Association between Dissociative Symptoms and Morning Cortisol Levels in Patients with Post-traumatic Stress Disorder

Abstract

Objective Patients with post-traumatic stress disorder (PTSD) showed inconsistencies in their cortisol level, an index of the hypothalamic-pituitary-adrenal axis function. This study examined the relationship between dissociation, childhood trauma, and morning cortisol levels in PTSD patients. Methods This study included 69 (23 males and 46 females) patients and 82 (22 males and 60 females) healthy controls (HCs). Clinical assessments, including the Childhood Trauma Questionnaire (CTQ) and Peri-traumatic Dissociative Experiences Questionnaire scores, and morning cortisol levels were evaluated. The morning cortisol levels were compared between PTSD with high dissociation and low dissociation (PTSD-LD) groups. The effect of CTQ subtype on morning cortisol levels was analyzed. Results The PTSD with high dissociation group showed significantly lower cortisol levels than that of the PTSD-LD and HC groups. A significant inverse correlation was found between cortisol levels and dissociation. A significant positive correlation was found between dissociation and physical abuse and sexual abuse scores. Morning cortisol levels showed a significant positive correlation with emotional abuse, emotional neglect, and physical neglect, respectively. There was no moderating or mediating effect of CTQ on the relationship between cortisol level and dissociation. Conclusion These findings suggest that dissociation is a significant factor related to hypocortisolism in PTSD patients. Additionally, basal morning cortisol levels and dissociation scores were closely associated with childhood trauma.

Inflammatory Markers and Brain Volume in Patients with Post-traumatic Stress Disorder

“…In general, during periods of stress, cortisol dysregulation can be identified, which produces volumetric alterations in the brain, so the two biomarkers have negative correlations in patients with PTSD [ 24 , 67 ]. How-ever, ironically, hypocortisolism was observed in patients with PTSD since it could be influenced by several causes including dissociative symptoms as we described [ 16 , 56 ,57]. Therefore, the relationship between cortisol and brain volume should be more discussed in further studies considering these points.…”

“…First, the characteristic of comparison group, sex, and comorbidity with other psychiatric disorder could account for the mixed finding. Second, dissociative symptom, which were commonly observed in patient with PTSD, could a significant influencing factor of low cortisol level in patients with PTSD [ 16 ]. Previous studies reported that the dissociative subtype of PTSD exhibit a symptom like derealization or depersonalization, which could be attributed to low cortisol levels of patients with PTSD [ 56 , 57 ].…”

“…Posttraumatic stress disorder (PTSD) is a complex and severe mental disorder [ 1 ]. It results from directly experiencing, witnessing, or being exposed to unexpected extreme traumatic events including combat, terrorist attack, physical illness, and sexual abuse [ 2 , 3 ].…”

“…Furthermore, elevated levels of cortisol in individuals with PTSD, except for a few phenomenon such as cortisol resistance, might result in decreased immune reactions and insufficient immune regulations in general [ 13 ]. However, several studies found relatively low levels of cortisol [ 14 ], specifically in women with PTSD [ 15 ] and individuals with severe dissociative symptoms [ 16 ].…”

Quetiapine Treatment for Post-traumatic Stress Disorder: A Systematic Review of the Literature

“…Posttraumatic stress disorder (PTSD) is a common mental disorder consequence of exposure to traumatic events. Its symptoms consist of 4 major diagnostic clusters: intrusion/re-experiencing symptoms, avoidance symptoms, negative cognitions, symptoms of hyperarousal [ 1 , 2 ]. Psychotherapy and pharmacotherapy recommendations differ across PTSD treatment guidelines.…”