Department of Psychiatry, University of Campania "Luigi Vanvitelli", Naples, Italy.
Department of Psychiatry, University of Campania "Luigi Vanvitelli", Naples, Italy.
J Psychiatr Res. 2018 Sep;104:39-45. doi: 10.1016/j.jpsychires.2018.06.013. Epub 2018 Jun 19.
Exposure to trauma in the childhood and abnormal interpersonal stress reactivity are believed to contribute to the pathophysiology of anorexia nervosa (AN), which suggests a possible role of the hypothalamus-pituitary adrenal (HPA) axis. Although an effect of early traumatic experiences on the cortisol awakening response has been proved in patients with AN, the consequences of childhood trauma exposure on HPA axis reactivity to psychosocial stressors has been never investigated in such individuals. Therefore, we have assessed emotional and cortisol responses to an acute psycho-social stress in AN patients with a history of childhood trauma exposure. Twenty-four AN women and 17 healthy women were enrolled in the study. Patients were classified as maltreated (Mal) or non-maltreated (noMal) according to their Childhood Trauma Questionnaire scores. Participants underwent the Trier Social Stress Test (TSST) and their emotional responses were measured through the state scale of the State-Trait Anxiety Inventory. Saliva samples were collected to measure cortisol production. Compared to both healthy subjects and noMal AN patients, Mal AN women exhibited a blunted cortisol response to TSST. With respect to healthy controls, pre-TSST anxiety levels were enhanced in both AN groups; moreover, Mal AN patients displayed a reduced anxiety increase after TSST as compared to both noMal patients and healthy women. Our findings for the first time provide the evidence of deranged biological and emotional responses to an acute social stress in AN patients with childhood trauma exposure, corroborating the idea of a maltreated ecophenotype in AN as in other psychiatric disorders.
童年期创伤暴露和异常的人际应激反应被认为是导致神经性厌食症（AN）病理生理学的原因，这表明下丘脑-垂体-肾上腺（HPA）轴可能发挥作用。尽管已经证明 AN 患者的早期创伤经历会对皮质醇觉醒反应产生影响，但童年期创伤暴露对 HPA 轴对应激源的反应性的影响在这些个体中从未被研究过。因此，我们评估了有童年期创伤暴露史的 AN 患者对急性心理社会应激的情绪和皮质醇反应。研究纳入了 24 名 AN 女性和 17 名健康女性。根据童年创伤问卷评分，将患者分为受虐待（Mal）或未受虐待（noMal）。参与者接受了特里尔社会应激测试（TSST），并通过状态-特质焦虑量表测量他们的情绪反应。采集唾液样本以测量皮质醇的产生。与健康对照组和未受虐待的 AN 患者相比，受虐待的 AN 女性对 TSST 的皮质醇反应迟钝。与健康对照组相比，两组 AN 患者的 TSST 前焦虑水平均升高；此外，与未受虐待的 AN 患者和健康女性相比，受虐待的 AN 患者在 TSST 后焦虑水平的增加减少。我们的研究结果首次提供了证据，表明有童年期创伤暴露史的 AN 患者对急性社会应激的生物和情绪反应异常，这支持了在 AN 中存在受虐待表型的观点，就像在其他精神障碍中一样。
