Treatment-Resistant Blunted HPA Activity, but Reversible Cardiovascular Stress Reactivity in Young Women With Eating Disorders.

Previous research has provided evidence for a reduced neuroendocrine stress response in women with eating disorders (EDs). In the present study female in-patients with Anorexia and Bulimia nervosa were compared to female healthy controls (HC) before and after completing an in-patient treatment program. Salivary cortisol, alpha-amylase (sAA), heart rate response (HR), high-frequency heart rate variability (HF-HRV) and negative affective state were measured before, during and after exposure to the Trier Social Stress Test (TSST) at pre- and post-treatment. Patients with EDs (n = 13) showed significantly less ED symptoms at post-treatment. Compared to HC (n = 22), patients displayed a blunted cortisol stress response combined with overall attenuated sAA levels at pre-treatment. At post-treatment, the blunted cortisol stress response was still observable, while the differences in sAA responses disappeared. HR was attenuated at pre-treatment in patients, also indicated by a stronger HF-HRV throughout the TSST. These cardiovascular differences disappeared at post-treatment. Patients reported in general (pre- and post-treatment) more negative affect compared to HC. This study provides further evidences of a hypo-reactive hypothalamus-pituitary-adrenal axis (HPA) in patients with EDs which persists even after symptom recovery while initial low cardiovascular stress reactivity apparently can be restored by psychotherapy. Given the small sample size the findings have to be considered preliminary.

Blunted neuroendocrine stress reactivity in young women with eating disorders.

OBJECTIVE: Stress is known to influence risk and progression of eating disorders (EDs). However, studies investigating physiological and psychological stress responses under laboratory conditions in patients with Anorexia nervosa or Bulimia nervosa are scarce and often produce conflicting findings. We therefore aimed to compare the neuroendocrine and affective stress response in ED inpatients and healthy controls. METHODS: Twenty-eight female inpatients with Anorexia or Bulimia nervosa and 26 healthy women were exposed to the Trier Social Stress Test (TSST). Salivary cortisol and alpha-amylase (sAA) levels were assessed before as well as repeatedly after stress exposure, while heart rate and heart rate variability were determined before and during the TSST. Negative affective state was assessed at baseline and post-TSST. RESULTS: Compared to healthy controls, ED patients showed blunted cortisol stress responses combined with overall attenuated sAA levels. The latter was reflected in generally enhanced parasympathetic activity indicated by lower heart rate and stronger high-frequency heart rate variability throughout the TSST. Although patients reported more negative affect overall, they did not differ in their affective stress response. CONCLUSIONS: In summary, patients suffering from eating disorders show a blunted HPA axis reactivity to stress exposure and a generally reduced sympathetic/exaggerated parasympathetic nervous system activity. This combination may contribute to elevated health risks seen in eating disorder patients, such as enhanced inflammatory activity, and thus provide insight into the underlying stress-related mechanisms.

Emotion regulation: exploring the impact of stress and sex.

Emotion regulation is a major prerequisite for adaptive behavior. The capacity to regulate emotions is particularly important during and after the encounter of a stressor. However, the impact of acute stress and its associated neuroendocrine alterations on emotion regulation have received little attention so far. This study aimed to explore how stress-induced cortisol increases affect three different emotion regulation strategies. Seventy two healthy men and women were either exposed to a stressor or a control condition. Subsequently participants viewed positive and negative images and were asked to up- or down-regulate their emotional responses or simultaneously required to solve an arithmetic task (distraction). The factors stress, sex, and strategy were operationalized as between group factors (n = 6 per cell). Stress caused an increase in blood pressure and higher subjective stress ratings. An increase in cortisol was observed in male participants only. In contrast to controls, stressed participants were less effective in distracting themselves from the emotional pictures. The results further suggest that in women stress enhances the ability to decrease negative emotions. These findings characterize the impact of stress and sex on emotion regulation and provide initial evidence that these factors may interact.

Writing about life goals: effects on rumination, mood and the cortisol awakening response.

