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

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.

Autonomic Nervous System Response to Psychosocial Stress in Anorexia Nervosa: A Cross-Sectional and Controlled Study

“…( H 3 ) We expected a blunted HR response to the TSST as consistently evidenced (Monteleone et al, 2011 , 2018 ; Het et al, 2015 , Het et al, 2020 ). (H 4 ) In consonance with studies based on the TSST (Het et al, 2015 , 2020 ), we assumed differences in ANS reactivity between both groups, whereby P AN expressed a low HRV reactivity with a (H 5 ) reduced SNS and pronounced PNS-reactivity.…”

“…(H 2 ) We hypothesized PNS hyperactivity and a decreased SNS in P AN at rest, when compared to HC (Mazurak et al, 2011;Jacoangeli et al, 2013;Bomba et al, 2014). (H 3 ) We expected a blunted HR response to the TSST as consistently evidenced (Monteleone et al, 2011(Monteleone et al, , 2018Het et al, 2015, Het et al, 2020. (H 4 ) In consonance with studies based on the TSST (Het et al, 2015(Het et al, , 2020, we assumed differences in ANS reactivity between both groups, whereby P AN expressed a low HRV reactivity with a (H 5 ) reduced SNS and pronounced PNS-reactivity.…”

“…Nevertheless, a general PNS/SNS imbalance with a trend in parasympathetic hyperactivity (Mazurak et al, 2011 ; Jacoangeli et al, 2013 ; Bomba et al, 2014 ) and sympathetic hypoactivity (at rest; Mazurak et al, 2011 ) has been constantly observed in P AN . Concerning heart rate (HR) reactivity, some researchers observed a blunted response in patients (Monteleone et al, 2011 , 2018 ; Het et al, 2015 , 2020 ) compared to healthy individuals, while others found a comparable reactivity between both groups (Vocks et al, 2008 ; Het et al, 2020 ). Regarding the cardiovascular reactivity as indexed by HRV, patients demonstrated a pronounced PNS reactivity (lower HR + stronger HF-HRV) and a SNS-hyporeactivity as indexed by salivary Alpha-Amylase (sAA; Het et al, 2015 , 2020 ).…”

“…Concerning heart rate (HR) reactivity, some researchers observed a blunted response in patients (Monteleone et al, 2011 , 2018 ; Het et al, 2015 , 2020 ) compared to healthy individuals, while others found a comparable reactivity between both groups (Vocks et al, 2008 ; Het et al, 2020 ). Regarding the cardiovascular reactivity as indexed by HRV, patients demonstrated a pronounced PNS reactivity (lower HR + stronger HF-HRV) and a SNS-hyporeactivity as indexed by salivary Alpha-Amylase (sAA; Het et al, 2015 , 2020 ). Although, the latter was not supported by LF-HRV, since it was comparable in patients and controls (Het et al, 2015 ).…”

“…Further, heterogeneity in patient population (e.g., mixed ED-groups) limits the comparability of results and small sample sizes make findings susceptible to random effects. Researches recommended to investigate these results in the light of ED-specific samples (Vocks et al, 2008 ; Het et al, 2020 ) due to differences in their stress response (Monteleone et al, 2011 ; Peschel et al, 2016 ). From this perspective, there is a need to clarify the ANS response in P AN.…”