Hypothalamic-Pituitary-Adrenal Axis Function in Children and Adults with Severe Antisocial Behavior and the Impact of Early Adversity

Abstract

Purpose of ReviewTo review recent studies investigating hypothalamic-pituitary-adrenal axis function in children and adolescents with disruptive behavior disorders (DBDs) and adults with antisocial personality disorder. We consider key concepts and methodological issues in cortisol assessment and review studies investigating basal cortisol secretion and stress reactivity in antisocial populations. Lastly, we consider whether cortisol abnormalities predict prognosis or treatment outcomes and the impact of exposure to adversity on hypothalamic-pituitary-adrena (HPA) axis activity.Recent FindingsStudies tracking cortisol levels across the day and assessing cortisol awakening responses (CARs) have reported broadly intact, but flatter, diurnal rhythms and lower CARs in children and adolescents with DBDs, whereas findings in antisocial adults have been mixed. Cortisol hyporeactivity to stress is consistently reported in male antisocial populations, whereas no comparable data exist in females.SummarySevere antisocial behavior is associated with cortisol hyporeactivity to stress, and such hyporeactivity predicts poor treatment outcomes. Further research investigating sex differences and the impact of adversity is needed. Harmonization of methods for assessing hypothalamic-pituitary-adrenal axis function and antisocial behavior would enhance progress in this area.

Neurofunctional abnormalities in antisocial spectrum: A meta-analysis of fMRI studies on Five distinct neurocognitive research domains

“…amygdala, ventromedial prefrontal cortex (PFC), dorsal anterior cingulate cortex, insular cortex, hypothalamus and periaqueductal gray) may be largely implicated in aggression (Blair et al, 2018;Blair, 2016;Crowe and Blair, 2008). A recent literature review suggests that CP/ASPD individuals show reduced Hypothalamic-Pituitary-Adrenal axis function in response to threat compared to healthy controls (HC) (Fairchild et al, 2018). Furthermore, a meta-analysis on fMRI studies of CP/ASPD subjects found significant underactivation in dorsolateral PFC and temporal pole during emotion processing (Alegria et al, 2016).…”

Child Temperament and Total Diurnal Cortisol in Out‐of‐Home Center‐Based Child Care and in At‐Home Parental Care

“…Finally, the interpretation of the results of this study is complicated by the incomplete understanding of what level of the diurnal cortisol output across development contributes to optimal, or on the contrary, nonoptimal developmental outcomes. There is evidence that both too low (Fairchild, Baker, & Eaton, 2018) and too high cortisol levels (Lupien et al, 2009) might play a role in developmental psychopathology, cause imbalance and lead to a constant allostatic load to the human body (McEwen, 2018). Furthermore, the distinct cortisol reactivity and the total diurnal cortisol might serve a different purpose in various environments.…”

Toddlers’ diurnal cortisol levels affected by out-of-home, center-based childcare and at-home, guardian-supervised childcare: comparison between different caregiving contexts

“…Long-term exposure to stress during childhood may be a risk factor for a child’s socio-emotional and cognitive development and also may undermine the functioning of the immune system and increase the child’s vulnerability to stress-related illnesses [ 15 – 17 ]. Of note, there is evidence showing that low and hyporeactive cortisol profiles in response to stressors may also be associated with adverse developmental outcomes, such as disruptive behavior disorders [ 18 ]. Hence, both too low and too high cortisol levels may imbalance homeostasis, cause an allostatic load, and associate with later health outcomes [ 19 ].…”