STRANDED on a freezing mountainside, wouldn鈥檛 you welcome a rescuer鈥檚 thermal blanket? Perhaps not. Your first instinct might be to throw it aside, and you might even have removed some of your own clothing before the rescue team got to you. Paradoxical undressing certainly lives up to its name.
鈥淵our first instinct might be to throw a rescuer鈥檚 thermal blanket aside鈥�
Between 20 and 50 per cent of deaths from hypothermia involve paradoxical undressing of some kind. Mountain rescuers are trained to expect it, and the spell of severe cold weather in North America earlier this year produced a handful of well-publicised cases.
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The cause is not known for sure; it is, after all, paradoxical. One explanation is that it is the result of the fine blood vessels near the surface of the skin reacting to cold by contracting. This limits heat loss and diverts blood to the vital organs.
Eventually, the theory goes, muscles keeping the vessels contracted become exhausted. Blood rushes into the skin, producing a deep flush and a sensation of being too hot. Shedding a layer or two of clothing suddenly seems like a good idea. The clouded judgement that comes with hypothermia makes it unlikely that a person will see the paradox of their undressing.
Another theory points the finger at the brain, suggesting that the almond-sized hypothalamus that functions as our thermostat gets dangerously confused. Either way, once someone has removed their clothes, the hypothermia gets worse 鈥� and faster. Another bizarre behaviour can occur in which the victim desperately tries to tunnel into his or her surroundings. Hide-and-die syndrome, also known as terminal burrowing behaviour, is the reason that people are found dead behind wardrobes, under beds or on shelves.
Once again, the exact mechanism behind the behaviour is unknown, not least because hypothermia is an area of physiology that does not allow for ethical experiment. Hide-and-die syndrome seems to be a remnant of a deep instinct seen in most animals, from cats to cockroaches. When things get really bad, find somewhere to hide. Perhaps it is also behind our occasional desire to 鈥渃url up and die鈥�.
Paradoxical undressing and terminal burrowing behaviour in combination can produce mysteries worthy of Edgar Allan Poe. In one case described in 2001 in The Medical Journal of Australia (vol 175, p 621) an elderly man was found dead at home in winter. He was only partly dressed, bruised on his head and limbs, and surrounded by upturned furniture. His house was locked from the inside.
The police suspected a struggle with an attacker, but an autopsy revealed the telltale stomach lesions that indicate hypothermia. The temperature had been below 15 掳C and the house鈥檚 heating was not working. A tragedy, but more believable than an attacker who had walked through walls and left no trace.
