Most of us have played the game of “Am I sick, or am I stressed?” and used a fever as the referee to make any close calls. But according to research, “chronic stress” and “emotional events” can cause people to develop temperatures of up to 105 degrees Fahrenheit. And like Ben Affleck smoking in a mask, that’s inexplicably hot.
Fevers are usually the body’s way of burning off viruses and bacteria that cause infections and illness. But far less is known about a “psychogenic fever” — also known as “stress-related hyperthermia,” which researchers referred to in a recent study as “one of the most common psychosomatic diseases.” And yet, “in spite of numerous case reports on psychogenic fever, there are few epidemiological studies.” As such, most of what we know about psychogenic fevers comes out of Japan, where medical schools have specific clinical departments that study psychogenic medicine, or physical illnesses caused from psychological problems.
To that end, a Japanese review of 195 case studies revealed that women were slightly more likely to develop stress-related fevers. Interestingly, adolescents were more likely than other age groups to have higher fevers for these reasons, suggesting that hormones may play a role that requires further investigation. Adults were at a lower risk for dangerously high psychogenic fevers and typically hovered around the low-grade range of 100 degrees.
“In the literature, both acute and chronic stress can cause psychogenic fevers,” Osamu Imataki, a researcher from Kagawa University in Japan, writes via email. “However, the chronic condition is more problematic because it would lead to a long-lasting fever.”
Recently, Imataki co-authored another case study that followed a 46-year-old man, who despite testing negative for COVID with two PCR tests, was convinced they were both false negatives — mostly because he maintained a low-grade fever for a week. The patient was eventually treated with Ethyl loflazepate, a benzodiazepine derivative closer to Xanax than Tylenol, but the treatment was “highly effective,” Imataki concluded.
Additional studies suggest that anxiety medications and sedatives treat psychogenic fevers more effectively, whereas regular fevers respond more to drugs like aspirin and ibuprofen. If standard over-the-counter drugs don’t work, this may also be a good indicator that you have a stress fever, Imataki explains. Some other clues are that while inflammatory fevers from sickness usually spike out of nowhere, stress causes a continuous fever that’s more annoying than anything else. “Patients with psychogenic fever usually express irritation and frustration,” Imataki says.
As much as they may be understudied, Imataki is relatively certain that psychogenic fevers are rare and account for only about 1 percent of fevers overall. And again, the few cases that topped out at 105 degrees were among those between 10 and 15 years of age. That said, knowing that such fevers are even possible is still concerning, and they “can injure the patient’s brain, [via] seizure, epilepsy, encephalopathy or consciousness disturbance,” Imataki warns.
Not surprisingly, current research hasn’t looked at how longer-term solutions to stress — e.g., physical activity, meditation, therapy and improved time management — might help with psychogenic fevers. But if you’re consistently stressed about whether or not you’re sick and have a low-grade fever that Advil doesn’t help, it might be worth talking to a doctor about your mental health.
Moreover, perhaps stress should be treated like a foreign invader on par with bacteria or a virus so we start to prioritize protecting ourselves from it in the same way. Besides, if our bodies are already acting like that’s the case, we may as well listen.