature."

https://psychiatry.org/news-room/news-releases/extreme-heat-contributes-to-worsening-mental-healt

Heat and Stress/Anxiety  

Higher temperatures add to the existing stresses of daily life. This can increase the likelihood of risky behaviors, resulting in the increased rates of emergency room visits. 

“Increased temperatures can trigger anxiety and cause higher cortisol levels and palpitations, nausea, and fatigue. 

These symptoms can feel similar to a panic attack, which can make us more anxious when we notice them. Humidity can also cause symptoms of dizziness and dehydration..”

One study found that temperatures above 70 degrees Fahrenheit (21 degrees Celsius), decreased reports of positive emotions like joy or happiness, and increased reports of negative ones like stress or anger, when compared to average daily temperatures of 50 to 60 degrees Fahrenheit (10 to 16 degrees Celsius). 

Heat and Sleep

Heat also impacts our sleep. Researchers have found that increased nighttime temperature was associated with increased occurrences of self-reported insufficient sleep (insomnia). Extreme heat can affect your ability to fall asleep, stay asleep, and feel refreshed from sleep. 

Sleep deprivation can easily result in worsened mental health. The two have a bidirectional relationship that anyone can experience. Specifically, a lack of sleep can trigger the onset of certain conditions—and conversely, mental health conditions can worsen sleep problems. 

“A lack of sleep can impact our physical, mental, and emotional health,” says Sarah Bitar, marriage and family therapist. “With the disturbances of sleep come disturbances of all other connected systems of operation in the human body.”  This Is How Sleep Affects Your Mental Health

Seasonal Affective Disorder in Summer (i.e., Summer Anxiety): 

After long winters, most of us look forward to warmer days, more sunshine, and lots of opportunities to have fun. However, social gatherings, vacations, changes in routine, and physical responses to heat can make any pre-existing anxiety or depression worse. 

We’re used to hearing that Seasonal Affective Disorder (SAD) happens in winter months as a result of shorter days and less sunlight. About 4-6% of the U.S. population struggles with SAD.  Of this group, about 10% experience summer anxiety and depression. 

Summer Anxiety is a form of Seasonal Affective Disorder that happens during the summer. Experts believe that summer SAD may be due to too much sunlight. This throws off our circadian rhythm, our body’s natural sleep-wake cycle. As a result, people with summer SAD, struggle to sleep as much as they need to.  There’s also evidence that struggling with higher temperatures and humidity contributes to summer anxiety. ~Summertime Anxiety

Medications That Make People Vulnerable to Heat

A lot of the medications our kids take can affect the body's ability to regulate temperature, making the person more vulnerable to heat.

Many kids with trauma and mental illness issues take meds for anxiety, depression, insomnia, ADHD, bipolar disorder... It's common for these meds to be off-label prescriptions (this is a common practice for physicians, currently about 1 in 5 prescriptions are off-label) -- meds that were originally designed for things like high blood pressure, anti-seizure meds... meds that can cause heat intolerances:

1.  Blood pressure medications (Ex . Clonidine, which is often prescribed for anxiety)
2. Thiazide diuretics 
3. Beta-blockers (off-label prescribed for anxiety, migraines, reducing tremors)
4.  Antihistamines (off-label prescribed to treat anxiety on a short-term basis)
5. Decongestants
6. Overactive bladder treatments
7. Stimulant medications for ADHD (such as Adderall (amphetamine/dextroamphetamine) and Ritalin (methylphenidate). 
8. Psychiatric medications (Ex. Tricyclic antidepressants such as Elavil (amitriptyline) and Pamelor (nortriptyline), Antipsychotics such as Haldol (haloperidol) or Thorazine (chlorpromazine) Dopaminergics such as Sinemet (carbidopa/levodopa) 

https://www.singlecare.com/blog/medications-that-cause-heat-intolerance

High Body Temperatures (Psychogenic Fever/ Functional Hyperthermia)

Some patients develop extremely high core body temperature [fever] when they are exposed to emotional events, whereas others show persistent low-grade [fever] during situations of chronic stress. In addition to the emotional events that provoke negative affect such as anxiety, anger, or fear, other psychological stressors that induce remarkable hyperthermia [high body temperature] include separation from nurturing persons (emotional deprivation) and suppression of negative emotion. Stress interviews, i.e., recalling and talking about stressful life events, also increases [high body temperature].

