Hypothalamic-pituitary-adrenal axis response in borderline personality disorder without post-traumatic features

Abstract

Hypothalamic-pituitary-adrenal (HPA) axis sensitivity was investigated in 32 non-medicated patients with borderline personality disorder without comorbid post-traumatic syndromes and in 18 normal individuals using a modified dexamethasone suppression test (0.25 mg). Enhanced cortisol suppression was found in the patients v. controls (P<0.05) and the percentage of participant's with non-suppression was smaller in the patient (34%) than in the control group (89%) (P<0.01). Baseline cortisol levels in the patients were also lower than in the controls (P<0.05). The 0.25 mg dexamethasone suppression test reveals increased feedback inhibition of the HPA in borderline personality disorder.

Blunted neuroendocrine stress reactivity in young women with eating disorders

“…One mechanism underlying this 'de-exaggerated' HPAA response could be that by eliminating fasting as an acute but constant trigger for HPAA hyperactivity, an underlying long-term exhaustion of the HPAA may become apparent, which makes individuals vulnerable for psychological disorders in line with the theory of allostatic overload [11,78,79]. Interestingly, a similarly blunted HPAA response was also described for subgroups of patients with posttraumatic stress disorder and borderline personality disorder [80,81], panic disorder [82,83], binge-eating disorder [84], and for patients at the onset of a psychosis [85]. A common feature in these disorders is a generally stronger degree of anxiety and a lack of emotional coping.…”

Personality Disorders and Traits as Predictors of Incident Cardiovascular Disease: Findings From the 23-Year Follow-Up of The Baltimore ECA Study

“…8 Although the results have been mixed, borderline PD, with or without posttraumatic stress syndrome, has been associated with dysregulation of the hypothalamic-pituitary-adrenal (HPA) axis. 27,31,32 HPA-axis dysregulation has a negative impact on established cardiovascular-disease risk factors, 33 and it is associated with early atherosclerosis. 34 A recent study suggests that HPA-axis dysregulation is a mediating factor between depression and increased risk of cardiovascular death.…”

The Hypothalamic-Pituitary-Adrenal Axis in Borderline Personality Disorder

“…Investigators also used an even lower DEX dose of 0.25 mg, with the expectation that it may be a more sensitive test for hypersuppression. The authors suggested that their finding of hypersuppression in BPD subjects without PTSD could be related to an increase in lymphocyte glucocorticoid receptor density, 67 presumably a marker of previous exposure to chronic and severe stress, similar to what has been found in PTSD. Importantly, the authors noted that the findings could not be generalized to all individuals with BPD since their subjects were selected for a history of repetitive self-harm.…”

“…89 Only one study demonstrated hypersuppression in BPD subjects (without concurrent MDD or PTSD) compared to a normal healthy sample. 67 This study reported the degree of cortisol suppression significantly correlated with the clinical severity of BPD but not with scores on a childhood trauma questionnaire.…”

“…The only study in this group, by Carrasco and colleagues, 67 to report hypersuppression in BPD samples in the absence of both PTSD and MDD utilized a different recruitment strategy and different DEX dosing. Specifically, BPD subjects presenting with "repetitive self-aggressive behavior" in the emergency department were recruited for this study.…”