Hostname: page-component-848d4c4894-sjtt6 Total loading time: 0 Render date: 2024-07-02T17:34:18.211Z Has data issue: false hasContentIssue false
  • English
  • Français

Impaired cortisol awakening response in eating disorder women with childhood trauma exposure: evidence for a dose-dependent effect of the traumatic load

Published online by Cambridge University Press:  29 August 2017

A. M. Monteleone ,
P. Monteleone ,
U. Volpe ,
F. De Riso ,
G. Fico ,
R. Giugliano ,
M. Nigro  and
M. Maj
A. M. Monteleone
Affiliation:
Department of Psychiatry, University of Naples SUN, Naples, Italy
P. Monteleone*
Affiliation:
Department of Psychiatry, University of Naples SUN, Naples, Italy Department of Medicine, Surgery and Dentistry ‘Scuola Medica Salernitana’, Section of Neurosciences, University of Salerno, Salerno, Italy
U. Volpe
Affiliation:
Department of Psychiatry, University of Naples SUN, Naples, Italy
F. De Riso
Affiliation:
Department of Psychiatry, University of Naples SUN, Naples, Italy
G. Fico
Affiliation:
Department of Psychiatry, University of Naples SUN, Naples, Italy
R. Giugliano
Affiliation:
Department of Psychiatry, University of Naples SUN, Naples, Italy
M. Nigro
Affiliation:
Department of Psychiatry, University of Naples SUN, Naples, Italy
M. Maj
Affiliation:
Department of Psychiatry, University of Naples SUN, Naples, Italy
*
*Address for correspondence: P. Monteleone, M.D., Department of Medicine, Surgery and Dentristy ‘Scuola Medica Salernitana’, Section of Neurosciences, University of Salerno, Via Allende, Baronissi, Salerno 80049, Italy. (Email: monteri@tin.it)
Get access Rights & Permissions [Opens in a new window]

Abstract

Background

Childhood trauma is a non specific risk factor for adult eating disorders (ED), and the hypothalamic-pituitary-adrenal (HPA) axis seems to mediate such a risk. Here we explored the impact of different types of childhood trauma and of traumatic load on the cortisol awakening response (CAR) of women with anorexia nervosa (AN) or bulimia nervosa (BN).

Methods

Saliva samples were collected at awakening and after 15, 30, 60 min to measure cortisol levels by 121 women (44 AN patients, 36 BN patients and 41 healthy women). Participants filled in the Childhood Trauma Questionnaire.

Results

AN and BN patients with childhood maltreatment exhibited an attenuated CAR compared with non-maltreated ones. In the whole ED patient group, the CAR showed a progressive impairment with the increasing number of reported trauma types. Although significant negative correlations emerged between the type or the number of traumas and the CAR, only the number of traumas remained significantly associated with the CAR in a stepwise multiple regression analysis.

Conclusions

Present findings confirm that childhood trauma is associated with an impaired CAR in adult AN and BN patients and demonstrate for the first time a negative dose-dependent effect of the traumatic load on HPA axis activity.

Keywords

Anorexia nervosabulimia nervosacortisoleating disorderstrauma
Type
Original Articles
Information
Psychological Medicine , Volume 48 , Issue 6 , April 2018 , pp. 952 - 960
Copyright
Copyright © Cambridge University Press 2017 

