Salivary cortisol and dehydroepiandrosterone sulfate in adolescent rape victims with post traumatic stress disorder (original) (raw)
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Background: Sexual assault is implicated in several adverse psychological and physical health outcomes, including posttraumatic stress disorder (PTSD) and depression. Neurobiological research has shown variations related to the hypothalamic-pituitary-adrenal (HPA) axis, immune alterations, metabolic function, and brain circuitry. Although these mechanisms have been extensively studied, the results have demonstrated different outcomes in PTSD. Methods: We compared the plasma adrenocorticotropin (ACTH) and salivary cortisol levels of fifty-eight women with PTSD developed after sexual assault to those of forty-four female controls with no history of trauma. We also evaluated the psychiatric diagnosis and symptom severity of PTSD and depression. The participants' clinical conditions were associated with their hormonal levels to assess whether symptom severity was related to hormonal imbalance. Results: A large percentage of sexually assaulted women had PTSD and comorbid depression. The ACTH levels were higher in the PTSD group than the control group and increased as PTSD severity increased, considering depressive symptoms, measured by the Beck Depression Inventory (BDI) (p < 0.0001), as well as PTSD symptoms, measured by subscale D of the Clinician-Administered PTSD Scale (CAPS-5) (p = 0.045) and the CAPS-5 total scale (p = 0.026). Cortisol levels measured at 10 pm were higher for the PTSD group than the control group (p = 0.045, p = 0.037, respectively), and the cortisol awakening response showed elevated cortisol levels for the PTSD group. Conclusions: These results show a correlation between symptom severity and HPA axis imbalance in patients with PTSD. Elevated ACTH and an elevated cortisol response in patients with comorbid depressive symptoms were the opposite of the expected response for patients with PTSD only. This association leads to the hypothesis that the neurobiological alterations of PTSD are related to the type of symptoms presented and their severity. These manifestations likely influence the disease course, prognosis and response to treatment. These outcomes highlight the need to discuss particular neurobiological alterations in patients with PTSD developed after sexual assault, mainly those with severe depressive symptoms.
Predictors of Cortisol and 3-Methoxy-4-Hydroxyphenylglycol Responses in the Acute Aftermath of Rape
Biological Psychiatry, 1998
Background: Prospective studies of trauma survivors can provide information about the relationship between rape characteristics and the development of subsequent symptoms. Methods: The present study examined the relationship of prior assault, rape severity, posttraumatic stress disorder (PTSD) symptoms following rape, and subsequent PTSD diagnosis, to the acute cortisol and 3-methoxy-4-hydroxyphenylglycol (MHPG) response to this traumatic event in 20 women. Results: Women with a history of prior physical or sexual assault showed a significantly attenuated cortisol response to the acute stress of rape compared to women without such a history. MHPG appeared to be associated with injury-related rape characteristics, and symptoms of active avoidance, but not prior history. PTSD status at the 3-month follow-up was predicted by both a prior history of assault and high injury rape, but was not directly predicted by either cortisol or MHPG levels. MHPG and cortisol were not correlated in the sample as a whole, but were correlated among individuals who did not subsequently develop PTSD (p ϭ .04).
