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

Serkan Het; Silja Vocks; Jutta M Wolf; Stephan Herpertz; Oliver T Wolf

doi:10.3389/fpsyt.2020.00726

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

Front Psychiatry. 2020 Jul 22:11:726. doi: 10.3389/fpsyt.2020.00726. eCollection 2020.

Authors

Serkan Het¹, Silja Vocks², Jutta M Wolf³, Stephan Herpertz⁴, Oliver T Wolf¹

Affiliations

¹ Department of Cognitive Psychology, Faculty of Psychology, Ruhr University Bochum, Bochum, Germany.
² Department of Clinical Psychology and Psychotherapy, Osnabrück University, Osnabrück, Germany.
³ Department of Psychology, Brandeis University, Waltham, MA, United States.
⁴ Department of Psychosomatic Medicine and Psychotherapy, LWL-University Clinic, Ruhr University Bochum, Bochum, Germany.

Abstract

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.

Keywords: Trier Social Stress Test (TSST); alpha amylase; anorexia nervosa; bulimia nervosa; cortisol; eating disorder; hypothalamus–pituitary–adrenal (HPA) axis; stress.