Cortisol reactivity in patients with anorexia nervosa after stress induction

Abstract

There is a need of experimental studies on biomarkers in patients with anorexia nervosa (P AN), especially in the context of stress, in order to foster understanding in illness maintenance. To this end, the cortisol response to an acute stressor was investigated in n = 26 P AN (BMI: 19.3 ± 3.4 kg/m 2), age, and gender matched to n = 26 healthy controls (HC; BMI: 23.08 ± 3.3 kg/m 2). For this purpose, salivary cortisol parameters were assessed in two experimental conditions: (1) rest/ no intervention and (2) stress intervention (TSST; Trier Social Stress Test). In addition, psychological indicators of stress were assessed (Primary Appraisal Secondary Appraisal, Visual Analogue Scale, and Trier Inventory for the assessment of Chronic Stress), as well as psychological distress, depression, and eating disorder (ED) symptoms. A 2 × 2 × 8 ANOVA demonstrated elevated cortisol levels in P AN in the resting condition. In the stress intervention no significant group effect in terms of cortisol (F (1, 50) = 0.69; p = 0.410; η 2 p ¼ 0:014). A significant condition (F (1, 50) = 20.50; p = 0.000; η 2 p ¼ 0:291) and time effect (F(2.71, 135.44) = 11.27; p = 0.000; η 2 p ¼ 0:20) were revealed, as well as two significant interaction effects. First: Condition × group (F (1, 50) = 4.17, p = 0.046; η 2 p ¼ 0:077) and second: Condition × time (F (2.71, 135.44) = 16.07, p = 0.000, η 2 p ¼ 0:24:). In terms of AUC G , no significant differences between both groups were exhibited. Regardless, significant results were evinced in terms of an increase (AUC i : F(1, 50) = 20.66, p = 0.015, η 2 p ¼ 0:113), baseline to peak (+20 min post-TSST: t 5 = 16.51 (9.02), p = 0.029) and reactivity (M PAN = 0.73 vs. M HC = 4.25, p = 0.036). In addition, a significant correlation between AUC G and BMI: r (24) = −0.42, p = 0.027 was demonstrated, but not between AUC i and BMI (r (24) = −0.26, p = 0.20). Psychological indices suggested higher levels of chronic and perceived stress in P AN relative to HC. However, stress perception in the stress condition (VAS) was comparable. Additional analyses demonstrated that ED-symptoms are highly correlated with psychological distress and depression, but not with BMI. In addition, it could be demonstrated that reactivity is rather related to EDsymptoms and psychological burden than to BMI. In conclusion, P AN showed elevated basal cortisol levels at rest and exhibited a blunted cortisol reactivity to the TSST as evinced by salivary cortisol parameters. Further, it was shown that weight recovery influences reversibility of hypercortisolemia, i.e., cortisol levels normalize with weight gain. However, HPAA (hypothalamus-pituitary-adrenal axis) irregularities in terms of reactivity persist even at a BMI ≤ 19.3 (±3.4). Our data suggest that pronounced psychological burden in P AN , have a greater impact on the HPAA functionality (secondary to the ED) than BMI itself.

Fear and food: Anxiety‐like behavior and the susceptibility to weight loss in an activity‐based anorexia rat model

“… 44 , 45 , 46 Although the irrational fear of excessive body mass persists or even grows regardless of body weight and weight loss during starvation, 47 some aspects of anxiety (e.g., blushing during public speaking) seem to diminish during acute starvation. 48 , 49 , 50 This may be caused by a shift of attention toward eating and body weight concerns and away from social issues. 51 , 52 Thus, the anxiolytic effect of starvation seen in the animal model can only partly be confirmed in clinical observations.…”

“…The reduction of anxiety can thus be considered as a decisive factor leading to the maintenance of self‐starvation 44–46 . Although the irrational fear of excessive body mass persists or even grows regardless of body weight and weight loss during starvation, 47 some aspects of anxiety (e.g., blushing during public speaking) seem to diminish during acute starvation 48–50 . This may be caused by a shift of attention toward eating and body weight concerns and away from social issues 51,52 .…”

A Comprehensive Review of Complications and New Findings Associated with Anorexia Nervosa

“…Elevated baseline cortisol levels are likely observed during extreme caloric restriction in both healthy individuals and patients with AN. However, reversibility of HPAA dysregulation, even in recovered patients with AN, is not always observed [34]. Cortisol stimulates gluconeogenesis, and cortisol levels in patients with AN have been shown to be inversely correlated to fasting glucose [35].…”

The Relationship Between Perceived Control and Hypothalamic–Pituitary–Adrenal Axis Reactivity to the Trier Social Stress Test in Healthy Young Adults

“…The visual analog scale for perceived control (PC) and the PANAS were immediately completed. Further, as previous studies have reported that the peak salivary cortisol levels would appear around 10-20 min after cessation of the TSST (Kirschbaum et al, 1993;Langer et al, 2020;Keenan et al, 2021; for a review, see Kudielka et al, 2007), saliva samples were collected four times at 0, 20, 45, and 60 min after the TSST as referred to measurement settings of previous studies using the TSST as the acute stressor (Johnson et al, 2019;Schmalbach et al, 2020; Figure 1).…”