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Bender, R, Lange, S (2001). Adjusting for multiple testing – -when and how? Journal of Clinical Epidemiology 54, 343–349.Google Scholar
Bernstein, DP, Stein, JA, Newcomb, MD, Walker, E, Pogge, D, Ahluvalia, T, Stokes, J, Handelsman, L, Medrano, M, Desmond, D, Zule, W (2003). Development and validation of a brief screening version of the Childhood Trauma Questionnaire. Child Abuse and Neglect 27, 169–190.CrossRefGoogle ScholarPubMed
Bremner, JD, Vythilingam, M, Anderson, G, Vermetten, E, McGlashan, T, Heninger, G, Rasmusson, A, Southwick, SM, Charney, DS (2003). Assessment of the hypothalamic-pituitary-adrenal axis over a 24-hour diurnal period and in response to neuroendocrine challenges in women with and without childhood sexual abuse and posttraumatic stress disorder. Biological Psychiatry 54, 710–718.Google Scholar
Caslini, M, Bartoli, F, Crocamo, C, Dakanalis, A, Clerici, M, Carrà, G (2016). Disentangling the association between child abuse and eating disorders: a systematic review and meta-analysis. Psychosomatic Medicine 78, 79–90.Google Scholar
Chapman, DP, Dube, SR, Anda, RF (2007). Adverse childhood events as risk factors for negative mental health outcomes. Psychiatric Annals 37, 359–364.Google Scholar
Cicchetti, D, Rogosch, FA (2001). Diverse patterns of neuroendocrine activity in maltreated children. Developmental Psychopathology 13, 677–693.Google Scholar
Díaz-Marsá, M, Carrasco, JL, Basurte, E, Pastrana, JI, Sáiz-Ruiz, J, López-Ibor, JJ (2007). Findings with 0.25 mg dexamethasone suppression test in eating disorders: association with childhood trauma. CNS Spectrums 12, 675–680.CrossRefGoogle ScholarPubMed
Dixon, J (1985). BMDP Statistical Software. University of California Press: Berkeley, CA.Google Scholar
Dube, SR, Felitti, VJ, Dong, M, Giles, WH, Anda, RF (2003). The impact of adverse childhood experiences on health problems: evidence from four birth cohorts dating back to 1900. Preventive Medicine 37, 268–277.CrossRefGoogle ScholarPubMed
Elzinga, BM, Roelofs, K, Tollenaar, MS, Bakvis, P, van Pelt, J, Spinhoven, P (2008). Diminished cortisol responses to psychosocial stress associated with lifetime adverse events a study among healthy young subjects. Psychoneuroendocrinology 33, 227–237.CrossRefGoogle ScholarPubMed
Fekedulegn, DB, Andrew, ME, Burchfiel, CM, Violanti, JM, Hartley, TA, Charles, LE, Miller, DB (2007). Area under the curve and other summary indicators of repeated waking cortisol measurements. Psychosomatic Medicine 69, 651–659.Google Scholar
First, MB, Gibbon, M, Spitzer, RL, Williams, JBW (1996). Structured Clinical Interview for Axis I DSM-IV Disorders-Non-Patient Ed – (SCID-I/NP, Version 2.0). New York State Psychiatric Institute, Biometrics Research Department: New York.Google Scholar
First, MB, Spitzer, RL, Gibbon, M, Williams, JB (1995). Structured Clinical Interview for DSM-IV Axis I Disorders – Patient Ed. (SCID-I/P, Version 2). New York State Psychiatric Institute, Biometrics Research Department: New York.Google Scholar
Föcker, M, Stalder, T, Kirschbaum, C, Albrecht, M, Adams, F, de Zwaan, M, Hebebrand, J, Peters, T, Albayrak, Ö (2016). Hair cortisol concentrations in adolescent girls with anorexia nervosa are lower compared to healthy and psychiatric controls. European Eating Disorders Review 24, 531–535.Google Scholar
Gustafsson, PE, Anckarsäter, H, Lichtenstein, P, Nelson, N, Gustafsson, PA (2010). Does quantity have a quality all its own? Cumulative adversity and up- and down-regulation of circadian salivary cortisol levels in healthy children. Psychoneuroendocrinology 35, 1410–1415.Google Scholar
