Awake/sleep cortisol levels and the development of posttraumatic stress disorder in injury patients with peritraumatic dissociation.

Abstract

Differences in the time of day that cortisol is sampled and failure to consider the impact of peritraumatic dissociation have been hypothesized as factors possibly contributing to the inconsistent findings in research examining associations between cortisol levels soon after trauma exposure and the subsequent development of posttraumatic stress disorder (PTSD). The present study examined associations between urinary cortisol levels during wake and sleep times soon after a serious injury and the subsequent development of PTSD in adult patients reporting low or high peritraumatic dissociative (PD) symptoms. Thirty-nine injury patients (20 with high and 19 with low PD symptoms) provided a 15-hour (6 PM to 9 AM) urine sample at 3-weeks post-injury and completed the Clinician Administered PTSD Scale at a 7-week follow-up. Participants collected their urine during wake and sleep times separately. Results showed that in the total sample and in the high PD group, wake, but not sleep, cortisol levels were lower in patients who developed PTSD compared to those who did not. A multiple linear regression analysis revealed a significant main effect of PD and a non-significant interaction between wake cortisol and PD in predicting PTSD symptom severity. In addition, results showed that PD was a better predictor of PTSD symptom severity than wake cortisol levels. These results were consistent with prior research indicating lower afternoon/evening cortisol levels in PTSD and strong associations between PD and PTSD, but did not support the existence of subgroups of PTSD patients (dissociators versus non-dissociators) who may differ in basal cortisol levels.

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]. However, 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.…”

“…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 ].…”

Hypothalamus volume mediates the association between adverse childhood experience and PTSD development after adulthood trauma

“…Associations between cortisol levels and PTSD have been studied extensively but remain incompletely understood [ 11 , 12 ]. For example, urinary or salivary cortisol levels have been reported to be lower [ 13 , 14 ], higher [ 15 ], or not changed [ 16 ] in PTSD groups compared to control groups. The role of the hypothalamus in regulation of cortisol in PTSD patients remains unclear.…”

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

“…These inconsistencies can be attributed not only to the methodological differences [ 4 ] but also heterogeneity within the PTSD group, including comorbid disorders [ 5 ], chronicity, types, and duration of the illness [ 2 ]. Further, emerging research has identified the divergent impact of the dissociative subtype of PTSD on cortisol levels [ 6 - 8 ]. The patients of this distinct PTSD subgroup exhibit an emotional detachment following traumatic events in the form of depersonalization or derealization [ 9 ].…”

“…The patients of this distinct PTSD subgroup exhibit an emotional detachment following traumatic events in the form of depersonalization or derealization [ 9 ]. Several studies have reported that patients with higher dissociation levels showed reduced blood cortisol levels when compared to those with lower dissociation levels [ 6 , 8 ].…”