Clinical Psychology & Neuropsychology, University of Konstanz, Germany.
Psychoneuroendocrinology. 2012 Feb;37(2):213-20. doi: 10.1016/j.psyneuen.2011.06.005. Epub 2011 Jul 1.
Studies investigating cortisol responses to trauma-related stressors in patients with posttraumatic stress disorder (PTSD) have yielded inconsistent results, demonstrating that cortisol responses were enhanced or unaffected when confronted with trauma reminders. This study investigated the effect of the type of trauma experienced on both salivary and plasma cortisol responses during confrontation with trauma-related material. Participants were 30 survivors of war and torture, with and without rape among the traumatic events experienced. Participants of both groups (raped vs. non-raped) fulfilled DSM-IV criteria of PTSD. Plasma and salivary cortisol levels were measured at three time points during a standardized clinical interview: once before and twice after assessing individual traumatic experiences. Results show that groups did not differ in basal plasma and salivary cortisol levels. However, differential salivary cortisol responses were observed in PTSD patients who had been raped compared to those who had not been raped (p<.05) but had experienced an equal number of traumatic events and showed equally high PTSD symptom severity. Whereas salivary cortisol levels decreased in the course of the interview for the group with no past experience of rape (p<.05), those PTSD patients who had been raped showed a significant cortisol increase when reminded of their traumatic events (p<.001). This effect was not found in plasma cortisol. Our results indicate that the type of traumatic stress experienced contributes to cortisol responses during the confrontation with trauma-related material. We hypothesize, that the nearness of the perpetrator during the traumatic event might shape later psychophysiological responding to trauma reminders.
研究表明，创伤后应激障碍（PTSD）患者在面对创伤相关应激源时，皮质醇反应存在不一致的结果，表现为皮质醇反应增强或不受影响。本研究旨在探讨经历的创伤类型对面对创伤相关材料时唾液和血浆皮质醇反应的影响。参与者为 30 名战争和酷刑幸存者，其中部分人经历过性暴力。两组参与者（经历过性暴力和未经历过性暴力）均符合 DSM-IV 创伤后应激障碍标准。在标准化临床访谈的三个时间点测量了参与者的血浆和唾液皮质醇水平：一次在评估个体创伤经历之前，两次在评估之后。结果表明，两组在基础血浆和唾液皮质醇水平上没有差异。然而，在经历过性暴力的 PTSD 患者中观察到了不同的唾液皮质醇反应，与未经历过性暴力的 PTSD 患者相比（p<.05），但他们经历了同样数量的创伤事件，且 PTSD 症状严重程度同样高。而在没有性暴力经历的组中，唾液皮质醇水平在访谈过程中下降（p<.05），而那些经历过性暴力的 PTSD 患者在回忆创伤事件时表现出显著的皮质醇增加（p<.001）。这种效应在血浆皮质醇中未发现。我们的结果表明，经历的创伤类型会影响面对创伤相关材料时的皮质醇反应。我们假设，创伤事件中施害者的接近程度可能会影响到对创伤提醒的后期心理生理反应。