Heim, C, Newport, DJ, Mletzko, T, Miller, AH, Nemeroff, CB (2008). The link between childhood trauma and depression: insights from HPA axis studies in humans. Psychoneuroendocrinology 33, 693–710.Google Scholar
Houtepen, LC, Vinkers, CH, Carrillo-Roa, T, Hiemstra, M, van Lier, PA, Meeus, W, Branje, S, Heim, CM, Nemeroff, CB, Mill, J, Schalkwyk, LC, Creyghton, MP, Kahn, RS, Joëls, M, Binder, EB, Boks, MP (2016). Genome-wide DNA methylation levels and altered cortisol stress reactivity following childhood trauma in humans. Nature Communication 7, 10967.Google Scholar
Ivanov, I, Yehuda, R, Greenblatt, E, Davidow, J, Makotkine, I, Alfi, L, Newcorn, JH (2011). The effect of trauma on stress reactivity in aggressive youth. Psychiatry Research 189, 396–402.Google Scholar
Johnson, DM, Delahanty, DL, Pinna, K (2008). The cortisol awakening response as a function of PTSD severity and abuse chronicity in sheltered battered women. Journal of Anxiety Disorders 22, 793–800.CrossRefGoogle ScholarPubMed
Kessler, RC, McLaughlin, KA, Green, JG, Gruber, MJ, Sampson, NA, Zaslavsky, AM, Aguilar-Gaxiola, S, Alhamzawi, AO, Alonso, J, Angermeyer, M, Benjet, C, Bromet, E, Chatterji, S, de Girolamo, G, Demyttenaere, K, Fayyad, J, Florescu, S, Gal, G, Gureje, O, Haro, JM, Hu, CY, Karam, EG, Kawakami, N, Lee, S, Lépine, JP, Ormel, J, Posada-Villa, J, Sagar, R, Tsang, A, Ustün, TB, Vassilev, S, Viana, MC, Williams, DR (2010). Childhood adversities and adult psychopathology in the WHO World Mental Health Surveys. British Journal of Psychiatry 197, 378–385.Google Scholar
Kuhlman, KR, Geiss, EG, Vargas, I, Lopez-Duran, NL (2015). Differential associations between childhood trauma subtypes and adolescent HPA-axis functioning. Psychoneuroendocrinology 54, 103–114.CrossRefGoogle ScholarPubMed
Lo Sauro, C, Ravaldi, C, Cabras, PL, Faravelli, C, Ricca, V (2008). Stress, hypothalamic-pituitary-adrenal axis and eating disorders. Neuropsychobiology 57, 95–115.Google Scholar
MacMillan, HL, Georgiades, K, Duku, EK, Shea, A, Steiner, M, Niec, A, Tanaka, M, Gensey, S, Spree, S, Vella, E, Walsh, CA, De Bellis, MD, Van der Meulen, J, Boyle, MH, Schmidt, LA (2009). Cortisol response to stress in female youths exposed to childhood maltreatment: results of the youth mood project. Biological Psychiatry 66, 62–68.CrossRefGoogle ScholarPubMed
Mangold, D, Wand, G, Javors, M, Mintz, J (2010). Acculturation childhood trauma and the cortisol awakening response in Mexican-American adults. Hormones and Behavior 58, 637–646.Google Scholar
Meinlschmidt, G, Heim, C (2005). Decreased cortisol awakening response after early loss experience. Psychoneuroendocrinology 30, 568–576.Google Scholar
Michels, N, Sioen, I, Huybrechts, I, Bammann, K, Vanaelst, B, De Vriendt, T, Iacoviello, L, Konstabel, K, Ahrens, W, De Henauw, S (2012). Negative life events, emotions and psychological difficulties as determinants of salivary cortisol in Belgian primary school children. Psychoneuroendocrinology 37, 1506–1515.Google Scholar
Monteleone, AM, Monteleone, P, Marciello, F, Pellegrino, F, Castellini, G, Maj, M (2017). Differences in cortisol awakening response between binge-purging and restrictive patients with anorexia nervosa. European Eating Disorders Review 25, 13–18.CrossRefGoogle ScholarPubMed
