Extreme Heat Tolerance and Cold Sensitivity: A Medical Inquiry

Health consultation: extreme constitution of being heat-sensitive and fear of cold air conditioning?

Hello Doctor, my condition is that I am more sensitive to cold compared to others, but I can tolerate heat well.
Additionally, I have a fear of air conditioning.
Here is my experience: My aversion to air conditioning began in middle school, where classmates often had the mindset of "if there's air conditioning, we should use it," leading to very strong cooling that made me uncomfortable.
This continued through high school and college, where I was forced to endure uncomfortable air conditioning.
My sensitivity to cold and preference for heat became noticeable around high school and has gradually intensified.
Currently, the most comfortable temperature for me is around 33 degrees Celsius, where I don't mind the temperature.
I start feeling cold at about 26 degrees Celsius, and even in summer, when it's 38 degrees Celsius, I can wear a thick jacket while biking; I feel hot but not uncomfortable.

Since college, being in air conditioning has caused me significant psychological and physiological stress, making me feel that my life is threatened.
In severe cases, I lose my composure, and I have experienced the following situations: incessantly muttering, "kill them, kill them, kill them..." (even though I have never intended to commit a crime) (this has happened at least five times), my mind going blank with only the thought of "I want to survive," and rushing out of the classroom the moment class ends (this happened once), crying and being unable to speak, even after leaving the air-conditioned room, I continued to be unable to speak for several minutes (this happened once).
I consulted at my school's health center, and the doctor suggested it might be a thyroid hormone secretion issue, but blood tests at a large hospital showed normal results, and the doctors there did not have a clear opinion on my condition.

I can distinguish whether the cold is from air conditioning or natural sources; while natural cold makes me uncomfortable, it does not lead to any negative thoughts.
My family and relatives do not have similar issues.
I am 166 cm tall, weigh 50 kg, and have a body fat percentage of about 11%.
I exercise frequently; in high school, I ran during physical education classes, and in college, I practiced kendo, which involves intense exercise twice a week for 2.5 hours, along with jogging with friends about 1.5 km weekly or biweekly.
I can accept my condition and even feel proud of it, but it causes significant inconvenience in most environments, such as schools and trains, which are air-conditioned.
Many people around me cannot understand my situation, and I fear that in the future, I will have to work in environments that pose a threat to me.
However, I am also afraid that if my condition is "cured," I will no longer be able to tolerate heat and will have to rely on air conditioning like everyone else during summer.

I would like to know what factors might be causing my condition, if there is a medical term for it, or if you could provide me with a certificate to inform others of my unique situation.
Additionally, what methods can assist me in coping with this condition?

Shirejun, 20~29 year old female. Ask Date: 2019/03/25

Dr. Chen Bozhang reply Family Medicine

Dear Thermophilic Bacteria,
Your letter mentions that for several years you have experienced an extreme sensitivity to cold and a fear of air conditioning.
Such experiences can indeed be very unpleasant and can lead to strong negative thoughts in air-conditioned environments.
Based on your description, you have sought medical attention and have had tests for thyroid and other endocrine functions, all of which were normal.
While you feel uncomfortable in naturally low temperatures, you do not have any negative thoughts in those situations.

It appears that your issue is not solely related to low temperatures or cold, but rather a fear of artificial air conditioning and cooling systems.
If your physiological response to air conditioning, such as whole-body shivering (a typical heat-producing reaction during hypothermia), is far less significant than the psychological feeling of panic and helplessness as if your life is threatened, it may indicate a specific phobia (an intense fear of a particular object or situation).
This is a type of anxiety disorder.

In this case, it is advisable to seek assistance from a psychologist or psychiatrist to clarify the root of your condition.
Typically, specific phobias can be related to innate predispositions or environmental factors, and with the support of a trusted mental health professional, there is a possibility for improvement.

I hope this response is helpful to you.
Sincerely,
Dr.
Chen Po-Chang
Department of Family Medicine
Keelung Hospital, Ministry of Health and Welfare

Reply Date: 2019/03/25

More Info

Your situation is indeed complex and multifaceted, involving both physiological and psychological components. The extreme heat tolerance and cold sensitivity you describe, along with your fear of air conditioning, suggest a unique response to environmental temperature that may not be fully understood in conventional medical terms.
From a physiological standpoint, your body seems to have an atypical thermoregulatory response. While most individuals have a relatively balanced response to temperature changes, your experience of feeling comfortable at higher temperatures (around 33 degrees Celsius) and discomfort at lower temperatures (starting around 26 degrees Celsius) indicates a potential alteration in your body's thermoreceptors or hypothalamic function. The hypothalamus is the part of the brain responsible for regulating body temperature, and any dysfunction here could lead to the symptoms you are experiencing.
Additionally, your description of the psychological responses to air conditioning—such as panic, irrational thoughts, and physical reactions—points towards a possible specific phobia or anxiety disorder. This condition could be classified under "specific phobia" in the DSM-5 (Diagnostic and Statistical Manual of Mental Disorders), where the fear is disproportionate to the actual threat posed by the cold environment. The fact that you can differentiate between natural cold and artificial cold suggests that your fear may be more related to the context and control over the environment rather than the temperature itself.

The absence of any identifiable endocrine issues, such as thyroid dysfunction, further complicates the picture. It is essential to consider that psychological factors, including past experiences and conditioning, can significantly influence how we perceive and react to environmental stimuli. Your history of discomfort with air conditioning during formative years may have contributed to the development of this fear.

To address your concerns, it may be beneficial to seek the help of a mental health professional who specializes in anxiety disorders or phobias. Cognitive-behavioral therapy (CBT) is often effective in treating specific phobias by gradually exposing individuals to the source of their fear in a controlled manner, helping them to develop coping strategies and reduce anxiety.
In terms of managing your physical symptoms, it would be wise to explore options that allow you to create a more comfortable environment for yourself. This could include using personal fans, wearing layers that you can adjust, or finding spaces that are less reliant on air conditioning. Additionally, discussing your condition with your future employers might help them understand your needs and create a more accommodating work environment.

As for documentation of your condition, while there may not be a specific medical diagnosis that encapsulates your experiences, a letter from a healthcare provider explaining your unique sensitivity to cold and your psychological response to air conditioning could help others understand your situation better. This documentation could be useful in educational or workplace settings where accommodations might be necessary.

In conclusion, your experiences reflect a combination of physiological and psychological factors that warrant further exploration. Engaging with both medical and mental health professionals can provide you with a comprehensive approach to managing your unique condition, allowing you to navigate environments that are typically uncomfortable for you while maintaining your health and well-being.

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