Rumination is a vulnerability factor for the onset and maintenance of emotional distress. This study examined whether writing about life goals is associated with a decrease in ruminative thinking and a reduced cortisol awakening response. 68 healthy participants either wrote about their personal life goals or a control topic. Writing about life goals was associated with a modest decrease in ruminative thinking and a reduced cortisol awakening response at the post-intervention assessment. Results provide initial evidence that writing about life goals can be a helpful aid in decreasing rumination and physiological stress reactivity.

Influence of violent video gaming on determinants of the acquired capability for suicide.

The interpersonal theory of suicidal behavior proposes that fearlessness of death and physical pain insensitivity is a necessary requisite for self-inflicted lethal self-harm. Repeated experiences with painful and provocative events are supposed to cause an incremental increase in acquired capability. The present study examined whether playing a first-person shooter-game in contrast to a first-person racing game increases pain tolerance, a dimension of the acquired capability construct, and risk-taking behavior, a risk factor for developing acquired capability. N=81 male participants were randomly assigned to either play an action-shooter or a racing game before engaging in a game on risk-taking behavior and performing a cold pressor task (CPT). Participants exhibited higher pain tolerance after playing an action shooter game than after playing a racing game. Furthermore, playing an action shooter was generally associated with heightened risk-taking behavior. Group-differences were not attributable to the effects of the different types of games on self-reported mood and arousal. Overall these results indicate that action-shooter gaming alters pain tolerance and risk-taking behavior. Therefore, it may well be that long-term consumption of violent video games increases a person's capability to enact lethal self-harm.

Stress-induced cortisol level elevations are associated with reduced negative affect after stress: indications for a mood-buffering cortisol effect.

OBJECTIVE: Stress is associated with increased negative affect and activation of the sympathetic nervous system and of the hypothalamic-pituitary-adrenal axis. However, the relationship between these stress systems and negative affect is incompletely understood. We therefore investigated positive and negative affects in relationship with salivary cortisol and salivary α-amylase (sAA) levels in a large sample of participants exposed to a psychosocial stressor or a control condition. METHODS: Cortisol and sAA levels from five studies with a total sample size of 232 participants were reanalyzed using hierarchical linear modeling. In these studies, we measured affective responses to the Trier Social Stress Test (TSST) and its control condition (placebo TSST) with the Positive and Negative Affect Schedule. RESULTS: An inverse relationship between cortisol and negative affect was observed across all participants (ß(06) = -0.13, p = .002). Higher level of negative affect was associated with lower mean cortisol levels 10 minutes after the TSST or the control condition. When the two conditions were tested separately, the effect was significant in the stress condition (ß(06) = -0.05, p = .02) but not in the control condition (ß(06) = -0.0008, p > .05). In contrast to the results for cortisol, a positive relationship was found between sAA and negative affect within the stress condition (ß(06) = 0.10, p = .005). CONCLUSIONS: The present findings suggest that cortisol is associated with an attenuated negative emotional arousal in response to acute stress, whereas sAA levels seem to reflect the degree of negative emotional arousal. Together with previous pharmacological studies, these data seem to support the hypothesis of mood-buffering effects of cortisol.

Mood changes in response to psychosocial stress in healthy young women: effects of pretreatment with cortisol.

Effects of cortisol on human mood during stress situations are still incompletely understood, although this topic has important clinical implications. In this experiment, the mood of 44 healthy young women (all oral contraceptive users) was examined. A double-blind, randomized, placebo-controlled time series paradigm was used. Subjects were treated with either 30-mg cortisol or placebo orally. Forty-five minutes later, subjects attended a psychosocial stress procedure (Trier Social Stress Test; TSST; C. Kirschbaum, K. M. Pirke, & D. H. Hellhammer, 1993). The course of the subjects' mood as well as salivary cortisol and alpha-amylase levels were measured before and after the TSST. With regard to mood, it was found that the groups did not differ in mood before the TSST. After stress exposure, the subjective ratings of current mood state of cortisol-treated women were significantly less negative than that of placebo-treated subjects. These findings show that raising cortisol levels prior to acute stress has a protective effect on mood during stress situations. Results are discussed with regard to the context of specific adaptive effects of cortisol and the role of cortisol in posttraumatic stress disorder.