Monteleone, AM, Monteleone, P, Serino, I, Amodio, R, Monaco, F, Maj, M (2016). Underweight subjects with anorexia nervosa have an enhanced salivary cortisol response not seen in weight restored subjects with anorexia nervosa. Psychoneuroendocrinology 70, 118–121.Google Scholar
Monteleone, AM, Monteleone, P, Serino, I, Scognamiglio, P, Di Genio, M, Maj, M (2015). Childhood trauma and cortisol awakening response in symptomatic patients with anorexia nervosa and bulimia nervosa. International Journal of Eating Disorders 48, 615–621.Google Scholar
Monteleone, P, Scognamiglio, P, Monteleone, AM, Perillo, D, Maj, M (2014). Cortisol awakening response in patients with anorexia nervosa or bulimia nervosa: relationships to sensitivity to reward and sensitivity to punishment. Psychological Medicine 44, 2653–2660.Google Scholar
Ouellet-Morin, I, Odgers, CL, Danese, A, Bowes, L, Shakoor, S, Papadopoulos, AS, Caspi, A, Moffitt, TE, Arseneault, L (2011). Blunted cortisol responses to stress signal social and behavioral problems among maltreated/bullied 12-year-old children. Biological Psychiatry 70, 1016–1023.Google Scholar
Peckins, MK, Dockray, S, Eckenrode, JL, Heaton, J, Susman, EJ (2012). The longitudinal impact of exposure to violence on cortisol reactivity in adolescents. Journal of Adolescent Health 51, 366–372.Google Scholar
Schalinski, I, Elbert, T, Steudte-Schmiedgen, S, Kirschbaum, C (2015). The cortisol paradox of trauma-related disorders: lower phasic responses but higher tonic levels of cortisol are associated with sexual abuse in childhood. PLoS ONE 10, e0136921.Google Scholar
Stalder, T, Kirschbaum, C, Kudielka, BM, Adam, EK, Pruessner, JC, Wüst, S, Dockray, S, Smyth, N, Evans, P, Hellhammer, DH, Miller, R, Wetherell, MA, Lupien, SJ, Clow, A (2016). Assessment of the cortisol awakening response: expert consensus guidelines. Psychoneuroendocrinology 63, 414–432.CrossRefGoogle ScholarPubMed
Steiger, H, Gauvin, L, Israël, M, Koerner, N, Ng Ying Kin, NM, Paris, J, Young, SN (2001). Association of serotonin and cortisol indices with childhood abuse in bulimia nervosa. Archives of General Psychiatry 58, 837–843.CrossRefGoogle ScholarPubMed
Steudte, S, Kirschbaum, C, Gao, W, Alexander, N, Schönfeld, S, Hoyer, J, Stalder, T (2013). Hair cortisol as a biomarker of traumatization in healthy individuals and posttraumatic stress disorder patients. Biological Psychiatry 74, 639–646.Google Scholar
Steudte, S, Kolassa, IT, Stalder, T, Pfeiffer, A, Kirschbaum, C, Elbert, T (2011). Increased cortisol concentrations in hair of severely traumatized Ugandan individuals with PTSD. Psychoneuroendocrinology 36, 1193–1200.CrossRefGoogle ScholarPubMed
Steudte-Schmiedgen, S, Stalder, T, Schönfeld, S, Wittchen, HU, Trautmann, S, Alexander, N, Miller, R, Kirschbaum, C (2015). Hair cortisol concentrations and cortisolstress reactivity predict PTSD symptom increase after trauma exposure during military deployment. Psychoneuroendocrinology 59, 123–133.Google Scholar
Trickett, PK, Gordis, E, Peckins, MK, Susman, EJ (2014). Stress reactivity in maltreated and comparison male and female young adolescents. Child Maltreatment 19, 27–37.Google Scholar
Walker, EA, Gelfand, A, Katon, WJ, Koss, MP, Von Korff, M, Bernstein, D, Russo, J (1999). Adult health status of women with histories of childhood abuse and neglect. American Journal of Medicine 107, 332–339.Google Scholar
Witteveen, AB, Huizink, AC, Slottje, P, Bramsen, I, Smid, T, van der Ploeg, HM (2010). Associations of cortisol with posttraumatic stress symptoms and negative life events: a study of police officers and firefighters. Psychoneuroendocrinology 35, 1113–1118.Google Scholar