Childhood trauma and cortisol awakening response in symptomatic patients with anorexia nervosa and bulimia nervosa

Int J Eat Disord. 2015 Sep;48(6):615-21. doi: 10.1002/eat.22375. Epub 2015 Mar 23.


Objective: Exposure to trauma during childhood is a risk factor for eating disorders (EDs) in adulthood. The biological mechanisms underlying such increased risk seem to involve the endogenous stress response system (i.e., the hypothalamic-pituitary-adrenal [HPA] axis), which undergoes trauma-induced functional changes that may persist later in life. In the present study, we examined the effects of childhood trauma experiences on HPA-axis activity, comparing saliva cortisol awakening response (CAR) in adult patients with anorexia nervosa (AN) or bulimia nervosa (BN) with CAR in adult healthy controls.

Method: Twenty-three patients with symptomatic AN, 21 patients with symptomatic BN, and 29 healthy women collected saliva samples at awakening and again after 15, 30, and 60 min. Participants also completed the Childhood Trauma Questionnaire and eating-related psychopathological rating scales.

Results: According to the Childhood Trauma Questionnaire, 13 individuals with AN and 12 individuals with BN, but none of the healthy women, reported childhood maltreatment. Compared with the control group, the non-maltreated AN patient group exhibited an enhanced CAR, whereas the group of non-maltreated BN patients showed a normal CAR. Moreover, both AN and BN patient groups with childhood maltreatment exhibited statistically significant blunting of CAR compared with non-maltreated groups.

Discussion: The present findings add to the evidence supporting the concept that there is a dysregulation of HPA-axis activity in symptomatic patients with EDs and suggest that childhood trauma exposure may contribute to such dysregulation.

MeSH terms

  • Adult
  • Anorexia Nervosa / metabolism*
  • Anorexia Nervosa / psychology
  • Bulimia Nervosa / metabolism*
  • Bulimia Nervosa / psychology
  • Case-Control Studies
  • Female
  • Humans
  • Hydrocortisone / metabolism*
  • Risk Factors
  • Surveys and Questionnaires
  • Trauma and Stressor Related Disorders / metabolism*
  • Trauma and Stressor Related Disorders / psychology
  • Young Adult


  • Hydrocortisone