Frigophobia: a case series from Sri Lanka.

Frigophobia is a condition in which patients report coldness of extremities leading to a morbid fear of death. It has been reported as a rare culture-related psychiatric syndrome in Chinese populations. An extensive survey of the literature yielded only six case reports. The present paper describes a series of 109 patients with frigophobia in Sri Lanka. The common clinical presentation was of patients initially examining their extremities for cold sensations, and then, with the onset of fear, covering themselves in layers of clothing, applying emollients, and staying near an open fire in an effort to ward off the cold. They avoided foods considered to be "cooling" and bathed only in the heat of the noonday sun. When the severity of the symptoms reached a peak, or when they felt death was imminent, Western medical aid was sought. The fear of dying is seen as the single most important aspect that drives these individuals to seek help. There was a preponderance of female patients, and a few had specific phobias as comorbid conditions. Management comprised primarily illness education, reassurance, and desensitisation by exposure to cold stimuli, with short-term anxiolytic medication use when necessary.