Acute Post-Rape Plasma Cortisol, Alcohol Use, and PTSD Symptom Profile among Recent Rape Victims
Annals of The New York Academy of Sciences, 1997
Our data from a sample of 37 rape victims indicated a significant interaction between a history of assault, rape stress characteristics, and initial post-rape plasma cortisol values.' Rape victims with an assault history had lower levels of post-rape cortisol, regardless of current rape stress characteristics, than did women for whom the recent rape was their first assault. This finding was consistent with previous studies of populations exposed to chronic stressors and may reflect downregulation of the cortisol system in response to chronic exposure to stress.2 Among rape victims without an assault history, cortisol level was significantly higher in association with increased rape severity characteristics. It was hypothesized that this finding may indicate the onset of dysregulation at the time of event exposure among those not previously assaulted. In this study, only a history of assault was a significant predictor of the Structured Clinical Interview for DSM-111-R (SC1D)-defined posttraumatic stress disorder (PTSD) at interviews conducted an average of 3 months po~t-rape.~
Psychoneuroendocrinology, 2012
Studies investigating cortisol responses to trauma-related stressors in patients with posttraumatic stress disorder (PTSD) have yielded inconsistent results, demonstrating that cortisol responses were enhanced or unaffected when confronted with trauma reminders. This study investigated the effect of the type of trauma experienced on both salivary and plasma cortisol responses during confrontation with trauma-related material. Participants were 30 survivors of war and torture, with and without rape among the traumatic events experienced . Participants of both groups (raped vs. non-raped) fulfilled DSM -IV criteria of PTSD. Plasma and salivary cortisol levels were measured at three time points during a standardized clinical interview: once before and twice after assessing individual traumatic experiences. Results show that groups did not differ in basal plasma and salivary cortisol levels. However, differential salivary cortisol responses were observed in PTSD patients who had been raped compared to those who had not been raped (p < .05) but had experienced an equal number of traumatic events and showed equally high PTSD symptom severity. Whereas salivary cortisol levels decreased in the course of the interview for the group with no past experience of rape (p < .05), those PTSD patients who had been raped showed a significant cortisol increase when reminded of their traumatic events (p < .001). This effect was not found in plasma cortisol. Our results indicate that the type of traumatic stress experienced contributes to cortisol • Corresponding author at
Biological Psychiatry, 2004
Previous studies indicate that adverse childhood events are associated with persistent changes in corticotropin-releasing factor neuronal systems. Our aim was to determine whether altered glucocorticoid feedback mediates the neuroendocrine sequelae of childhood trauma. Methods: Standard and low-dose dexamethasone suppression tests (DST) were performed in women with a history of child abuse (n ϭ 19), child abuse and major depression (n ϭ 16), major depression and no childhood trauma (n ϭ 10), and no history of mental illness or childhood trauma (n ϭ 19). Secondary analysis with posttraumatic stress disorder (PTSD) as the organizing diagnosis was also conducted. Results: In the low-dose DST, depressed women with a history of abuse exhibited greater cortisol suppression than any comparator group and greater corticotropin suppression than healthy volunteers or nondepressed abuse survivors. There were no differences between nondepressed abuse survivors and healthy volunteers in the low-dose DST or between any subject groups in the standard DST. The PTSD analysis produced similar results. Conclusions: Cortisol supersuppression is evident in psychiatrically ill trauma survivors, but not in nondepressed abuse survivors, indicating that enhanced glucocorticoid feedback is not an invariable consequence of childhood trauma but is more related to the resultant psychiatric illness in traumatized individuals.
Journal of Depression and Anxiety, 2013
of the HPA axis when these patients are exposed to stressors. This neuroendocrine pattern distinguishes PTSD from Major Depressive Disorder (MDD), a frequently comorbid (but distinct) disorder, which could partially be responsible for the inconsistency of HPA axis studies in PTSD. Another factor that could be responsible for this inconsistency is a history of childhood maltreatment. There is extensive literature evaluating HPA axis function in individuals with a history of childhood maltreatment. Heim et al. used the Trier Social Stress Test (TSST) to evaluate neuroendocrine and autonomic responses in four groups of women who had been carefully categorized according to the presence or absence of early-life abuse and current major depression [6]. Women with a history of childhood abuse, with or without current major depression, exhibited increased ACTH responses to stress compared with controls (6-fold greater when abused depressed women were compared to controls). Abused women who were not currently