Although some patients have no complaints except for the high [body temperature], others complain of numerous symptoms. These symptoms include insomnia, fatigue, headache, nausea, and/or abdominal pain. Some patients are neurotic and have high anxiety. Psychogenic fever is also observed in patients who have traumatic experiences in their early lives and with psychiatric disorders such as anxiety (panic and post-traumatic stress) disorders, mood (depressive and bipolar) disorders, somatoform (conversion) disorders, catatonia, and borderline personality disorders. For these reasons, they worry about their high [body temperature] and may consult their physicians asking for treatment.

This type of fever typically doesn’t respond to regular fever reducers. Instead, anxiety medications may offer relief. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4843908/

Tips to Stay Cool!

• Taking deep, slow breaths whenever you feel your anxiety rise can help slow down your heart rate and calm your body and mind. See more Relaxation and Calming Techniques.
• If you must go outside, stay in the shade and wear light-colored, loose fitting clothing. Avoid going outside during the hottest part of the day (between 11am and 3pm).
• Stay hydrated. Drinking lots of water can help ease symptoms of anxiety as well as physical symptoms of dehydration.
• Keep your extremities (hands, feet, and head) cool -  “Our hands and feet are equipped with vessels known as AVAs [arterio-venous anastomoses] that are especially effective at heat removal. Keep your hands and feet bare, and submerged in cold water. Tap water is sufficient, as that usually comes out around 68 degrees, but cooler temperatures are better. Just don’t make the water too icy; if extremities are too cold, blood vessels shrink to reduce blood flow, and that makes it actually makes it harder for your body to cool." ~ https://www.texasmonthly.com/news-politics/texas-heat-tips/ 
  Soak your feet in cold water for 10 minutes before going to bed, as heat is lost more quickly through your extremities (feet and head). Wetting your hair is another alternative. Wet your face and arms with a washcloth or towel, or use a water filled spray bottle, then stand in front of a fan. Apply wristbands soaked in cold water, as this will have the similar effect.
• Apply cool wet cloths, cold water or ice packs (armpits and groin for short periods) to the skin, as these areas are where your blood flows closest to the surface of your skin. This will help cool you down. Have a cool or lukewarm shower or bath just before going to bed. This cools the body directly and can help reduce the temperature of your skin.
• For people dealing with anxiety, it can be helpful to remind ourselves that our body isn’t necessarily in danger when we experience uncomfortable symptoms from the heat. Knowing that the heat amplifies symptoms of anxiety can help us to recognize and monitor symptoms that occur in hot weather. We can aim to recognize uncomfortable symptoms such as sweating or palpitations as our body’s natural reaction to the heat, rather than believing we are experiencing anxiety or a panic attack. It can also be helpful to find ways distract yourself from overthinking about these changes.
• Exploring the root cause of your anxiety can better help you manage its symptoms. A therapist can support you in this process. Finding a therapist who has experience treating anxiety can help you develop coping skills that may offer temporary and long-term relief.
• Set your thermostat to 65 degrees: Many experts agree that 65 degrees Fahrenheit (18.3 degrees Celsius) is the best temperature for sleep. While it might sound relatively cool, this thermostat setting helps your body maintain its natural core temperature for sleeping.

SUMMARY

If your body temperature can rise when it's hot outside, when you take certain medications, and/or when you are stressed (and our kids with trauma and mental illnesses are often stressed). How likely is it that this could be a large contributor to a child feeling irritable, aggressive (in children, depression often shows as anger), and miserable?

It's definitely something to consider.

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Kitty keeps her home's thermostat set at 66 degrees and drops it to 62 at night (because the only way she can sleep at night is snuggled up in her blankets with her pets. She says that when she gets too hot most extreme, sweat dripping on her face, her skin becomes itchy, and has violent screaming outbursts. Mildest is slight irritability. The longer she's uncomfortable the more intense it becomes, from mild impatience to screaming, "Get out of my f-ing face!"  it's any higher she feels irritable and I will admit that until I started researching this, I dismissed her explanations as being thoughtless, entitled, exaggerated, and wasteful she was being childish, ridiculous, and annoying.