Findings with 0.25 mg Dexamethasone Suppression Test in Eating Disorders: Association with Childhood Trauma

ArticleinCNS spectrums 12(9):675-80 · September 2007with28 Reads
DOI: 10.1017/S1092852900021507 · Source: PubMed
Abstract
While both blunted and enhanced cortisol suppression following a dexamethasone suppression test (DST) are described in eating disorders, some evidence suggests that enhanced cortisol suppression might be associated with the presence of trauma history. The objective of this study is to investigate hypothalamic-pituitary-adrenal axis response to a modified DST in eating disorders and its relationship with childhood trauma. Fifty-two patients with eating disorders were studied with a 0.25 mg DST and with measures of childhood trauma. Patients with bulimia symptoms had significantly greater cortisol suppression than controls and restrictive anorexia patients (F=8.2, P<.05). Cortisol suppression was significantly correlated with intensity of childhood traumatic events (F=0.32, P<.05). Hypersensitive hypothalamic-pituitary-adrenal axis response to DST in eating disorders may be related with a history of childhood trauma and suggests some biological similarities with posttraumatic syndromes that should be further explored.
    • "Some of the findings suggested a link between fear memories related to trauma, symptoms of emotion dysregulation, and an abnormal cortisol response to stress in BPD. Diaz-Marsa [76] found an exaggerated response to dexamethasone administration in impulsive patients with eating disorders, which could suggest an increased sensitization of the hypothalamic-pituitary glucocorticoid receptors. This enhanced response was found in those patients with a history of trauma compared to those without trauma. "
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    • "These disturbances are linked to abnormal NVS responses often observed among individuals with binge-type EDs and psychological risk factors for LOC eating. Such stressor-induced biological alterations may serve as mechanisms through which sustained childhood stressors increase risk for binge-type EDs (Steiger et al. 2001; Díaz-Marsá et al. 2007). Childhood appears to represent a sensitive period for the impact of chronic stressors, as more persistent and atypical neurodevelopmental alterations in corticolimbic circuitry emerge when sustained threats and losses occur at an earlier age and for a longer duration (Lupien et al. 2009). "
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    • "Of note, sexual trauma during military service is strongly associated with lifetime eating disorders. The association is perhaps biologically based; weight loss, as a result of an eating disorder, may cause changes to the body that increase vulnerability to PTSD (Diaz-Marsa et al., 2007). In addition, once exposed to a trauma, the need for a gained sense of control can be heightened, and the impulse to regulate behaviors may manifest in hyperawareness of food consumption (Yager, 1996). "
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