JAMA, 2000
HE RELATIVE CONTRIBUTION OF genetic and environmental factors in the etiology of psychiatric disorders has long been a hotly debated area of investigation. Considerable evidence from a variety of studies suggests a preeminent role of early adverse experiences in the development of mood and anxiety disorders. One study 1 composed of almost 2000 women revealed that those with a history of childhood sexual or physical abuse exhibited more symptoms of depression and anxiety and had more frequently attempted suicide than women without a history of childhood abuse. Women who have been abused in childhood are 4 times more likely to develop syndromal major depression in adulthood than women who have not been abused, and the magnitude of the abuse is correlated with the severity of depression. 2 Early parental loss predominantly due to parental separation has also been found to increase the risk for major depression in case-control and epidemiological studies. 3-8 Twin studies 9,10 have provided concordant findings. Child
Journal of Anxiety Disorders, 2008
Although intimate partner violence (IPV) is a significant social problem associated with severe psychiatric problems, most notably PTSD, only a handful of studies has examined PTSD and associated physiological factors in battered women. Further, no research to date has investigated impact of abuse chronicity on HPA functioning. The present study examined the impact of PTSD severity and abuse chronicity on the cortisol awakening response in a sample of 52 sheltered battered women. Results suggest that IPV-related PTSD and abuse chronicity have opposite effects on waking salivary cortisol curves in battered women. PTSD severity was associated with significantly greater cortisol output the first hour after awakening, while more chronic abuse was associated with lower total cortisol output in the first hour after awakening. Implications of findings and suggestions for future research are discussed. #
Psychiatry Investigation, 2016
ObjectiveaaThe aim of this study was to investigate whether cortisol and oxidative stress levels and DNA damage differ between individuals who developed PTSD or not following a sexual trauma. MethodsaaThe study included 61 children aged between 5 and 17 years who sustained sexual abuse (M/F: 18/43). The patients were divided into two groups: patients with PTSD and patients without PTSD based, based on the results of a structured psychiatric interview (K-SADS-PL and CAPS-CA). Cortisol, glutathione peroxidase (GPx), superoxide dismutase (SOD), coenzyme Q, 8-Hydroxy-2-Deoxyguanosine (8-OHdG) were all evaluated by the ELISA method. ResultsaaOur evaluation revealed a diagnosis of PTSD in 51% (n=31) of victims. There was no significant difference between the groups with or without PTSD in terms of cortisol, GPx, SOD, coenzyme Q, and 8-OHdG levels. There was no correlation between CAPS scores and GPx, SOD, coenzyme Q, and 8-OHdG levels between patients with or without PTSD. In patients with PTSD, both cortisol and 8-OHdG levels decreased with increasing time after trauma, and there was no significant correlation with cortisol and 8-OHdG levels in patients without PTSD. ConclusionaaAlthough the present study did not find any difference between the groups in terms of 8-OHdG concentrations, the decreases in both cortisol and 8-OHdG levels with increasing time after trauma is considered to indicate a relationship between cortisol and DNA damage.
Journal of Psychiatric Research, 2008
Reports about alterations of hypothalamic-pituitary-adrenocortical (HPA) function in patients with chronic posttraumatic stress disorder (PTSD) are inconsistent and controversial. More refined laboratory tests and subgrouping of PTSD patients might help to decrease variance of findings. 14 subjects with chronic PTSD and 14 healthy controls were examined between 13:00 and 17:00 using a modified combined dexamethasone/CRH test (0.5 mg dexamethasone at 23:00, 100 microg CRH at 15:00). Plasma adenocorticotropic hormone (ACTH), cortisol and blood pressure were measured every 15 min from 14:45 until 17:00. No significant differences between patients and controls were found in the analyses of ACTH and cortisol levels, but a significantly elevated systolic and diastolic blood pressure in PTSD. Severity of depressive symptoms had no influence. However, explorative analyses showed that patients with a history of childhood traumatization had significantly higher post-dexamethasone-ACTH levels and a significantly lower diastolic blood pressure in comparison to patients without early trauma. In this first pilot study in a typical clinical sample of patients with chronic PTSD we found effects of severe adverse events in childhood on HPA axis regulation. Maybe, childhood traumatization could influence HPA axis findings in PTSD. Further research is needed, especially dose-response studies with different doses of dexamethasone in dexamethasone/CRH tests in PTSD.