Blunted cortisol response to stress in patients with eating disorders: Its association to bulimic features

Vaz-Leal, Francisco J.; Ramos-Fuentes, María Isabel; Rodríguez-Santos, Laura; Chimpén‐López, Carlos Alexis; Fernández-Sánchez, Nieves; Zamora-Rodríguez, Francisco J; Beato-Fernández, Luís; Rojo-Moreno, Luís; Guisado, Juan A.

doi:10.1002/erv.2581

Cited by 12 publications

(15 citation statements)

References 55 publications

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“…It was also shown in outpatients with AN and BN with an average BMI in the normal range that heightened TSST-induced cortisol secretion is associated with high attachment anxiety or avoidance which might result from childhood trauma (35). Vaz-Leal et al (36) demonstrated also blunted cortisol stress responses to the TSST in patients with AN and BN (considered as a single group in contrast to HCs) which is in line with our findings. Additionally, they showed that this blunted cortisol response pattern is mainly associated with binge-purging eating behavior as seen typically in BN but sometimes in AN as well.…”

Section: Discussionsupporting

confidence: 92%

“…Based on previous observations (19,36) we predicted that patients with EDs will show blunted cortisol stress responses at pre-treatment compared to HCs. As described before (19) we suppose a long-term exhaustion of the HPA axis in patients with ED that makes individuals vulnerable for this and other psychological disorders.…”

Section: Introductionmentioning

confidence: 98%

“…In line with a transdiagnostic perspective (33,34), which conceptualizes AN and BN as states on a continuum of psychopathology, patients with AN and BN were investigated as one group [cf. (19,35,36)].…”

Section: Introductionmentioning

confidence: 99%

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

et al. 2020

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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.

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Section: Discussionsupporting

confidence: 92%

Section: Introductionmentioning

confidence: 98%

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

et al. 2020

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“…Some studies point to a possible decrease in baseline cortisol levels and cortisol awakening response (e.g. Rosenberg et al, 2013;Vaz-Leal et al, 2018), but overall there is more support for increased levels, at least in BN (e.g. Monteleone et al, 2017;see Culbert et al, 2016 for an overview).…”

Section: Negative Affect and Stressmentioning

confidence: 99%

“…Whether this is also the case for BED is debatable, since the number of studies is more limited. The majority of studies report a blunted response in BN and BED following acute stress (Carnell et al, 2018;Culbert et al, 2016;Ginty et al, 2012;Het et al, 2015b;Koo-Loeb et al, 1998;Naish et al, 2018;Rosenberg et al, 2013;Vaz-Leal et al, 2018;Wierenga et al, 2018), but not all do (Coutinho et al, 2007;Vannucci et al, 2015). This blunted reactivity is also positively associated with binge-eating severity in BED (Coutinho et al, 2007) and an increase in the desire to eat after acute stress exposure (Rosenberg et al, 2013).…”

Section: Negative Affect and Stressmentioning

confidence: 99%

Volumetric and connectivity changes in brain networks associated with reward sensitivity, cognitive control, and negative affect in binge eating disorder and bulimia nervosa

Hartogsveld¹,

Cw²,

P³

et al. 2020

Preprint

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Binging disorders are characterized by episodes of eating large amounts of food whilst experiencing a loss of control. Recent studies suggest that the underlying causes of these binging disorders consist of a complex system of environmental cues, different processing of food stimuli, altered behavioral responding, and brain changes. We propose that task-independent volumetric and connectivity changes in the brain are highly related to altered functioning in reward sensitivity, cognitive control, and negative affect, which in turn promotes and conserves binging behavior. We here review imaging studies and show that volume and connectivity changes in the orbitofrontal cortex, inferior frontal gyrus, medial prefrontal cortex, striatum, insula and amygdala overlap with distorted brain activation associated with increased reward sensitivity, decreased cognitive control, and distorted responses to negative affect or stress seen in binging disorder. Future research integrating both task-based and task-independent neuroimaging approaches therefore shows considerable promise in clarifying binging behavior. We provide suggestions for how this integration may guide future research and inform novel brain-based treatment options in binging disorders.

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Coping strategies and stress‐induced natural killer cell redistribution in women with eating disorders

Vaz-Leal

Ramos-Fuentes

Guisado

et al. 2020

Intl J Eating Disorders

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Background: Patients with eating disorders (ED) are very sensitive and responsive to psychosocial stress. Stress response includes changes in immune cell distribution and may be modulated by the capability to cope with stressors. Thus, the present study sought to analyze the association between coping strategies and immune response (natural killer [NK] cell redistribution following psychosocial stress) in patients with anorexia nervosa (AN) and bulimia nervosa (BN) and healthy controls (HC).Method: Twenty-four AN patients, 29 BN patients, and 58 HC were studied. A multidimensional assessment tool, the COPE Inventory, was used to assess coping strategies.The number of NK cells was quantified in peripheral blood before and after the application of the Trier Social Stress Test (TSST). Potentially mediating variables, such as weight status, severity of eating pathology, depression, anxiety, and impulsivity were controlled. Results:The three groups differed in intensity and direction of cell redistribution:The TSST was followed in BN patients by a significant decrease in the number of NK cells, whereas HC displayed a moderate decrease and AN a clear increase. Specific correlations between coping strategies and NK cell mobilization were found, especially in BN patients (positive for "planning" and negative for "substance abuse").Conclusion: Recognition and subsequent modification of the dysfunctional coping strategies used by patients with ED could contribute to improving their immune status, strengthening their resilience and increasing their ability to overcome the disease. K E Y W O R D Sanorexia nervosa, bulimia nervosa, leukocyte, natural killer cells, stress, Trier Social Stress Test

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Blunted cortisol response to stress in patients with eating disorders: Its association to bulimic features

Abstract: The results support the association between blunted cortisol response and bulimic features.

Cited by 12 publications

References 55 publications

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

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

Volumetric and connectivity changes in brain networks associated with reward sensitivity, cognitive control, and negative affect in binge eating disorder and bulimia nervosa

Coping strategies and stress‐induced natural killer cell redistribution in women with eating disorders

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