Paradoxical Undressing Syndrome

Cold, real cold can result in physical problems, like hypothermia and frostbite. But the freezing cold can also play havoc with your brain. We have already reported on the Third Man Syndrome and the Arctic Hysteria Syndrome. But those are transient syndromes, the Paradoxical Undressing Syndrome is worse. It is deadly.

It is estimated that twenty to fifty percent of hypothermia deaths are associated with paradoxical undressing[1]. This typically occurs during moderate and severe hypothermia, as the person becomes disoriented, confused, and combative. They may begin discarding their clothing, which, in turn, increases the rate of heat loss.

One explanation for the effect is a cold-induced malfunction of the hypothalamus, the part of the brain that regulates body temperature. Another explanation is that the muscles contracting peripheral blood vessels become exhausted (known as a loss of vasomotor tone) and relax, leading to a sudden surge of blood (and heat) to the extremities, causing the person to feel overheated.

In the end, when death from hypothermia is imminent, another strange phenomenon occurs: Terminal Burrowing Behaviour[2]. It is an apparent self-protective behaviour, also known as the Hide-and-Die Syndrome. Like a dying cat that will search for an secluded place, the afflicted will enter small, enclosed spaces, such as underneath beds or behind wardrobes. Researchers suggest this is possibly an autonomous process of the brain stem, which is triggered in the final state of hypothermia and produces a primitive and burrowing-like behavior of protection. This happens mostly in cases where temperature drops slowly.

[1] Turk: Hyperthermia in Forensic Science, Medicine and Pathology - 2010
[2] Rothschild, Schneider V: Terminal burrowing behaviour: a phenomenon of lethal hypothermia in International Journal of Legal Medicine - 1995